Induction of labour: How do women get information and make decisions? Findings of a qualitative study

Abstract

Background 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. Method 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. Findings 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. Conclusions 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.

Women‘s experiences of postterm induction of labor: A systematic review of qualitative studies

“…These studies comprised a total of 277 women, of which 161 women were participants in the study by Henderson et al, 34 which was also the only mixed-methods study with a qualitative analysis of open-ended survey questions included in this review. [35][36][37][38][39][40] However, the reporting of other participant information was very inconsistent among the studies and did not allow us to synthesize the demographic characteristics of the sample. All studies addressed women's experiences of IOL in postterm pregnancy, and six studies included only primiparous women.…”

“…Three studies of high methodological quality, 35,37,38 one study of moderate methodological quality (less appropriate methodology), 33 and two studies of low methodological quality (unclear methodology and weak grounding of results) 36,39 No to very minor concerns …”

“…Two studies of high methodological quality, 34,37 one study of moderate methodological quality (less appropriate methodology), 33 and two studies of low methodological quality (unclear methodology and weak grounding of results) 36,39 No to very minor concerns themes and discrepancies in the material. Subsequently, the final analysis and synthesis of findings were performed to identify three separate themes, which are presented below.…”

“…Thus, induction represented a "push" 38 toward the desired delivery, and for some women, the induction represented a sense of gaining control in an unpredictable situation. [35][36][37][38][39][40][41] For these women, their original hopes and expectations of spontaneous labor were disrupted by the induction guidelines or induction offer/recommendations. Now I have more control over my birth because I know when it will happen and I will be at the hospital when it starts.…”

“…35,41 For example, Jay et al 35 recruited participants from an NHS Maternity Unit in the south of England and found that women who had expected to attend the low-risk birthing unit were disappointed to discover that this option was only available to women in spontaneous labor. [34][35][36][37][38][39] Concerns for the health of the unborn baby and potential risks if the induction was not initiated were the main reasons for this behavior. As one woman explained, she had to switch her mindset from "just breathe" to suddenly "just get this needle in your arm."…”