Women's Experiences of Mechanical Balloon Catheter Induction With Self-Traction

OBJECTIVE

To explore women's experiences of mechanical labor induction using a balloon catheter with self-traction.

DESIGN

Descriptive qualitative.

SETTING

Birth unit of an urban hospital in Quebec, Canada.

PARTICIPANTS

Fourteen women who experienced labor induction with a balloon catheter using self-traction.

METHODS

We conducted individual structured interviews between May 2022 and January 2023 to collect data that we subsequently analyzed using the manifest content analysis approach of Graneheim et al. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

RESULTS

We identified five categories: Expectations, Pain or Comfort Experienced, Emotions Felt, Support From Nursing Staff, and Appreciation of the Procedure. The participants anticipated rapid, effective induction, expressed concerns about potential discomfort, and appreciated control of their experiences. We found a generally positive trend in terms of appreciation for all categories.

CONCLUSION

The positive experiences of participants underline the promising potential of the balloon catheter method of labor induction with self-traction. Given the continuing growth in labor induction rates, it becomes necessary to continue efforts to offer services specifically geared to women's needs. Offering an additional option such as self-traction is a step in this direction.

Women's experiences of consent to induction of labour: A qualitative study

OBJECTIVE

Induction of labour (IOL) does not require formal written consent, and little is known about how consent operates in this context. This prospective study explores pregnant women's experiences of the IOL consent process.

METHODS

Qualitative study using semi-structured, interviews with thirteen women admitted to hospital for IOL. Data were analysed using thematic analysis.

RESULTS

Three themes emerged: 1) Voluntary nature of consent: Some women experienced genuine choice; others perceived pressure to prioritise their baby. 2) Understanding the why and how, risks and benefits: Information provision and explanation was often minimal, particularly regarding risks and alternatives to induction. The possibility of IOL failing was not discussed 3) Non-personalised information process: Few women received information specific and relevant to their circumstance.

PRACTICE IMPLICATIONS

There is an urgent need for healthcare professionals to be supported in actively facilitating consent consultations which enable women undergoing IOL to make a fully autonomous, informed choice.

CONCLUSIONS

Women did not always experience choice about whether to be induced. This sense of disempowerment was sometimes exacerbated by inadequate information provision. The study reveals a practice imperative to address consent in IOL and we suggest there is an urgent need for HCPs to be offered high quality training specific to IOL.

The experiences of shared decision-making of women who had an induction of labour

OBJECTIVES

The importance of shared decision-making (SDM) in relation to induction of labour (IOL) is recognised, little is known about women's experiences of and satisfaction with decision-making and how this can be improved. The aim of this study was to 1) gain insight into women's experiences of SDM in relation to IOL, 2) understand the factors associated with satisfaction versus dissatisfaction during SDM, and 3) identify recommendations for service improvement.

METHODS

Qualitative semi-structured telephone interviews were conducted with 32 women who had a recent IOL at one of eight public hospitals in Sydney, Australia. An inductive approach to coding and categorisation of themes was used.

RESULTS

While women reported varied experiences with SDM, many reported not feeling that they had a choice about IOL, not being presented with the risks and benefits of different birth options, and receiving insufficient information about the IOL process and methods. Satisfaction versus dissatisfaction with SDM appeared more closely related to a woman's willingness to have an IOL and their willingness to defer decision-making, rather than the process of SDM. Recommendations for improvement included improved SDM practices, access to guidelines and continuity of care.

CONCLUSION

There is a need to improve SDM processes around IOL.

PRACTICE IMPLICATIONS

Particular areas for improvement include more comprehensive discussions surrounding the pros and cons of different birth methods and the IOL process. Decision aids and clinician training may assist with SDM.

Factors associated with women's birth beliefs and experiences of decision-making in the context of planned birth: A survey study

OBJECTIVE

In many high-income countries, approximately half of all births are now planned regarding timing, either by elective Caesarean Section (CS) or induction of labour (IOL). To what degree this is explained by women's birth beliefs and preferences, and in turn, factors such as parity and ethnicity that may influence them, is contentious. Within a broader study on Timing of Birth by planned CS or IOL, we aimed to explore the association between demographic and pregnancy factors, with women's birth beliefs and experiences of planned birth decision-making in late pregnancy.

