Improving women's knowledge of prostaglandin induction of labour through the use of information brochures: A quasi-experimental study

Attitudes of pregnant women and healthcare professionals to labour induction and obtaining consent for labour induction

Induction of labour is experienced by up to one third of women and can be a negative experience, in relation to both the decision about whether to have an induction of labour (IoL) and the experience of the process of IoL. This paper reviews the limited evidence of women's views on and experiences of: information provision; shared decision-making; preferences for method and location of IoL; indications for IoL; pain management; and effective communication and support. Healthcare professionals' views are reviewed, but are underrepresented, and further research is needed to understand experiences of gaining consent for IoL. Systematic review evidence is drawn on where possible, but reviews often found small numbers of papers for inclusion, and provide insights rather than conclusive evidence. Future research would benefit from using validated measures to assess the experience of IoL.

An educational video's impact on the induction of labor experience: a randomized controlled trial

BACKGROUND

Induction of labor is a common obstetrical intervention; much research focuses on medical indications, clinical outcomes, and induction agents. Little research has been conducted evaluating the patients' understanding of and satisfaction with induction of labor. Video-based educational tools have been validated as a practical and efficient counseling method by previous studies.

OBJECTIVE

This study aimed to evaluate whether an educational video enhances the patients' knowledge about induction of labor and improves satisfaction with the induction of labor process.

STUDY DESIGN

This was a single-center study in which women undergoing a scheduled induction of labor were randomized to either the control or intervention group. The control group was given a knowledge questionnaire about induction of labor before meeting their provider (midwife or obstetrician) on the day of scheduled induction of labor. The intervention group was shown a 3-minute educational video about induction of labor before administration of the knowledge questionnaire. Both groups, 24 to 48 hours after delivery, were asked to fill out a second questionnaire about satisfaction with the induction of labor process. Moreover, the video intervention group was asked to evaluate the video in the second questionnaire. Both knowledge and satisfaction questionnaires were compared between the control and intervention groups.

RESULTS

From October 2019 to February 2020, 145 women scheduled for induction of labor were eligible and approached for the study. Of the 145 participants, 129 consented and 119 completed the entire study. Moreover, 64 participants were randomized into the control group and 55 into the intervention group. Compared with patients in the control group, the patients who watched the educational video in the intervention group had significantly improved baseline knowledge about induction of labor (P<.001). Knowledge scores remained significantly higher in the intervention group when considering participants who had a previous induction of labor (parity, P<.001; nulliparity, P<.001; multiparity, P<.001). In addition, satisfaction with the induction of labor process among participants in the intervention group was significantly higher than those in the control group (P<.001). Moreover, this held true in those who had a cesarean delivery or had a history of a previous induction of labor (P<.003 and P<.001, respectively).

CONCLUSION

A brief educational video about induction of labor improved the patients' knowledge about the induction of labor process and their overall satisfaction with their delivery experience. Video-based education can play an innovative and important role in patient knowledge and satisfaction with the induction of labor process.

A systematic review of supportive interventions to promote women's comfort and well-being during induction of labour

AIMS

To evaluate the effectiveness of non-pharmacological non-invasive supportive interventions for impacts on women's comfort and well-being during induction of labour.

DESIGN

A quantitative systematic review without meta-analysis.

DATA SOURCES

Databases were searched for primary research published in English between 2000-2019: AMED, CINAHL, Medline, Maternity and Infant Care database, PsycINFO, and ProQuest. The quality of studies was evaluated using JBI levels of evidence and established critical appraisal tools. Studies describing measures of comfort, coping, and well-being for women during induction of labour were included.

RESULTS

Two articles met the criteria for inclusion. There is limited evidence to suggest that women having outpatient cervical priming were more satisfied with their experience than women having inpatient cervical priming and that outpatient cervical priming did not increase women's anxiety. A specifically designed information brochure explaining the induction process improved women's knowledge and understanding.

