Cooper M, Warland J. Improving women's knowledge of prostaglandin induction of labour through the use of information brochures: A quasi-experimental study. Women Birth. 2011; 24:(4)156-164

NHS Internal Audit Standards.London: Department of Health; 2012

Downe S, Finlayson K, Fleming A. Creating a collaborative culture in maternity care. J Midwifery Womens Health. 2010; 55:(3)250-4

Freeman G, Hughes J. Continuity of care and the patient experience: An Inquiry into the Quality of General Practice in England.London: The Kings Fund; 2010

Flottorp SA, Jamtvedt G, Gibis B, McKee M. Using audit and feedback to health professionals to improve the quality and safety of health care.Copenhagen: World Health Organisation; 2010

Gatward H, Simpson M, Woodhart L, Stainton MC. Women's experiences of being induced for post-date pregnancy. Women Birth. 2010; 23:(1)3-9

Gokturk U, Cavkayatar S, Danisman N. Can measurement of cervical length, fetal head position and posterior cervical angle can be an alternative method to Bishop Score in the prediction of successful labour induction?. Journal of Maternal-Fetal and Neonatal Medicine. 2014; 28:(11)1-6 4767058.2014.954538

Henderson J, Redshaw M. Women's experience of induction of labor: a mixed methods study. Acta Obstet Gynecol Scand. 2013; 92:(10)1159-67

Hildingsson I, Karlström A, Nystedt A. Women's experiences of induction of labour--findings from a Swedish regional study. Aust N Z J Obstet Gynaecol. 2011; 51:(2)151-7

Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M. Mechanical methods for induction of labour. Cochrane Database Syst Rev. 2012; 14:(3)

Kent County Council Housing Led Forecast (September 2017).Maidstone: Strategic Business Development Intelligence; 2017

McCarthy FP, Kenny LC. Induction of labour. Obstetrics, Gynaecol Reprod Med. 2014; 24:(1)9-15

How to Change Practice: Understand, identify and overcome barriers to change.London: NICE; 2007

Induction of Labour [CG70].London: NICE; 2008

Insertion of a double balloon catheter for induction of labour in pregnant women without previous caesarean section [IPG528].London: NICE; 2015

Better Births: Improving Outcomes of Maternity Services in England.London: NHS England; 2016

NHS Digital. NHS Maternity Statistics England 2016-17. 2017. (accessed 20 February 2018)

Nicholas E, Qureshi H. Developing outcome-focused practice: examining the process. Research Policy and Planning. 2004; 22:(3)1-14

Schwarz C, Gross MM, Berger B. Women's perceptions of induction of labour outcomes: Results of an online survey in Germany. Midwifery. 2016; 35:3-10

Shetty A, Burt R, Rice P, Templeton A. Women's perceptions, expectations and satisfaction with induced labour—A questionnaire-based study. Eur J Obstet Gynecol Reprod Biol. 2005; 123:(1)56-61

Sidani S. Health Intervention Research: Understanding Research Design and Methods.London: Sage Publishing; 2015

Spiby H, Walsh D, Green J Midwives' beliefs and concerns about telephone conversations with women in early labour. Midwifery. 2014; 30:1036-42

Tsang JCK, Wyn Jones N. Antepartum fetal health Obstetrics. Gynaecology and Reproductive Medicine. 2014; 24:(3)80-4

Twycross A., Shorten A. Service evaluation, audit and research: what is the difference?. Evidence Based Nursing. 2014; 17:(3)65-6

Improving induction of labour for women through the development of a new pathway

02 September 2018
Volume 26 · Issue 9



Although induction of labour is a safe procedure for the pregnant woman at term, the process is not without risk. In recognition of these challenges associated with induction, an audit of local service provision was undertaken.


To identify problems with the existing induction service.


This was a retrospective analysis of women's notes from May to December 2016. All patient records of pregnant women who had received induction during this time (n=870) were examined, as well as complaints and feedback received by the service.


The audit identified several issues that would need to be addressed if the service was to be improved. These concerns were divided into two groups: the pregnant woman's perspective and service provision issues.


A new induction of labour pathway was created that aimed to address some of the concerns identified by the audit, and improve the care that women received. A further audit was conducted to assess the improvement in care as a result.

Induction of labour, whereby the onset of labour is stimulated using either pharmacological or mechanical methods, is one of the most common obstetric procedures carried out in the UK (McCarthy and Kenny, 2014). The incidence of women receiving induction of labour has increased over the past 10 years. In 2008, the Royal College of Obstetricians and Gynaecologists (RCOG) calculated that one in five women in the UK had labour induced, while latest figures suggest that the induction of labour rate is approximately 29.4%, and that this is on an upward trend (NHS Digital, 2017). This increasing number of women receiving induction creates its own challenges. Although induction of labour is a safe procedure for the pregnant woman at term, the process is not without risk (Schwarz et al, 2016), and problems include: increased pain and reduced efficiency when compared to spontaneous labour (National Institute for Health and Clinical Excellence (NICE), 2008); concerns related to the participation in the decision-making process (Henderson and Redshaw, 2013); and a disparity between women's expectations of labour and their lived experience (Shetty et al, 2005; Gatward et al, 2010).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month