Development of a home induction of labour framework
Nationally, it is recommended that women should be offered post-dates induction of labour (IOL) at 40 weeks + 10–12 days. There is evidence that an outpatient IOL service may be associated with improved maternal satisfaction.
A home IOL service was developed to offer women choice about where labour onset can be awaited.
In an attempt to fully understand key factors and improve the local IOL service, a baseline audit of care and outcomes for low-risk post-dates women was undertaken (hospital group). A home IOL service was then set up (home group) for women to await labour onset in the comfort of their own home. Once this option was available, a second audit aimed to highlight any advantages or disadvantages with the new service so as to inform future improvement.
Audit findings highlighted that the majority of women remained at home for between 6–14 hours and all returned to the hospital safely.
Findings from the audits undertaken before, during and after the home IOL service was implemented, highlight useful benefits for women. It is recommended that other Trusts considering implementing the same improvement carefully monitor their findings.
Approximately 25% of pregnant women in the UK have their labour induced (Kelly et al, 2013). At a national level, it is recommended that women be offered a membrane sweep to avoid the need for post-dates induction of labour (IOL) (National Institute for Health and Care Excellence (NICE), 2008). Locally, it is advocated that all women are offered a membrane sweep at both 40 weeks and 41 weeks, and that IOL is booked between 10–12 days post-dates.
IOL has been described by women as more painful than spontaneous onset of labour, and may have a negative impact on a woman's birth experience (Shetty et al, 2005). Traditionally, IOL has taken place in hospital. However, national guidance now upholds the principle of maternity services offering IOL in an outpatient setting, as long as safety and support procedures are in place (NICE, 2008). Having the choice to go home while waiting for labour onset is appealing both to women and most care providers. An outpatient service suggests improved maternal satisfaction (Kelly et al, 2013; Dhavliker et al, 2016) and a potential reduction in hospital length of stay, with associated reduced cost to the NHS.
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