REVIEW METHODS

The quantitative systematic review followed the Centre for Reviews and Dissemination guidelines and Cochrane Effective Practice and Organisation of Care guidance. Quality appraisal was conducted using JBI levels of evidence, Cochrane Risk of Bias, and other established tools. A narrative description of the quantitative data was undertaken. There was insufficient evidence to perform a narrative synthesis or meta-analysis due to the nature of the study designs and insufficient outcome data.

CONCLUSIONS

Globally, the number of women having an induction of labour is increasing and there is a lack of evidence on the effectiveness of supportive interventions. Components of supportive care for women having induction of labour require urgent evaluation. Measurement tools which capture the complexity of supportive care for women having induction of labour need to be developed and validated.

IMPACT

This is the first review to evaluate non-pharmacological, non-invasive supportive interventions for women having induction of labour. The findings of this review identify the urgent need to develop an evidence base for effective supportive.

Women's experiences of outpatient induction of labour with double balloon catheter or prostaglandin pessary: A qualitative study

BACKGROUND

One quarter to one third of women experience induction of labour. Outpatient induction of labour may be safe and effective but women's views of this setting and of different methods of induction are sparse.

AIM

To explore women's experiences of outpatient induction of labour with either prostaglandin pessary or double balloon catheter.

METHODS

Qualitative study using semi-structured, audio-recorded interviews with twenty-one women recruited to a feasibility trial of outpatient induction of labour. Transcripts were coded and analysed using a thematic framework approach.

FINDINGS

Two key themes were identified. 'Ownership of induction of labour' concerned how women understood and experienced the induction of labour process and tried to maintain control of a procedure managed by medical professionals. Women felt unprepared for the steps in the process and for the time it would take. The balloon method was preferred as it was considered a gentler start to the process, although some women reported it was painful on insertion. 'Importance of place' reflected women's associations of the home with comfort, ease of support and distraction, and the hospital with safety yet also with discomfort and delays.

DISCUSSION

This sample of women were keen to start induction without hormones. The randomised controlled trial design may have biased the sample towards women who wanted to experience the balloon method and outpatient setting where these were not usually offered, thus further cohort studies would be beneficial.

CONCLUSIONS

Women were positive about experiencing the early stages of induction of labour at home with the balloon catheter.

Patients' perspectives regarding induction of labor in the absence of maternal and fetal indications: are our patients ready for the ARRIVE trial?

BACKGROUND

After careful review of the ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) data, induction of labor prior to one's due date in the absence of maternal and fetal indications (which the American College of Obstetricians and Gynecologists currently refers to as "elective") is now endorsed as a "reasonable" option by the American College of Obstetricians and Gynecologists (ACOG). As a result, there has been much discussion among providers regarding how best to operationalize this ACOG recommendation into shared decision making regarding delivery planning. However, we lack a formal understanding of the perspectives of patients themselves on this topic.

OBJECTIVE

To assess patient understanding and preference for induction of labor prior to one's due date.

MATERIALS AND METHODS

We conducted an anonymous, cross-sectional survey of women in their third trimester of pregnancy presenting for routine obstetric care in August 2018. The survey included a series of questions designed to assess basic demographics, obstetric history, and patient understanding and opinions about the practice of induction of labor, with a focus on induction of labor prior to one's due date in the absence of maternal and fetal indications.

RESULTS

A total of 108 women were approached for participation, and 100 women participated in this survey (93% participation). Of the participants, 99% were supportive of induction of labor for fetal indications, and 96% were supportive for maternal indications prior to one's due date. In contrast, 54% of participants were not interested in induction of labor in the absence of maternal and fetal indications prior to one's due date. Women opposed to induction of labor in the absence of maternal and fetal indications were almost 4 times more likely to be concerned about the possibility that induction of labor in the absence of maternal and fetal indications could cause fetal harm (odds ratio, 3.9; confidence interval, 1.2-13.2).

CONCLUSION

Nearly all women surveyed in our pilot study were interested in induction of labor prior to one's due date for maternal or fetal indications. 46% of those surveyed were interested in induction of labor in the absence of maternal and fetal indications prior to their due date. Concern about potential fetal harm was more likely among women opposed to induction of labor in the absence of maternal and fetal indications. As providers discuss delivery planning with their patients, these results may provide a useful context for operationalizing and individualizing the results of the ARRIVE trial for their patients.