DESIGN

Survey study of women's birth beliefs and experiences of planned birth decision-making. Both univariate analysis and ordinal regression modelling was performed to examine the influence of; parity; cultural background; continuity of pregnancy care; CS or IOL; and whether CS was "recommended" or "requested", on women's stated birth beliefs and decision-making experience.

SETTING

8 Sydney hospitals PARTICIPANTS: Women planned to have an IOL or CS between November 2018-July 2019.

MEASUREMENT

The survey included four statements regarding birth beliefs and ten statements about experiences of decision-making on a 5-item Likert scale, as well as questions about demographic and pregnancy factors that might influence these beliefs.

FINDINGS

Of 340 included surveys, 56% regarded IOL and 44% CS. Women indicated strong belief both that they should be supported to make decisions about their birth and that their doctor/midwife knows what is best for them (over 90% agreement for both). Regarding decision-making, over 90% also agreed they had trust in the person providing information, understood it, and had sufficient time for both questions and decision-making. However only 58% were provided written information, 19% felt they "didn't really have a choice", and 9% felt pressure to make a decision. On both univariate and multivariate analysis, women having CS (versus IOL) expressed more positive views of their experience and involvement in decision-making, as did women experiencing a pregnancy continuity-of-care model. Women identifying as from a specific cultural or ethnic background expressed more negative experiences. On modelling, the studied factors accounted for only a small proportion of the variation in responses (3-19%).

CONCLUSIONS

Continuity of pregnancy care was associated with positive decision-making experiences and cultural background with more negative experiences. Women whose planned birth was IOL versus CS also reported more negative decision-making experiences.

IMPLICATIONS FOR PRACTICE

Attention to improving quality of information provision, including written information, to women having IOL and women of diverse background, is recommended to improve women's experiences of planned birth decision-making.

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.

"I guess baby was just too comfy in there…": A qualitative study of women's experiences of elective late-term induction of labour

BACKGROUND

The frequency of induction of labour (IOL) in late-term pregnancy has increased significantly, but little is known about how women with uncomplicated pregnancies experience IOL for late-term indication alone.

AIM

To explore how women with uncomplicated pregnancies experienced late-term IOL.

METHODS

Qualitative interviews were conducted with 23 women who all had labour induced on late-term indication only. Participants were recruited from two Danish hospitals who offered an outpatient induction regime. The women were interviewed 4-8 weeks after birth. Data were analysed using thematic analysis.

RESULTS

All women had hoped for a spontaneous birth. Prolonged pregnancy was understood as the body/baby "not being ready", but generally, the women were not worried at that point. Most women felt adequately informed about the reasons for IOL, but some requested more information and time to consider their options. The majority considered IOL to be both an offer and a recommendation. One-third of the participants were initially hesitant but chose/accepted IOL because of weariness from pregnancy and the impatience to deliver a healthy child. The opportunity of outpatient induction was generally appreciated as it allowed the women to continue everyday activities while waiting for labour to begin. Nineteen women reported having a good birthing experience. Two women felt that negative birthing experiences were partly related to IOL.

CONCLUSIONS

Most women considered the late-term IOL to be a positive experience. Some women requested more information and time to consider alternatives. These women should be provided with supported opportunities to consider the options.

Women's experiences of decision-making and attitudes in relation to induction of labour: A survey study

BACKGROUND

Rates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women's mode of birth preferences and experiences of shared decision-making for induction of labour.

METHOD

An antenatal survey of women booked for an induction at eight Sydney hospitals was conducted. A bespoke questionnaire was created assessing women's demographics, indication for induction, pregnancy model of care, initial birth preferences, and their experience of the decision-making process.

RESULTS

Of 189 survey respondents (58% nulliparous), major reported reasons for induction included prolonged pregnancy (38%), diabetes (25%), and suspected fetal growth restriction (8%). Most respondents (72%) had hoped to labour spontaneously. Major findings included 19% of women not feeling like they had a choice about induction of labour, 26% not feeling adequately informed (or uncertain if informed), 17% not being given alternatives, and 30% not receiving any written information on induction of labour. Qualitative responses highlight a desire of women to be more actively involved in decision-making.

