Informed consent and induction of labour at term gestation
Research type
Research Study
Full title
Informed consent and induction of labour at term gestation: process and implications
IRAS ID
296491
Contact name
Soo Downe
Contact email
Sponsor organisation
University of Central Lancashire
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
2 years, 5 months, 31 days
Research summary
Research Summary:
Professional Doctorate in Health:
Title: "Informed consent and induction of labour at term: process and implications".
Phase 1 research question: "How are the principles of informed consent applied when induction of labour is discussed with pregnant people with a term pregnancy and what are the experiences for service users and practitioners"?
This will be explored via a systematic literature review (ethical approval not required).
Phase 2 research question: "How is informed consent discussed with maternity service users who are offered induction of labour at or beyond term gestation?"
This will be explored via an online questionnaire for maternity service users having conversations with practitioners re labour induction.
Phase 3 A research question: "What do postnatal service users say about communication with practitioners with regard to induction of labour at or beyond term gestation, the impact this had on their decisions about induction of labour and their subsequent birth experience?"
This will explored via interviews with postnatal service users who had discussion(s) with practitioners about induction of labour.
Phase 3 B research question: "What are midwives and obstetricians views and experiences of communication with maternity service users regarding induction of labour at or beyond term gestation."
This will be explored via interviews with obstetricians and midwives.
Phase 3 C research question: "What are midwives views on the impact of induction of labour on maternity service users birth experiences and the wider experiences for staff within the birth suite environment?"
This will be explored via a focus group with birth suite lead midwives.
The research is independent and original work that will produce new knowledge, since no previous study in this area has triangulated the perspectives of the current literature, the views of service users before and after birth and the views and experiences of midwives and obstetricians from the same Trust to produce a multi-dimensional view of the topic of interest.Lay summary of study results:
The study revealed that women were being induced for a variety of different reasons. These were reflective of the rise in diabetes and other medical complexities as well as the option for maternal request in the absence of any other rationale. In contrast to many other studies in this area, most of those responding to the questionnaire and taking part in the qualitative data collection, reported being happy to be offered induction. This may be because 85.2% of respondents (n=86) and all the service user interviewees were being induced for medical complications, rather than for uncomplicated pregnancies that proceeded beyond 41 week’s gestation. The questionnaire and interview findings highlighted that women use a variety of sources to obtain additional information including the induction of labour information leaflet, the internet, social media, partners, friends, and family. From a birth experience viewpoint, the interview findings highlighted that women’s retrospective views ranged between extremely positive to extremely negative. Although physical events involved with the induction process had a significant impact on women’s perceptions of induction of labour, relationships with health professionals were also an important factor. The study revealed the individual nature of each woman’s account of her experiences, and that overall perceptions of induction were affected by multiple factors, including women’s individual personalities as well as their expectations for induction. Despite women feeling overall well informed, the questionnaires and interview findings showed there were some gaps in women’s knowledge about various aspects of the induction of labour processes. The disparity between expectations of induction and reality highlighted that some of the women were not fully prepared for the duration, intensity, how they would experience induction and the potential implications of an induced labour. 5 from the interviews with health professionals, findings highlighted how protective steering may impact on obtaining informed consent, the nature of informed consent in current practice and how the health professional as ‘second victim’ may impact upon the informed consent process. Suggestions by health professionals for improvements to assist with informed consent highlighted the need for more information on various aspects of the induction of labour processes during the antenatal period when discussing induction. These included statistics associated with risk and also accessibility of information and guidance to share with women, particularly in the community setting. Continuity of carer, improved hospital resources to meet demand, accessible information for more marginalised women and for staff in all settings, antenatal education about induction, birth choices/pre induction of labour clinics, staff education, and induction consent forms detailing risks and benefits were all noted by health professionals as having the potential to improve informed consent. Suggestions such as innovations around outpatient induction and balloon induction of labour were proposed. These have been discussed to mitigate some of the disconnect between expectation and experience. However, there are gaps in the scientific evidence about the acceptability, equity, feasibility, and efficacy of these approaches. Overall, the study highlighted the scope available for improvements to the informed consent provision for induction of labour for women being offered induction for medical complications, to take account of how it might be experienced and how long it may take, and to acknowledge the environment in which it takes place, including how staff experience the rising rates of labour induction on their workload and capacity to provide optimal care.
The PRD pass result was confirmed at the end of March. The university are due to publish the thesis to their central research repository ‘CLOK’ in due course. This will involve minting a DOI unique identifier.REC name
London - Brighton & Sussex Research Ethics Committee
REC reference
21/PR/1583
Date of REC Opinion
22 Dec 2021
REC opinion
Favourable Opinion