Experience of induction of labour: a cross-sectional postnatal survey of women at UK maternity units

Abstract

Background: Induction of Labour (IOL) is an increasingly common obstetric intervention, offered to 30-50% of pregnant women in the UK. IOL affects experience of childbirth: it is more painful than spontaneous labour and more likely to lead to additional interventions including operative birth. Experience of childbirth is important to women, and negative experience of childbirth has been linked to serious psychological harm. The high and rising rate of IOL has implications for provision of safe, effective, person-centred maternity services, yet there is little information about womens experiences of induction. Aim: To explore womens views and experiences of key elements of the IOL process, including at home or in hospital cervical ripening (CR) Methods: A questionnaire-based postnatal survey of 309 women who had IOL at UK maternity units in 2021/22, undertaken as part of the CHOICE Study process evaluation The questionnaire was administered online and included fixed response and free text options. Findings are reported as descriptive statistics with content analysis of womens comments providing context. Findings: Information to support choice and understand what to expect about IOL is often inadequate or unavailable. Having IOL can create anxiety and remove options for birth that women had hoped would enhance their experience. Although it can provide a more comfortable environment, home CR is not always an acceptable solution. Women described maternity care negatively impacted by staffing shortages; delays to care sometimes led to unsafe situations. Women who had a positive experience of IOL described supportive interaction with staff as a significant contribution to that. Conclusions: Women do not experience IOL as a benign and consequence free intervention. There is urgent need for research to better target IOL and optimise safety and experience for women and their babies. Relatively few women were offered CR at home and further research is needed on this experience.

Competing Interest Statement

The authors declare the following competing interests Support for the present manuscript The CHOICE Study was funded by National Institute of Healthcare Research Health Technology and Assessment (NIHR HTA). The grant was paid to institution and the authors have the following associations: Patient and public involvement (PPI) Group member (paid), Funded research fellows (2), Principal investigator and co-investigators with funded time. CHOICE study budget has been used by some authors for travel and conference cost. Authors hold additional, paid to institution, grants from: NIHR, Wellcome Trust, Medical Research Council, Chief Scientist Office of Scotland, Tommys Charity, Scottish government, Aberlour Childcare Trust (small project grant), University of Stirling article processing fund. Authors declare the following Consultancy fees: Natera, consultancy on pre-term birth treatments (paid to institution) Honoria: Hologic, Honoria for educational talk (paid to institution) Expert testimony: Expert witness in (midwifery) in civil litigation claims (self employed) Participation on a Data Safety Monitoring Board or Advisory Board Member of several NIHR Trial Steering committees, NIHR Health Technology and Assessment DMC and TSC Authors are unpaid members or trustees of the following Boards and Committees: National Institute of Health and Care Excellence Antenatal Guideline Group 2018-202, Cysters (CIO) Chair of trustees, Platform Housing Group, trainee Board role, UK Government Period Poverty Task Force, member, UK sepsis Trust, Trustee

Clinical Protocols

https://bmjopen.bmj.com/content/11/5/e050452

Funding Statement

The CHOICE Study was funded by the National Institute of Healthcare Research Health Technology and Assessment (NIHR HTA) NIHR 127569. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics approval was obtained from the York & Humber Sheffield Research Ethics Committee in June 2020 (IRAS: 276788) as part of the CHOICE Study application.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

The data sets generated during this study are available from the corresponding author upon reasonable request.

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