CONCLUSION

A substantial minority of women did not feel adequately informed or prepared, and indicated they were not given alternatives to induction. Suggested improvements include for face-to-face discussions to be supplemented with written information, and for shared decision-making interventions, such as the introduction of decision aids and training, to be implemented and evaluated.

Women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour

OBJECTIVE

To explore and synthesise evidence of women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour.

DESIGN

A systematic review following the Joanna Briggs Institute (JBI) meta-aggregative approach to qualitative evidence synthesis. Relevant databases were searched for literature published in English between 2000-19. Study quality was assessed using the JBI quality assessment tool for qualitative studies.

SETTING

Qualitative research conducted in OECD countries describing women's information needs, decision-making and/or experiences of membrane sweeping to promote spontaneous labour.

FINDINGS

One article met the criteria for inclusion. This article describes the experience of a membrane sweep given without consent.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

There is a lack of evidence around women's information needs, decision-making and experiences of membrane sweeping. This is concerning, especially in the context of rising rates of formal induction of labour. Further research is needed to investigate how women are being offered membrane sweeping and what information women need to make informed choices about membrane sweeping to promote spontaneous labour.

Women's experiences of postterm induction of labor: A systematic review of qualitative studies

BACKGROUND

Over the last decade, induction of labor (IOL) in postterm pregnancies has increased. Studies have shown the medical advantages of postterm IOL, but less is known about the perspectives of the pregnant women. This review aimed to summarize the current qualitative evidence on women's experience of postterm IOL.

METHODS

A systematic literature search was performed in three databases. A total of 3193 publications were identified, but only eight studies met the inclusion criteria. Thematic analysis guided the data extraction and synthesis. The Confidence in the Evidence for Reviews of Qualitative research (CERQual) approach was used to assess confidence in the findings.

RESULTS

Three major findings were identified. First, for some women, IOL required a shift in expectations because the hope of spontaneous labor had to be given up. Second, the IOL decision was considered a recommendation from health care professionals and was experienced as a nondecision. Finally, the induction process was experienced as a sequential set of steps where the women were expected to fit into the existing hospital organization. The CERQual assessment suggested moderate confidence in all findings.

DISCUSSION

The negative experiences identified in this review can be greatly reduced by a communicative and patient-centered approach. To support informed choice and shared decision making, women need high-quality, unbiased information about IOL, alternative options, and potential outcomes, in addition to time for reflection on their personal values and preferences. Women may need a professionally initiated and supported opportunity to re-evaluate their hopes and expectations before IOL.

Induction of labour: Experiences of care and decision-making of women and clinicians

BACKGROUND

There has been a rise in induction of labour over recent decades. There is some tension in the literature in relation to when induction is warranted and when not, with variability between guidelines and practice. Given these tensions, the importance of shared decision-making between clinicians and women is increasingly highlighted as paramount, but it remains unclear to what extent this occurs in routine care.

METHOD

Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question "What are the views, preferences and experiences of women and clinicians in relation to induction of labour more broadly, and practices of decision-making specifically?" To identify studies, the databases PubMed, Maternity and Infant Care, CINAHL and EMBASE were searched from 2008 to 2018, and reference lists of included studies were examined.

FINDINGS

20 papers met inclusion criteria, in relation to (a) women's preferences, experiences and satisfaction with IOL; (b) women's experience of shared-decision making in relation to induction; (c) interventions that improve shared decision-making and (d) factors that influence decision-making from the perspective of clinicians. Synthesis of the included studies indicates that decision-making in relation to induction of labour is largely informed by medical considerations. Women are not routinely engaged in the decision making process with expectations and preferences largely unmet.

CONCLUSION

There is a need to develop strategies such as decision aids, the redesign of antenatal classes, and clinician communication training to improve the quality of information available to women and their capacity for informed decision-making.

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.

