One poor decision in technology design can lead to a cascading failure for the user experience. One poor decision in the design process can lead to users having no control over the technology. Case in point: the electronic fetal monitor (EFM). Critics argue it is more technology than is needed, leads to more Caesarian sections, does little to improve either baby or mother mortality rates, and worst of all, takes power from women to their caregivers.
Was a coincidence that the EFM was made for a solely female user population? No, of course not. The fact that doctors (mostly men at the time) only believed “objective” data from machines, not “subjective” insight from nurses or women themselves. This power imbalance was embedded into the EFM. As technology theorist Wiebe Bjiker likes to say, gender was “baked in” to the technology.
How can we fix the EFM?
The EFM was introduced in the 1950s in an effort to provide more insight into the health of the baby during labour. By the 1970s, it was widely used. Nurses were no longer even taught the manual technique to monitor the baby’s heartbeat. Women themselves told researchers they were satisfied with the EFM, which allowed them to share the baby’s heartbeat with their partners. So what was the problem?
The EFM has questionable benefits. Studies have consistently failed to show its benefits in routine births (that is, the vast majority). The tool’s designers clearly disregarded nurses’ insight into the birthing process. A simple observation would have revealed how nurses carefully look for subtle changes over the course of labour (as midwives do). Nurses now focus more on the data spouted out the machine than watching and interacting with the pregnant woman. But the worst part was for labouring women themselves.
The EFM only works when women remain completely still. The tool was clearly not designed by observing actual women in actual childbirth. Millennia of labour practices have women walking, crouching, shifting positions — anything but lying still in a supine position. But the EFM simply will not work if women move to mitigate the pain of childbirth. The solution? Drugs.
The EFM also lead to the widespread use of the epidural, which numbs labouring women from the waist down. This leads to more tearing, less interaction with the baby upon birth, and a slower healing period. All this for a technology that has questionable benefits!
What if we redesigned the EFM to include multiple user requirements? First, it would have to work while women walked, rotated, and shifted during contractions. That would eliminate the need for excessive use of drugs. Second, it would have to be a “calm technology” that disappears when not in use. Nurses would then be able to have that meaningful interaction with labouring women, and would rely not just on the EFM but their own observations during childbirth. And most importantly, the EFM should be designed specifically to NOT work in routine births. The evidence simply does not support its use.
Technology design is often a case of cascading failures. User-centred feature lists make it possible to avoid the worst of these effects.
Technology designers should ask themselves what they are “baking in” to their technology and whether it serves them or their users.