Women's experiences of induction of labour: Qualitative systematic review and thematic synthesis

OBJECTIVES

To explore and synthesise evidence of women's experiences of induction of labour (IoL).

DESIGN

Systematic review and thematic synthesis of peer-reviewed qualitative evidence. Relevant databases were searched from inception to the present day. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool.

SETTING AND PARTICIPANTS

Low and high risk women who had experienced IoL in an inpatient or outpatient setting.

FINDINGS

Eleven papers (representing 10 original studies) published between 2010 and 2018 were included for thematic synthesis. Four key analytical themes were identified: ways in which decisions regarding induction were made; women's ownership of the process; women's social needs when undergoing IoL; and the importance of place in the induction process. The review indicates that IoL is a challenging experience for women, which can be understood in terms of the gap between women's needs and the reality of their experience concerning information and decision-making, support, and environment.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Providing good quality appropriately timed information and supporting women's self-efficacy to be involved in decision-making around IoL may benefit women by facilitating a sense of ownership or control of labour. Compassionate support from significant others and healthcare professionals in a comfortable, private and safe environment should be available to all women.

The pregnancy experience: a mixed methods analysis of women's understanding of the antenatal journey

BACKGROUND

Positive contact with antenatal care and its providers improves positive outcomes for women and their babies. This involves the accrual and use of knowledge accumulated through education, experiential learning and other fora and is reliant on a positive experience.

AIMS

Women's knowledge of antenatal and postnatal care was examined, in addition to the positive and negative feelings and experiences they associate with it.

METHODS

Employing a mixed methodology, a self-administered questionnaire was distributed to women attending antenatal clinics. It consisted of open and closed questions examining women's experiences of antenatal care and knowledge of the intrapartum and postnatal journey. Following this, individual semi-structured interviews were conducted with eight postnatal women gaining further in-depth insight into their peripartum experiences.

RESULTS

Respondents to the questionnaire had varied opinions and beliefs about the purpose of antenatal care and prenatal screening policies, with the majority of their knowledge obtained from non-medical sources. The knowledge of labour and its complications was significantly better in multiparous women. However, in some postnatal scenarios, both cohorts lacked knowledge. In the qualitative study, women described positive feelings with their experience of antenatal care, with women expressing variations in the amount of knowledge they wanted to receive.

CONCLUSIONS

This research demonstrates the varied experiences of women attending our services, highlighting both the positive and negative aspects of care. Topics of poor knowledge are highlighted, particularly in primiparous women and regarding the postnatal period. Using this information, women can be provided with an optimised, personalised experience in our maternity services.

Variation in clinical decision-making for induction of labour: a qualitative study

Background

Unexplained variation in induction of labour (IOL) rates exist between hospitals, even after accounting for casemix and hospital differences. We aimed to explore factors that influence clinical decision-making for IOL that may be contributing to the variation in IOL rates between hospitals.

Methods

We undertook a qualitative study involving semi-structured, audio-recorded interviews with obstetricians and midwives. Using purposive sampling, participants known to have diverse opinions on IOL were selected from ten Australian maternity hospitals (based on differences in hospital IOL rate, size, location and case-mix complexities). Transcripts were indexed, coded, and analysed using the Framework Approach to identify main themes and subthemes.

Results

Forty-five participants were interviewed (21 midwives, 24 obstetric medical staff). Variations in decision-making for IOL were based on the obstetrician’s perception of medical risk in the pregnancy (influenced by the obstetrician’s personality and knowledge), their care relationship with the woman, how they involved the woman in decision-making, and resource availability. The role of a ‘gatekeeper’ in the procedural aspects of arranging an IOL also influenced decision-making. There was wide variation in the clinical decision-making practices of obstetricians and less accountability for decision-making in hospitals with a high IOL rate, with the converse occurring in hospitals with low IOL rates.

Conclusion

Improved communication, standardised risk assessment and accountability for IOL offer potential for reducing variation in hospital IOL rates.