Women's experiences of outpatient induction of labour
Outpatient induction of labour is offered to relieve the pressure on inpatient stay and to improve women's experiences.
To contribute to the knowledge of outpatient induction of labour with the focus on women's experiences to inform practice. The question was: ‘What are women's experiences of outpatient induction of labour?’
A comprehensive literature review using a pluralistic approach and thematic analysis.
The review found three themes: the home as a positive setting for outpatient induction of labour, the value of outpatient induction of labour in promoting normality and the importance of receiving reassurance during outpatient induction of labour.
Although the results were mostly positive and in favour of outpatient induction of labour, there were variations in service provision. There was a lack of understanding as to how best to offer reassurance to women once discharged home, which was found to have a direct effect on their experiences.
Approximately 32.6% of labours in the UK are induced, either before or after the estimated due date (NHS Digital, 2018). This number has increased by 12.2% in the past 10 years (NHS Digital, 2018) and is likely to increase further due to a rise in more complex pregnancies with risk factors that indicate the need for delivery of the fetus. A further significant influence on induction of labour rates is the publication of the Saving Babies' Lives Care Bundle (O'Connor, 2016), which states an objective to decrease the stillbirth rate by 20% by 2020. By implementing the recommendations set out in the care bundle, there is a likelihood that induction of labour rates will increase and affect service demands (O'Connor, 2016).
However, it is widely recognised that most women want as much as possible to have a physiological and normal birth (Gammie and Key, 2014; Downe, 2017; Jay et al, 2018). Induction of labour has been shown to have a negative impact on women's experiences, often leading to dissatisfaction, increased pain, increased likelihood of instrumental births and obstetric interventions (O'Dwyer et al, 2015). Women have also reported neglect due to staff shortages, a lack of choice in care when undergoing induction of labour and a lack of privacy in the ward environment, which is typically where induction of labour takes place (Henderson and Redshaw, 2013). As a result, outpatient induction of labour services have become an attractive option to improve women's experience of induction of labour (Henderson and Redshaw, 2013). This supports the recommendations set out in Better Births (National Maternity Review, 2016), which called for high-quality, personalised and family friendly services to be provided to women and their families. Seven key recommendations were developed, one of which, ‘personalised care’, identified that women should be encouraged to make informed choices about their care, with clinical commissioning groups (CCGs) providing maternity services in a range of settings, including the home (National Maternity Review, 2016).
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