The induction decision: what do women want?

What do women want when it comes to the induction decision? This month, one of the most interesting studies I spotted is on one of the most talked-about topics of the past year or two: induction of labour, and what women want.

I receive many messages and comments from women and others who feel that induction is (or was) not what they want. Often, women find that it’s hard to be heard. It’s also hard to get good information which isn’t coercive and fear-based. Many also find that it’s hard to say no to induction of labour. Those are just some of the reasons that I have an entire information hub on this topic. And why the recent research into post-term pregnancy and stillbirth is a key topic in Gathering in the Knowledge 2020.

The study is called, “What women want and why. Women’s preferences for induction of labour or expectant management in late-term pregnancy.” Carried out by researchers in The Netherlands, the study involved low-risk women with an uncomplicated pregnancy which had reached a gestational age of 41 weeks.

What do women want?

Here’s a summary of the key findings:

“Induction at 41 weeks was preferred by 44.7% (270/604) women, 42.1% (254/604) preferred expectant management until 42 weeks, while 12.2% (74/604) of women did not have a preference. Women preferring induction reported significantly more problems regarding quality of life and were more anxious than women preferring expectant management ( p < 0.001). Main reasons for preferring induction of labour were: “safe feeling” (41.2%), “pregnancy taking too long” (35.4%) and “knowing what to expect” (18.6%). For women preferring expectant management, the main reason was “wish to give birth as natural as possible” (80.3%).”

It is also key to remember the wider picture, of course. Another recent study has highlighted how almost a third of first-time mums who opt for induction are dissatisfied with their experiences. In some studies, that figure is even higher; this research showed that 57% of women who experienced an induced labour said they wouldn’t choose it again.

This isn’t a new finding, either. Older studies have also highlighted women’s dissatisfaction with induction. And many women say they wanted more information before they made their decision. Another important study showed that induction of labour is associated with avoidable harm. So a key question is to ask what we can do to help sort out this mismatch between the number of women who want induction and the number who will later regret or be harmed by that decision. Difficult stuff indeed.

This is a really complex area, and there’s lots of delve into here. That’s is exactly why I offer courses for those who want to learn about and practice digging into research. But we can learn even by just looking at one issue.

 

How research happens

Let’s explore, for instance, why we need to think about how research happens and what might influence the results rather than just taking the results as being a completely straightforward ‘snapshot’ of reality.

First, the women were self-selected; some declined to answer. Then, they had already been asked if they would agree to be in the INDEX trial, which means that they had already thought about this question. Some had declined to have the decision made by chance. But, unlike some previous studies on induction, which reported only the views of women who were happy to have the decision about whether they were induced or not left to chance (which suggests that, at the least, they didn’t mind induction and they may have had a preference for it), this study included at least some of the women who didn’t feel that way. That’s really positive. We always need to remember that there will be a few women, who may perhaps feel quite strongly, whose views won’t have been sought because they decided not to interact with the maternity care system at all, or to choose private midwifery care.

Why we need a pinch of salt

Having said all of that, I want to be clear that I’m not criticising the research itself, or the researchers. Because it’s incredibly difficult to know how to best design such a study to get the most accurate results. Are you, like many people, more likely to respond to one of the tens of emails you get every day which ask for your feedback if you’ve had a particularly good or poor experience? Yes? Well, so are the rest of us. Some types of research – or research questions – are more likely to attract people who have a strong preference for or against something, and we suspect that these are the people who are most likely to respond in studies like this one. So a pinch of salt is always needed, as is the ability to think critically about how research is designed and whether elements of the design might mean that we are more likely to see results that go in a particular direction.

You can see the research study that I’m talking about here: What women want and why. Women’s preferences for induction of labour or expectant management in late-term pregnancy. If you’d like to delve deeper into birth-related research and thinking, you’re always welcome to come and join me in Gathering in the Knowledge. Or sign up to my newsletter so that, like thousands of other people, you can get my research updates early, and straight to your email inbox.

Keulan JKJ, Nieuwkerk PT, Kortekaas JC et al (2020). What women want and why. Women’s preferences for induction of labour or expectant management in late-term pregnancy. Women and Birth DOI: https://doi.org/10.1016/j.wombi.2020.03.010

 

 

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