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Aipedia: Nurses and allied health professionals
Midwives remain accountable for interpreting fetal monitoring and escalating concerns, whether computerised CTG analysis agrees with them or not. Delay in recognising fetal compromise can cause lifelong harm.
Part of: AI in nurses and allied health professionals
In short
Computerised CTG analysis and AI decision support aim to make fetal monitoring more consistent, but they can reassure when a midwife's assessment says otherwise, or alarm when the whole clinical picture is stable. NMC Code 13.1 to 13.2 requires midwives to assess worsening health and refer in time, and 16.1 requires concerns to be raised and escalated. For NHS trust maternity care, claims are usually handled under CNST against the trust. Independent midwives need their own indemnity arrangement, which must suit the role and the risks of the work.
Computerised CTG systems calculate features such as baseline rate and variability and apply criteria to flag traces as normal or concerning. Newer decision support may combine the trace with risk factors to suggest when to escalate. Some systems alert a central monitor so senior staff can see several traces at once. Used well, they provide consistency and a second view during long labours. Used badly, they move attention from the woman and the whole clinical picture to a screen.
Illustrative scenario: during labour, the computerised analysis reports that criteria are met. The midwife notices changes on the trace and the woman reports reduced movements earlier in the day, but, reassured by the system, continues to observe rather than escalate. When a senior review happens, there is evidence of fetal compromise and an emergency birth follows. The review focuses on why the midwife's concerns were not escalated.
The opposite failure is escalating so often on system alerts that obstetric staff start to discount them. Other risks include signal loss that the system interprets as a reassuring trace, maternal heart rate recorded as fetal, and system downtime with no agreed fallback.
Neither choice is automatically right. A midwife who accepts a computerised reassurance against clear clinical signs may be criticised under NMC 13.1. A midwife who rejects a system warning should record the clinical reasons and, where uncertain, seek a second opinion. In both cases, the decision and its reasoning need to be in the record at the time. Units should make clear in guidelines how computerised analysis fits with fresh-eyes reviews and escalation.
Students and newly qualified midwives may be particularly exposed to automation bias, because the system can seem more experienced than they are. Supervisors should make clear that a concern about the woman or the trace is always a reason to ask for review, whatever the screen shows, and that escalating against the system will be supported.
For NHS trust maternity care, CNST covers clinical negligence claims, which are usually brought against the trust rather than individual midwives. The question will be whether the care was reasonable, including how the midwife used the computerised analysis. If the system itself was faulty, the trust may look to the supplier. Fitness-to-practise proceedings and internal investigations are outside state indemnity, so union or professional-body support or private cover for regulatory matters is important.
Independent midwives are self-employed, and the NMC says self-employed work usually needs the registrant's own arrangement, suited to the role, scope and risks. Practising without appropriate cover can lead to removal from the register. Check that any arrangement covers the full scope of care you offer, including intrapartum care, and how it treats any decision support you use.
Related: AI early warning tools, the NMC position on AI, indemnity for AI errors, the nursing and allied health AI hub and where NHS indemnity stops.
Apex arranges indemnity for self-employed midwives and maternity services outside the NHS. A broker checks your scope of practice and how any decision support is treated.
As a support, yes; as a substitute for your assessment, no. NMC Code 13.1 requires you to assess signs of worsening health, and 16.1 requires you to escalate concerns. Record your reasoning when you accept or override the analysis.
For NHS trust care, CNST usually handles clinical negligence claims against the trust. Individual midwives are not usually the defendant, but may face internal or regulatory investigation, which state indemnity does not cover.
An arrangement of their own that suits their role, scope and risks, because the NMC says self-employed work usually needs the registrant's own cover. Check it includes all the care you provide and how it treats any decision support tools.
Tell us about your practice and the work you do. A broker will review how your current cover treats AI-assisted work, or arrange new cover. No fee for a quote. Or call 0117 325 0027.
Start an indemnity quote Request a callbackApex Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales, company number 07014570. This page is general information about how AI is used in the profession and how insurance may respond. It is not legal, regulatory or insurance advice on your circumstances, and it does not guarantee that cover will be available or on what terms.
