Offering women a choice in induction of labour: a prospective cohort study

Abstract

To evaluate women's choice in the method of labour induction between oral misoprostol, PGE2 pessary and the Foley catheter. To compare women's satisfaction according to their choice and to identify factors associated with patient satisfaction. MethodsWe conducted a comparative, prospective cohort study of 520 women who chose their preferred method for labour induction, in a French tertiary hospital, from July 2019 to October 2020. Before and after the delivery, they were asked to argument their choice and to evaluate their satisfaction through the use of questionnaires. The primary outcome was global level of satisfaction. ResultsOf the 520 women included, 67,5% of women chose oral Misoprostol compared to 21% PGE2 pessary and 11.5% the Foley catheter. Regarding global satisfaction, we found no signi cant difference between the three groups: 78,4%, 68,8% and 71,2% (p = 0,091) for respectively oral misoprostol, PGE2 pessary and the Foley catheter. Factors that seem to improve women's satisfaction were nulliparity (OR = 2.03, 95%CI[1.19-3.53]), delivery within 24 hours after the start of induction (OR = 3.46, 95%CI. [2.02-6.14]) and adequate information (OR = 4.21,). Factors associated with lower satisfaction rates were postpartum hemorrhage (OR = 0.51, 95%CI [0.30-0.88]) and caesarean section (OR = 0.31, 95%CI [0.17-0.54]). ConclusionWomen satisfaction rates were not different between the three methods, when chosen by the patients themselves. These nding should encourage caregivers to promote shared decision making when possible.

Patient Perspectives on Outpatient versus Inpatient Cervical Ripening for Induction of Labor

“…Consistent with our findings, previously published studies have found a high degree of patient satisfaction regardless of cervical ripening setting. 19,[21][22][23][24] One study noted that although satisfaction was less for outpatients, patients in that group would opt for the same method and setting in subsequent pregnancies. 25 This discrepancy may relate to the finding that cervical ripening has been associated with a less positive experience of childbirth, regardless of method or setting.…”

“…25 This discrepancy may relate to the finding that cervical ripening has been associated with a less positive experience of childbirth, regardless of method or setting. 18,19,23,26 Qualitative feedback from participants provides a richer understanding of patients' behaviors during cervical ripening. Similar to the themes highlighted by our outpatients, Coates et al reported key themes of "ownership of induction of labor" and "importance of place" in patients undergoing outpatient cervical ripening.…”

“…The areas highlighted by our patients for improvement efforts and future research, most notably pain management strategies and clear expectations through education, are consistent with those reported by others. 18,19,23,26 Continued scholarly work should be undertaken to address these opportunities.…”

Factors of Non-Compliance with a Protocol for Oral Administration of Misoprostol (Angusta®) 25 Micrograms to Induce Labor: An Observational Study

“…More than 80% of patients were satisfied with oral inductions, and 64% of patients stated that they would prefer to have the inducing agent given orally if they were to have another induction [ 10 ]. A French prospective cohort study of 520 women who chose their preferred method for labour induction showed that 67.5% of women chose oral misoprostol compared to 21% who chose a PGE2 pessary and 11.5% who chose a Foley catheter [ 11 ].…”

Women satisfaction on choosing the cervical ripening method: Oral misoprostol versus balloon catheter

“…However, data in the literature on women t satisfaction during induction of labor are scanty [13] , [14] , [15] . Few of them compare different methods of cervical ripening, with satisfaction as secondary outcome [16] , or by evaluating not only the induction but the whole childbirth [17] , [18] .…”