BACKGROUND:
Intermittent auscultation (IA) is endorsed as an efficacious method of intrapartum fetal monitoring. However, successive studies and reports have demonstrated that midwives find it challenging. This qualitative interview study sheds light on the causal mechanisms that contribute to this.

OBJECTIVES:
1) To describe how midwives carry out intrapartum IA 2) To investigate midwives' perceptions relating to the efficacy of intrapartum IA 3) To explore midwives' opinions about the benefits and challenges of using intrapartum IA 4) To explore if midwives have developed intrapartum care strategies to support their use of IA

METHODS:
Qualitative interview study involving 13 midwives from across Wales. Interviews were inported into NVIVO for a Critical Realist analysis using Reflexive Thematic Analysis.

RESULTS:
Two themes were identified. Demonstrating how, for study participants, IA was a dichotomous activity. The first theme - IA: It’s a midwife’s bread and butter, participants describe how they enjoyed using IA, as it offers a sense of connectedness to the woman, fetus and the ethos of midwifery models of care. IA facilitated freedom and agency during birth, for women and midwives. The second theme – IA: Midwives bearing the responsibility of fetal monitoring, illustrates that IA is also a demanding activity that subjects participants to various clinical challenges these include managing competing demand in the birth room, negotiating organisational policy about how the fetal heart rate is counted and interpreted, the burden of proof for midwives of a 'heard' heart rate (through IA) versus one that is 'seen' (through EFM) and proficiency with IA is strongly connected to experience and opportunity to work within midwifery models of care.

CONCLUSIONS:
IA is valued by midwives. However, their work-based social world and organisational culture impacted on how they practiced this essential midwifery skill.

KEY MESSAGE:
The midwives that participated in this study enjoyed undertaking IA but felt that organisational systems and cultures impacted on their practice Poster session 2 (Group A)