Evaluating the impact of the induction of labour improvement initiative on clinical outcomes, women’s care satisfaction, and clinician experiences

Background

Rates of induction of labour (IOL) continue to rise globally. Clinician recommendations for IOL vary and are often driven by uncertainty or risk aversion. Evidence suggests that improving guidelines and practices may support clinician IOL decision-making, and support women to make informed choices and have positive IOL experiences. An IOL improvement initiative, including evidence-based guidelines and an IOL Liaison Midwife, was implemented at an Australian maternity hospital.

Aims

To evaluate the outcomes of the IOL improvement initiative by examining clinical outcomes, compliance with new IOL guidelines, women’s care satisfaction, and clinicians’ experiences.

Methods

A multi-method evaluation including: a retrospective audit of medical records to determine rates and reasons for IOL pre/post-initiative (n = 2676), surveys (pre IOL, n = 100) and interviews (post-birth, n = 48) with women, and clinician focus groups or interviews (n = 23).

Findings

The IOL rate significantly reduced by 5 % post-implementation (43.3 % vs 38.6 %; p < 0.01). Indications for IOL also changed significantly, with fewer women being induced for reasons no longer being recommended in the new guidelines. The survey findings showed that over half of the women did not know why (54 %) or how (36 %) they would be having an IOL. Qualitative data indicated that discussions with the IOL Liaison Midwife improved women’s understanding and expectations of IOL. Clinician feedback highlighted the improved workflows and justification for IOL recommendations as a result of the initiative.

Conclusions

The initiative had a positive impact on IOL rates and reasons, and the experiences of women and clinicians. Implementation in other maternity settings is warranted.