Relying on technology

Maternity services began to develop its reliance on technology when hospital births became the norm. The need for surveillance of the baby in utero prompted the development of technical solutions, and as these matured their use became widespread.

There is a place for the use of technology in childbirth when applied appropriately. And technology can enhance our perceptions when we use it to support or confirm assessments made with our other senses. But we do not always consider their socio-psychological impact.

Reliance on technology comes from beliefs about the superiority of machines to human faculties - forgetting that its value depends on the ability of the person who interprets its output. Unfortunately, we live in an age where technology is often assumed to be cleverer than it really is, and where human input is not valued enough.

How technology undermines core midwifery skills

Like many other professions, midwives have been socialised into reliance on technology - to the extend that it is now part of our everyday practice. Even when we are presented with evidence based-guidelines about the use and efficacy of certain technologies, some of us continue to rely on technology in situations where it is not appropriate. For example, despite the publication of the NICE Guidelines on Electronic Fetal Monitoring, many midwives continue to monitor women in labour unnecessarily.

At the same time, many midwives - particularly the newly qualified - are no longer capable of auscultating the fetal heart without a machine. In losing traditional midwifery skills such as the ability to palpate a pregnant woman's abdomen, to locate the fetal heart or listen with a Pinard Stethoscope, we are losing our own ability to act as a very sensitive and intelligent monitor.

Machines can have great accuracy, but they have no intelligence and no intuition. The capacity of human beings to pick up cues that are sublte and process this information subconsciously is truly extraordinary. These abilities can only be developed and honed through experience. Total reliance on machinery, without the use of these abilities, renders us less than the machines we use. We are becoming people who just serve the machines' requirements, wheeling them about and plugging them in.

There is more to midwifery than machinery

A sign of the times is that most midwives now prefer to work on the labour ward - the technological orientation of most modern labour wards is undeniably attractive. But there is now a plethora of evidence which tells us that the outcomes are better for women who labour and give birth without technological intervention. And there is much more to giving birth than a reliance on technology: birth is a social event, not a technological process.

We tend to fear what we cannot understand or control, and technology's primary function is to increase our control. However, labour is a physiological process that exists in a social context and physiological processes cannot be controlled by humans or machines.

Yet, because technology is in common usage within the childbirth process we may not recognize some of this as for what it is - technological intervention.

Tips and tricks

Observe the impact of the routine use of technology - examine the last three labours you have attended and count the number of technologies that were used.

Own your own Pinard stethescope and use it - this will help you to reclaim one of your core midwifery skills.

Include the use of technology in your risk management assessment - help the women you are attending understand what technology can and cannot do for them.

Relying on technology

How technology undermines core midwifery skills

There is more to midwifery than machinery

Tips and tricks

Further reading