Induction of labour during the COVID-19 pandemic: a national survey of impact on practice in the UK

Abstract

Background Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK. Method We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach. Findings Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women’s response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women. Conclusions The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

“…Those include care provision with telemedicine, attempts to minimise the duration women spend in hospitals (either by labour induction or by discharging early after birth), changes in anaesthesia practices and reduction in the number of allowed companions during birth. [14][15][16] In an effort to minimise negative consequences, international and national guidelines were developed, modified and adapted for maternal health service provision across the entire continuum of care including antenatal care, intrapartum and postnatal care. [17][18][19][20][21] Maternity skilled health personnel (SHP)-including doctors, nurses and midwives-were at the forefront of implementing these regularly updated guidelines and faced many challenges during the COVID-19 pandemic.…”

Pre and Post-Lockdown Cesarean Deliveries and Perinatal Quality Indicators During the COVID-19 Pandemic

“…Reasons for the abrupt increase in NTSV and decrease in NMETD are unclear based on these data but may be due to delay or avoidance of care, limited resources, changes in labor and delivery unit practices or management. 2 , 10 , 15 , 16 , 24 , 25 These perinatal quality indicators are reported to the Joint Commission 26 and may be available to hospitals in their hospital electronic medical records in near real-time or monthly or quarterly basis. Further, perinatal quality collaboratives 26 can play an important role in monitoring these indicators 4 , 10 , 11 , 27 and may provide guidance in quality initiatives to improve triage, labor and delivery staffing during public health emergencies.…”

Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two Trusts in England using the ASPIRE COVID-19 framework

“…One Trust responded to national guidelines, while the other did not. These differences are re ected in a national study that found the majority of Trusts in the UK made no major changes to induction practices during the COVID-19 pandemic (27). National evidence also con rms the temporary cessation of home births in many areas (5).…”