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Journal of AdvancedNursing 52(3), 307–314Developing a tool to appraise fetal monitoring guidelines for women at lowobstetric riskAim. The aim of this paper is to report the development and use of a tool to appraiseguidelines for fetal heart rate monitoring and discuss the findings generated in theappraisal process.Background. Expert guidance on the appropriate method of monitoring the fetalheart in labour has been available for some time. However, practices not based onevidence were continuing routinely in the United Kingdom.Methods. We produced an 18-item tool for the appraisal of guidelines. Heads ofMidwifery Services were asked to send the guideline currently in use. Twenty-fourout of 28 responded, and sent 32 guidelines. Pairs of multidisciplinary reviewersappraised each guideline.Results. A prevalidated generic appraisal instrument was not found to be appro-priate for intrapartum fetal monitoring guidelines. When using our own specifically-developed appraisal tool for assessing the quality of fetal monitoring guidelines,only 11 reviewer pairs showed ‘good’ or ‘moderate’ agreement in their scores.Conclusions. Generically-validated guidelines may not be sufficiently discriminatoryfor specialized areas of practice such as intrapartum fetal monitoring.Keywords: appraisal, guidelines, midwifery