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A qualitative study of women’s experiences of labour induction

Annabel Jay Senior Lecturer

(Midwifery)University of Hertfordshire

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Why Study Induction?• Much medical research, but women’s experiences poorly

explored in recent years• Seminal work of Cartwright in 1970s

- women lacked information, choice and control• BUT IOL remains a major source of verbal and written

complaints in some NHS Maternity Units.• Verbal evidence suggests large discrepancies between

women’s expectations of induction and the realities they experience

Has anything changed since the 1970s?

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According to the NICE guideline...“Women who are having or being offered induction of labour

should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals” (NICE 2008 p4).

Healthcare professionals should:• Allow women time to discuss induction before deciding.• Encourage women to explore other sources of information. • Encourage women to ask questions and consider various

options • Support the woman whatever her final decision. (NICE,

2008)

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What the literature says• Shetty, Burt et al (2005)

– Need for more information and involvement in decision-making

• Westfall & Benoit (2004), Gatward & Simpson (2007) -need for better information and choice

• Rice-Simpson, Newman et al, (2010), Gatward and Simpson (2007)– Suggest that targeted education (for planned IOL) may

improve women’s experience by enabling adjustment of expectations

• NICE (2008), Gulmezoglu, Crowther et al, (2006)– Call for more research into women’s experiences of IOL

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Research questions:• How do women expecting their first baby acquire

knowledge about induction?

• How does this impact on their decision making?

• How do does this affect their subsequent experience of labour, birthing and early parenthood?

• How does targeted antenatal preparation for IOL affect women’s experience and perception of induction?

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Methodology and sample• Situated within the context of current discourse

on informed choice• 30 women

– Aim: approx 50% from pre-induction class• Broadly phenomenological approach; semi-

structured, face to face interviews.• First-time mothers• Over 18 years of age and able to give informed

consent• Able to speak, understand and read English

without assistance

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Plan of investigation• Women approached on PN ward or IOL class• Information given, permission to contact sought• Contacted 3-4 weeks postnatally• Face to face, semi-structured interviews

conducted in women’s homes• Audio recorded and transcribed • Complete anonymity assured• Full REC and R & D approval received

May/June 2012

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Ethical issues• Gaining access to participants• Access to records• Personal stance

– Midwife, mother, teacher, researcher• Role conflict• Responding to difficult situations• Disengaging

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Early themes• Unexpectedly high rate of CS

• Limited perception of choice– Acceptance of standard care plan– Not always negative

• Unprepared for delays– Boredom, anxiety, fear (including

partners)– Exhaustion through lack of sleep

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Early themes• Need for specific information at time of

induction– Poor coverage in local AN classes– Most information from media & friends– Fear of knowing too much in advance

• IOL gives sense of control over labour – Faith in clinical staff– Fear of natural birth?

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What women have said...

“I have to do what’s right for

the baby”

”I need a little handout to say “this will happen now...this will happen next”...I need a little flowchart!”

“We sat around for the whole

day”

“..no...didn’t sleep at all (in)

24 hours”

“It was a big relief to know it was all being controlled”

“..I just thought that was the way

it went!”

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Where to now?• Continue data collection• Commence formal analysis

– Thematic induction– NVIVO9

• Access medical records to add further layer of data

• Consider alternative ways of gaining access to women from pre-IOL class