Induction of labour: what do women think?

A German study has shown that women want more information and support with decision-making about induction of labour, especially when there is no good medical reason to do this (for instance in the case of routine induction for so-called ‘post-term’ pregnancy). The study also found that most women who experienced induction of labour would try to avoid it in a future pregnancy, and many would like to have information on alternative and complementary methods of induction of labour.

I’ve written loads about induction of labour, and it is one of the most searched-for topics on my website. You can find a page detailing the resources that I have available on post-term pregnancy and induction of labour here, and I’ve written recent blog posts detailing the ten things that I wish women knew about induction of labour (and that’s because I speak to so many women who feel like the ones in the study above) and how to cancel a labour induction, because it saddens me that, these days, some women don’t even realise that they have a choice.

In Your Own Time was written to help parents and professionals better understand the issues and the evidence relating to the current induction epidemic. Looks at the evidence relating to due dates, ‘post-term’, older and larger women, suspected big babies, maternal race and more.

I want to live in a world where women and their families are well-informed about the issues and about the pros and cons of interventions before they have to make decisions about whether these interventions are right for them. I know that lots of other people want that too, and they want to gain the knowledge and build the confidence to talk to others about these important issues.

I also know that one or two women will reply to this to say that they were really happy with their induction experience. That’s great. I am genuinely delighted that some women have a good experience. But too many don’t, as this latest research shows, and we need to do something about this.

Schwarz C, Gross MM, Heusser P et al (2016). Women’s perceptions of induction of labour outcomes: Results of an online-survey in Germany. Midwifery. DOI: http://dx.doi.org/10.1016/j.midw.2016.02.002

The Research

Objective: Induction of labour (IOL) is a common procedure in high income countries. It may be conducted for medical as well as non-medical reasons.Women’s views on induction of labour have not extensively been evaluated as yet. Also, women’s preferences for certain methods of induction including alternative and complementary methods need further exploration in order to meet their expectations and needs.

Design and setting: We published a short online questionnaire on women’s views and experiences with IOL.

Measurements and findings: We asked for indication and gestational age at induction; method of induction, duration of labour and mode of birth. We also asked for the extent of desired, and experienced support and participation in decision-making. Within four weeks of being online, 698 women answered the questionnaire. Most frequent reasons for induction were postmaturity (51.7%), doctor´s recommendation (31.6%) and medical complications (25.6%). Most women were induced with misoprostol or dinoprostone, but nearly half of the respondents were also offered, or asked for, complementary and alternative methods (CAM). 50% or more women would have preferred more information on alternatives to IOL, methods of IOL, side effects of the drugs, information on alternatives (59.2%) and on the medication (55.3%). Many would have wished for more support (49.9%) with decision-making (55.2%), and more time (54.1%).

Key conclusion: Women’s´ expectations and needs regarding IOL are widely unmet in current clinical practice.

Implications for practice: There is a need for evidence-based information and decisional support for pregnant women who need to decide how to proceed once term is reached.