Inter-hospital and inter-disciplinary variation in planned birth practices and readiness for change: a survey study

Abstract

Background How the application of evidence to planned birth practices, induction of labour (IOL) and prelabour caesarean (CS), differs between Australian maternity units remains poorly understood. Perceptions of readiness for practice change and resources to implement change in individual units are also unclear. Aim To identify inter-hospital and inter-professional variations in relation to current planned birth practices and readiness for change, reported by clinicians in 7 maternity units. Method Custom-created survey of maternity staff at 7 Sydney hospitals, with questions about women’s engagement with decision making, indications for planned birth, timing of birth and readiness for change. Responses from midwives and medical staff, and from each hospital, were compared. Findings Of 245 completed surveys (27% response rate), 78% were midwives and 22% medical staff. Substantial inter-hospital variation was noted for stated planned birth indication, timing, women’s involvement in decision-making practices, as well as in staff perceptions of their unit’s readiness for change. Overall, 48% (range 31–64%) and 64% (range 39–89%) agreed on a need to change their unit’s caesarean and induction practices respectively. The three units where greatest need for change was perceived also had least readiness for change in terms of leadership, culture, and resources. Regarding inter-disciplinary variation, medical staff were more likely than midwifery staff to believe women were appropriately informed and less likely to believe unit practice change was required. Conclusion Planned birth practices and change readiness varied between participating hospitals and professional groups. Hospitals with greatest perceived need for change perceived least resources to implement such change.

Likelihood of primary cesarean section following induction of labor in singleton cephalic pregnancies at term, compared with expectant management: An Australian population‐based, historical cohort study

“…The conflicting findings as discussed above may reflect differences in clinical practice of IOL 35 , 36 , 37 among different settings and raise the concern of external validity regarding the findings of previous studies. In 2020, 22% of women who had IOL gave birth by CS in Australia.…”

“…After adjusting for potential confounding factors, similar increased likelihood of primary CS following IOL was found at 37 weeks (paras: aRR = 1.52, 95% CI 1. 35 For the secondary analyses of a different reference group (only beyond the gestation of birth following IOL, up to 41 +6 weeks), an increased likelihood of CS was found at 38 weeks (aRR = 1.12, 95% CI 1.08-1.16) and 39 weeks (aRR = 1.09, 95% CI 1.05-1.12) for nulliparas, and at 37 weeks (aRR = 1.53, 95% CI 1. 37 CI 1.14-1.40) for paras (Figures 2 and 3).…”

From data to practice change – exploring new territory for atlases of clinical variation

“…Primarily illustrating geographic differences in healthcare utilisation, atlases have been produced in multiple jurisdictions over many years [1]. They range widely in terms of breadth and depth of clinical areas covered (Supplementary Table 1) and their approach also features in more focused studies in the peer reviewed literature [2][3][4][5][6]. Despite significant adoption of the atlas approach, evidence demonstrating its impact on actually reducing clinical variation is limited [7,8].…”