Induction of labour: How do women get information and make decisions? Findings of a qualitative study
Induction of labour is one of the most frequent interventions in pregnancy. While it is not always unwelcome, it is associated with increased labour pain and further interventions. Evidence from earlier studies suggests that induction is often commenced without full discussion and information, which questions the validity of women's consent. This study aimed to add depth and context to existing knowledge by exploring how first-time mothers acquire information about induction and give consent to the procedure.
A qualitative study into women's experiences of induction was undertaken, comprising 21 women, who were interviewed 3-6 weeks after giving birth following induction.
Information from midwives and antenatal classes was minimal, with family and friends cited as key informants. Midwives presented induction as the preferred option, and alternative care plans, or the relative risks of induction versus continued pregnancy, were rarely discussed. Women reported that midwives often appeared rushed, with little time for discussion.
Providers of maternity care need to devise more flexible ways of working to create time and opportunities for midwives to discuss induction in detail with women and to promote fully informed decision-making.
Induction of labour is one of the most frequently performed interventions in pregnancy, accounting for around 25% of all births in England (NHS Digital, 2017). Induction carries the risk of further interventions and is associated with increased pain in labour and an increased likelihood of instrumental delivery (Shetty et al, 2005; National Institute for Health and Clinical Excellence (NICE), 2008; Cheyne et al, 2012).
Epidemiological evidence from numerous studies in Europe, Israel and the USA (National Collaborating Centre for Women's and Children's Health (NCC-WCH), 2008) has shown a gradually increasing risk of perinatal mortality in pregnancies exceeding 40 weeks, although the absolute risk remains very low. These studies suggest that the potential health benefits to women and babies of inducing labour after 41 weeks outweigh the additional costs to the maternity care provider (NCC-WCH, 2008). Where medical conditions such as pre-eclampsia or Type 1 diabetes exist, the dangers of continuing the pregnancy may not be controversial (Cheyne et al, 2012); however, approximately half of all inductions in the UK are performed for uncomplicated, post-date pregnancies, where the risk of perinatal death is low (2-3 per 1000 births). In these situations, the risk of maternal morbidity resulting from induction is relatively high, compared to spontaneous labour (NCC-WCH, 2008; Cheyne et al, 2012). In keeping with the principles of woman-centred care (Department of Health, 2007), the decision to induce labour or continue with the pregnancy rests with the woman. NICE guidelines state that:
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