“Babies come when they are ready”: Women’s experiences of resisting the medicalisation of prolonged pregnancy

Being pregnant beyond one’s estimated due date is a relatively common experience and requires complex decisions about whether to induce labour or wait for spontaneous onset. We report a qualitative study undertaken in the UK in 2016. We interviewed fifteen women and eleven more took part in an online focus group. Using thematic analysis, resistance to the medicalisation of prolonged pregnancy was identified as a strong theme. Drawing on the work of Armstrong and Murphy, we identify both conceptual and behavioural resistance in the accounts of women who accepted, delayed or declined induction of labour. Experiential knowledge played a key role in resistance, but women found this was devalued. Some healthcare staff used risk discourse to pressure women to comply with induction protocols but were unwilling to engage in discussion. The social context provided further pressure to produce a baby ‘on time’, with induction normalised as the way to manage prolonged pregnancy. Online spaces provided additional information and support for women to question the medicalisation of prolonged pregnancy. We end by considering the implications for policies of choice and agency in maternity care as well as the need for additional social support for women who are ‘overdue’.

In labor or in limbo? The experiences of women undergoing induction of labor in hospital: Findings of a qualitative study

BACKGROUND

Induction of labor currently accounts for around 25% of all births in high-resource countries, yet despite much research into medical aspects, little is known about how women experience this process. This study aimed to explore in depth the induction experience of primiparous women.

METHODS

A qualitative study was undertaken, using a sample of 21 first-time mothers from a maternity unit in the south of England. Semi-structured interviews were conducted in women's homes between 3 and 6 weeks postnatally. Data were recorded, transcribed, and analyzed thematically.

RESULTS

Women awaiting induction on the prenatal ward appeared to occupy a liminal state between pregnancy and labor. Differences were noted between women's and midwives' notions of what constituted "being in labor" and the ward lacked the flexibility to provide individualized care for women in early labor. Unexpected delays in the induction process were common and were a source of anxiety, as was separation from partners at night. Women were not always clear about their plan of care, which added to their anxiety.

CONCLUSIONS

Conceptualizing induction as a liminal state may enhance understanding of women's feelings and promote a more woman-centered approach to care. Thorough preparation for induction, including an explanation of possible delays is fundamental to enabling women to form realistic expectations. Care providers need to consider whether women undergoing induction are receiving adequate support, analgesia, and comfort aids conducive to the promotion of physiological labor and the reduction of anxiety.

Does a policy of earlier induction affect labour outcomes in women induced for postmaturity? A retrospective analysis in a tertiary hospital in the North of England

OBJECTIVES

to investigate whether a change in the management of postmature pregnancy to earlier induction affects the length of labour and the induction process. Secondly, to assess the feasibility of the research process to inform a future larger study.

DESIGN

a change in management of postmature pregnancy in an NHS hospital in October 2013, from induction at 42 weeks gestation to induction between 41-42 weeks, provided an opportunity to conduct a retrospective analysis. Pre-existing data from the maternity database and casenotes were collected and primary outcomes analysed using the Mann-Whitney test and the Hodges-Lehman confidence interval for differences in medians.

SETTING

a large city based tertiary referral hospital in the North of England.

PARTICIPANTS

125 women induced before the change in policy were compared with 309 women induced after the change.

MEASUREMENTS

primary outcomes were length of 1st and 2nd stage of labour, overall length of labour, length of induction to established labour and length of induction to birth.

FINDINGS

the median overall length of labour for women induced at 42 weeks was 6.5hours, while for women induced at 41-42 weeks this was 5.2hours. The difference was not statistically significant (p=0.15, 95% CI for median difference -0.27 to 1.93hours) with a small effect size (Pearson's r=-0.08). The median length of induction to birth was 13.6hours for women induced at 42 weeks and 16.5hours for women induced at 41-42 weeks. This difference was also not statistically significant (p=0.14, 95% CI for median difference -7.25 to 1.20hours) with a small effect size (Pearson's r=-0.13).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

This study demonstrated no statistically significant differences in length of labour and induction following a change in the management of postmature pregnancy to earlier induction. A large study is needed to establish definitively the effects of earlier induction on labour outcomes.