Development of a home induction of labour framework

Abstract

Background 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. Aims A home IOL service was developed to offer women choice about where labour onset can be awaited. Methods 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. Findings Audit findings highlighted that the majority of women remained at home for between 6–14 hours and all returned to the hospital safely. Conclusions 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.

Safety, effectiveness, womenʼs experience, and economic costs of outpatient induction in women with uncomplicated pregnancies: A systematic review and meta‐analyses

“…Maternal satisfaction was reported in three RCTs 9,14,31 and one non‐RCT, 40 including 1707 women. One RCT 9 reported high satisfaction ratings in the outpatient group (83/149; 56%) compared with the inpatient group (59/150; 39%).…”

Outpatient versus inpatient cervical ripening with a slow‐release dinoprostone vaginal insert in term pregnancies on maternal, neonatal, and birth outcomes: A systematic review

“…Finally, it was not possible to do a meta‐analysis on maternal satisfaction as this outcome was only reported by one of the studies 8 . As women's preference is often mentioned as a reason to introduce outpatient IOL, 17,18,39 it was unexpected to find so little of this data. Biem et al 8 reported that women in the outpatient setting had an overall higher satisfaction rate.…”

“…49,50 Although studies on outpatient cervical ripening using a dinoprostone insert have been performed in countries other than Canada, unfortunately, they did not meet the inclusion criteria for this systematic review because lacking the comparative group or because including a high-risk population of women in their sample. 18,33,34,48,51 The baseline characteristics of the women included were substantially different among the two settings (parity, gestational age, cervix status) as well as the rationale for IOL. Although the included studies stated that they comprised women with uncomplicated pregnancies, this was not always the case.…”

“…However, the Canadian health care maternity system presents a combination of obstetric‐led and midwifery‐led care and different health care providers according to women's preference and their health status 49,50 . Although studies on outpatient cervical ripening using a dinoprostone insert have been performed in countries other than Canada, unfortunately, they did not meet the inclusion criteria for this systematic review because lacking the comparative group or because including a high‐risk population of women in their sample 18,33,34,48,51 …”

“…13,15,16 It has been suggested that the equivalent benefits for staying at home may be extended to healthy women who are having their labor induced for postdate pregnancies or other less medically indicated IOL reasons (such as, social reasons or a woman's request in an otherwise uncomplicated pregnancy). 6,9,17 Home is associated with unrestricted space and freedom of movement, 18 with the feeling of comfort and privacy, and constant presence of one or more family member. 9,19 This is particularly relevant considering the recent trend in shifting maternity care outside the hospital and the visiting restrictions resultant from the Covid-19 global pandemic.…”