Newswise — A recent study proposes that the potential consequences of raising rates of induction of labour (IOL) for expectant individuals in the UK, without adequately assessing the effect on staffing and patient care, could be unforeseen.
The research conducted by City, University of London, the University of Edinburgh, and other institutions emphasizes the insufficient evidence regarding home-based induction of labor (IOL) services. These services were considered a crucial measure in alleviating the workload of maternity staff.
The study identifies significant knowledge gaps concerning the implementation of home-based care, particularly in relation to the workload, which in certain instances was found to be higher compared to hospital-based services.
In 2021, approximately one-third of pregnant women and individuals in the UK underwent induction of labor (IOL). The rates have significantly increased in recent years, driven by emerging evidence supporting its safety and effectiveness. However, there is substantial variation in IOL rates among different maternity services, with some facilities reporting rates as high as fifty percent.
Nevertheless, a recent survey conducted by the Royal College of Midwives (RCM) highlighted a concerning trend. It revealed that senior midwives in the UK heavily rely on the voluntary efforts of staff working additional hours to maintain safe services. This comes at a time when staff retention and recruitment rates have reached a critical level described as a "boiling point" by the RCM.
According to the Royal College of Midwives (RCM), midwives are leaving their profession due to multiple factors. One major reason is their inability to provide the desired quality of care, primarily caused by declining pay rates. Additionally, midwives are experiencing exhaustion, emotional fragility, and burnout, further contributing to their decision to leave the profession.
Induction of labor (IOL), which involves initiating labor artificially, is provided when the potential risks of continuing the pregnancy are considered greater than the risks associated with inducing labor. In cases where individuals are deemed to be at lower risk, maternity services are offering an "outpatient" IOL service. This approach involves the woman returning home during the initial stage of induction. However, there is limited evidence regarding the acceptability of this approach to pregnant women, birth partners, and maternity staff, as well as how various methods of outpatient induction work in practical terms.
The recent study examined the experiences and perspectives of 73 clinicians, including 49 midwives, 22 obstetricians, and two other maternity staff members. These participants were from five different maternity services throughout the UK. The focus of the study was on the initial stage of induction known as "cervical ripening" (CR) and the possibility for pregnant individuals to return home from the hospital during this process. The study aimed to shed light on these aspects of induction of labor and gather insights from the clinicians' point of view.
The process of cervical ripening (CR) involves utilizing either topical medication (prostaglandin) or mechanical methods (such as a balloon catheter or osmotic dilator) to aid in the dilation of the cervix for pregnant individuals. After this initial stage, additional measures are typically required to induce labor and initiate the onset of active contractions.
In the study, researchers employed a combination of direct interviews and focus groups to gather the perspectives of clinicians. These interactions were aimed at eliciting their views and opinions on the subject matter. The collected data underwent a thematic analysis, where common themes and patterns were identified and examined to provide a comprehensive understanding of the clinicians' responses. This methodology allowed for a thorough exploration of the shared perspectives within the study cohort.
The study documented a diverse array of practices and viewpoints concerning induction of labor (IOL), indicating that the integration of home cervical ripening (CR) into care is not a straightforward process. It highlights the complexity of IOL care, whether it is provided in a hospital or home setting. Additionally, the study underscores that IOL care places a substantial workload on maternity services staff, further emphasizing the challenges associated with its implementation and management.
This study closely follows another related research effort that surveyed 309 women in the UK who had undergone induction of labor (IOL). The findings from this sister study, which was published earlier this month, revealed that the women reported receiving inadequate information about IOL and experienced consistent delays throughout the care pathway. These delays were widely attributed to staffing shortages, according to the participants. The results of this study align with the current research, further highlighting the challenges and issues surrounding IOL and the impact of staffing shortages on the overall care experience for pregnant individuals.
Professor Christine McCourt, who heads the Centre for Maternal and Child Health Research at City, University of London and co-authored the study, shared her perspective on the findings.
Professor Christine McCourt, co-author of the study and head of the Centre for Maternal and Child Health Research at City, University of London, expressed her interpretation of the study's findings. She emphasized that although interventions like induction of labor may have good intentions, they can have unintended consequences for both the quality of care provided and the workload of staff members. To address these issues, she called for targeted and effective approaches to induction of labor, including the promotion of genuine informed choice. Additionally, she emphasized the importance of adequately resourcing maternity services to ensure the provision of safe care.
The study is published online in the journal, PLOS ONE.
ENDS
City, University of London
- City, University of London is a global higher education institution committed to academic excellence, with a focus on business and the professions and an enviable central London location.
- City’s academic range is broadly-based with world-leading strengths in business; law; health sciences; mathematics; computer science; engineering; social sciences; and the arts including journalism and music.
- City has around 20,000 students (46% at postgraduate level) from more than 160 countries and staff from over 75 countries.
- In the last REF, City doubled the proportion of its total academic staff producing world-leading or internationally excellent research.
- More than 140,000 former students from over 180 countries are members of the City Alumni Network.
- The University’s history dates from 1894, with the foundation of the Northampton Institute on what is now the main part of City’s campus. In 1966, City was granted University status by Royal Charter and the Lord Mayor of London became its Chancellor. In September 2016, City joined the University of London and HRH the Princess Royal became City’s Chancellor.
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