Healthcare provision involves humans (clinicians and non-clinicians) working in a complex environment consisting of equipment, technology, organizational culture and attitudes and behaviours of fellow team members as well as their patients and families. Human factors refer to the intricate link between knowledge, skills and competencies, the environment in which clinicians work, their personal circumstances, and the nature of communication between team members. Possession of individual knowledge, skills and competencies alone will not lead to the desired clinical outcomes if all other aspects of human factors are not understood and rectified. Pereira et al. identified 12 key aspects of human factors that may contribute to poor outcomes relating to CTG interpretation, based on ‘Du Pont’s dirty dozen’ from the airline industry. Addressing these key areas where ‘human factors’ is essential to optimize perinatal outcomes. Four consecutive ‘Each Baby Counts’ (EBC) Reports have reported that >50% of all cases of severe intrapartum hypoxia-related brain injury and perinatal deaths in the UK was due to CTG misinterpretation/fetal scalp blood sampling.

It is very much hoped that this book, which has moved away from the illogical, unscientific and potentially dangerous ‘nNormal, suspicious, pathological’ classification from its first publication in 2017, and is based on the principles of physiological interpretation of CTG, in line with the International Expert Consensus Statement published by more than 50 CTG experts from over 20 countries in 2024, will continue our journey to reduce avoidable harm to women, birthing people, their babies and the families. We owe this to women, birthing people, their babies and families who have placed in their trust in us to provide evidence-based clinical care, which is based on scientific foundations and the application of the knowledge of fetal pathophysiology.