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

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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 languageEnglish
Article numbere0297857
Number of pages13
JournalPLoS ONE
Volume19
Issue number2
DOIs
Publication statusPublished - 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

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