Induction of labour care in the UK: A cross-sectional survey of maternity units

UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) Members

doi:10.1371/journal.pone.0297857

Induction of labour care in the UK: A cross-sectional survey of maternity units

UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) Members

Applied Health Research

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives: To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice.

Design: National survey.

Setting: Hospital maternity services in all four nations of the UK.

Sample: Convenience sample of 71 UK maternity units.

Methods: An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher’s Exact and ANOVA.

Main outcome measures: Induction rates, criteria, processes, delays, incidents, safety concerns. Results: 54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported ‘often/always’ in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 ‘often/always’). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work.

Conclusions: There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.

Original language	English
Article number	e0297857
Number of pages	13
Journal	PLoS ONE
Volume	19
Issue number	2
DOIs	https://doi.org/10.1371/journal.pone.0297857
Publication status	Published - 28 Feb 2024

Bibliographical note

Funding: SK, BT, FCS were funded by the National Institute for Health Research (NIHR) grant 970014 through the Applied Research Collaborative (ARC) West Midlands (Maternity Theme) programme. SK is also an NIHR Senior Investigator. https://www.nihr.ac.uk/explore-nihr/support/collaborating-in-applied-health-research.htm MPR is funded by an MRC Centre for Reproductive Health Grant (MR/N022556/1). https://www.ed.ac.uk/centre-reproductive-health The views expressed are those of the authors and not necessarily of the NHS, the NIHR, MRC, or the Department of Health. The funders had no involvement in the study design; in the collection, analysis, interpretation of data; in the writing of the report; or in the decision to submit the article for publication, or in the preparation of the manuscript.

Keywords

Pregnancy
Humans
Female
Cross-Sectional Studies
State Medicine
Obstetrics
Labor, Induced
United Kingdom

Access to Document

10.1371/journal.pone.0297857Licence: Creative Commons: Attribution (CC BY)

TaylorB2024InductionFinal published version, 531 KBLicence: Creative Commons: Attribution (CC BY)

ARC - Theme 4 Maternity
Kenyon, S.
NIHR CENTRAL COMMISSIONING FACILITY
1/10/19 → 30/09/24
Project: Other Government Departments

Cite this

@article{ce957b803dfa44f38ce75ef883057246,

title = "Induction of labour care in the UK: A cross-sectional survey of maternity units",

abstract = "Objectives: To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice. Design: National survey. Setting: Hospital maternity services in all four nations of the UK. Sample: Convenience sample of 71 UK maternity units. Methods: An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher{\textquoteright}s Exact and ANOVA. Main outcome measures: Induction rates, criteria, processes, delays, incidents, safety concerns. Results: 54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported {\textquoteleft}often/always{\textquoteright} in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 {\textquoteleft}often/always{\textquoteright}). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work. Conclusions: There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.",

keywords = "Pregnancy, Humans, Female, Cross-Sectional Studies, State Medicine, Obstetrics, Labor, Induced, United Kingdom",

author = "{UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) Members} and Beck Taylor and Fiona Cross-Sudworth and Michael Rimmer and Laura Quinn and Morris, {R. Katie} and Tracey Johnston and Sharon Morad and Louisa Davidson and Sara Kenyon",

note = "Funding: SK, BT, FCS were funded by the National Institute for Health Research (NIHR) grant 970014 through the Applied Research Collaborative (ARC) West Midlands (Maternity Theme) programme. SK is also an NIHR Senior Investigator. https://www.nihr.ac.uk/explore-nihr/support/collaborating-in-applied-health-research.htm MPR is funded by an MRC Centre for Reproductive Health Grant (MR/N022556/1). https://www.ed.ac.uk/centre-reproductive-health The views expressed are those of the authors and not necessarily of the NHS, the NIHR, MRC, or the Department of Health. The funders had no involvement in the study design; in the collection, analysis, interpretation of data; in the writing of the report; or in the decision to submit the article for publication, or in the preparation of the manuscript.",

year = "2024",

month = feb,

day = "28",

doi = "10.1371/journal.pone.0297857",

language = "English",

volume = "19",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science (PLOS)",

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T1 - Induction of labour care in the UK

T2 - A cross-sectional survey of maternity units

AU - UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) Members

AU - Taylor, Beck

AU - Cross-Sudworth, Fiona

AU - Rimmer, Michael

AU - Quinn, Laura

AU - Morris, R. Katie

AU - Johnston, Tracey

AU - Morad, Sharon

AU - Davidson, Louisa

AU - Kenyon, Sara

N1 - Funding: SK, BT, FCS were funded by the National Institute for Health Research (NIHR) grant 970014 through the Applied Research Collaborative (ARC) West Midlands (Maternity Theme) programme. SK is also an NIHR Senior Investigator. https://www.nihr.ac.uk/explore-nihr/support/collaborating-in-applied-health-research.htm MPR is funded by an MRC Centre for Reproductive Health Grant (MR/N022556/1). https://www.ed.ac.uk/centre-reproductive-health The views expressed are those of the authors and not necessarily of the NHS, the NIHR, MRC, or the Department of Health. The funders had no involvement in the study design; in the collection, analysis, interpretation of data; in the writing of the report; or in the decision to submit the article for publication, or in the preparation of the manuscript.

PY - 2024/2/28

Y1 - 2024/2/28

N2 - Objectives: To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice. Design: National survey. Setting: Hospital maternity services in all four nations of the UK. Sample: Convenience sample of 71 UK maternity units. Methods: An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher’s Exact and ANOVA. Main outcome measures: Induction rates, criteria, processes, delays, incidents, safety concerns. Results: 54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported ‘often/always’ in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 ‘often/always’). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work. Conclusions: There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.

AB - Objectives: To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice. Design: National survey. Setting: Hospital maternity services in all four nations of the UK. Sample: Convenience sample of 71 UK maternity units. Methods: An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher’s Exact and ANOVA. Main outcome measures: Induction rates, criteria, processes, delays, incidents, safety concerns. Results: 54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported ‘often/always’ in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 ‘often/always’). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work. Conclusions: There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.

KW - Pregnancy

KW - Humans

KW - Female

KW - Cross-Sectional Studies

KW - State Medicine

KW - Obstetrics

KW - Labor, Induced

KW - United Kingdom

U2 - 10.1371/journal.pone.0297857

DO - 10.1371/journal.pone.0297857

M3 - Article

C2 - 38416750

SN - 1932-6203

VL - 19

JO - PLoS ONE

JF - PLoS ONE

IS - 2

M1 - e0297857

ER -

Induction of labour care in the UK: A cross-sectional survey of maternity units

Abstract

Bibliographical note

Keywords

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Projects

ARC - Theme 4 Maternity

Cite this