Whose Knowledge Counts in Labour? Obstetric Nurses Negotiating Clinical Judgement, Algorithmic Authority and Woman-Centred Care in Artificial Intelligence-Enhanced Foetal Monitoring.

Artificial intelligence-enhanced foetal monitoring is entering intrapartum care, yet little is known about how it reshapes the credibility of nursing knowledge, professional authority and relational practice. This interpretive description study explored how obstetric nurses negotiated clinical judgement, autonomy and woman-centred care while working with an artificial intelligence-enhanced cardiotocography system in a physician-led tertiary maternity service in Saudi Arabia. Semi-structured interviews with 18 obstetric nurses, each with 6 months to 4 years' experience of the system, were analysed using reflexive thematic analysis sensitised by Cognitive Continuum Theory and the concept of epistemic injustice. Analysis showed that nurses read beyond the trace, negotiated autonomy under algorithmic surveillance and worked deliberately to keep the woman in view. Alerts often legitimised concerns nurses had already formed, functioning as institutional permission to escalate rather than clinical revelation. When judgement diverged from system output, nurses experienced asymmetric accountability and performed epistemic translation work, recasting embodied and relational knowledge into algorithm-compatible language to secure recognition. Artificial intelligence-enhanced monitoring was therefore experienced as an epistemic and relational intervention, not merely decision support, that could reinforce established hierarchies of credibility. Whose knowledge counts during labour is thus a question of justice as much as safety. Trial Registration: Not applicable. This study was a qualitative interview study and did not involve a clinical trial.