Rates of induced labour must be reconsidered amid maternity staffing crisis, study shows

A new study has warned that increasing rates of induction of labour of pregnant women and people in the UK, without considering the impact on staffing workloads and patient care, may have unintended consequences.

The study, from City University in London, the University of Edinburgh and others, highlights the limited evidence around the delivery of home-based induction of labour (IOL services), which were seen as an important step to reducing maternity staff workload.

It finds large gaps in knowledge on how to deliver home-based care, with workload perceived to have increased in some cases compared to hospital-based services.

Around a third of pregnant women and people underwent IOL in the UK in 2021. Rates have surged in recent years due to new evidence on safety and efficacy, and vary considerably between maternity services, with some rates as high as 50%.

IOL, or starting labour artificially, is offered when the risks of the pregnancy continuing are believed to outweigh the risks of artificially starting labour. For those deemed at lower risk, maternity services are offering this as an ‘outpatient’ service where the woman returns home in the first stage of induction, despite limited evidence on its acceptability to pregnant women, birth partners and maternity staff, and how different approaches work in practice.

The current study explored IOL from the perspectives of 73 clinicians, including 49 midwives, 22 obstetricians and two other maternity staff from five maternity services across the UK. It investigated the recommended first stage of induction known as ‘cervical ripening’ (CR) and the option of the pregnant person to return home from hospital during that process.

CR is either the use of topical medication or mechanical means to help dilate the pregnant person’s cervix. Following this first stage, further steps are generally necessary to stimulate the onset of labour.

In the study, clinicians were either interviewed directly by the researchers or took part in focus groups to elicit their views, which then formed part of a thematic analysis to reveal common themes in their responses.

A wide range of practices and views regarding induction were recorded, suggesting that the integration of home CR into care is far from straightforward, and demonstrating that whether provided at hospital or home, IOL care is complex and represents a significant workload to maternity services staff.

Professor Christine McCourt, who leads the Centre for Maternal and Child Health Research at City University, co-authored the study. She said: ‘This study shows that well-intentioned interventions may have unintended consequences for quality of care and staff workload. Efforts are needed to target induction of labour effectively and ensure genuine informed choice; meanwhile, maternity services must be adequately resourced to ensure safe care.’

Image: Anna Hecker