Leads: Prof Sara Kenyon, Dr Beck Taylor (Maternity), Dr Laura Quinn (Meths)

Throughout the project, the team are working in partnership with public contributors linked to ARC WM's Maternity theme.

Dates: Summer/autumn 2021 – end 2022

Background:

The numbers of women undergoing induction of labour (IOL) is steadily increasing with current estimates suggesting that overall 33% of women in England underwent induction of labour in 2019 to 2020 from 20% of all births in 2007 to 2008 (https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2019-20). The increasing number of women undergoing IOL presents an escalating logistical problem for maternity services. The survey was undertaken through the UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG Link opens in a new windowLink opens in a new window), which was established in 2014. It is a network of trainee/ junior doctors that work jointly on large audit and research projects in the field of obstetrics and gynaecology (O&G) throughout the UK. Their overall objectives are to engage the network of UK trainees to undertake audit and research projects; improve healthcare service locally and nationally; perform joint nationwide audit and research projects and through the completion and publication of their audit and research projects, they aim to improve medical practice and thus the quality of women’s health care.

Policy and Practice Partners:

UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG).

A summary of the results is below and the study has been presented as a poster and a workshop at the British Intrapartum Care Society (BICS) meeting in September 2022, and an oral presentation at British Maternal and Fetal Medicine Society (BMFMS) in November 2022. The manuscript is being prepared for publication.

Objectives To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice.

Design National survey.

Setting UK hospital maternity services.

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). Median induction rate 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%) but rarely resulted in harm (6%, 3/54). 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.

Implications for implementation As a result of the interest generated a national meeting is being facilitated in January 2023 to a start to bring together the quality improvement work undertaken locally in an attempt to reduce variation in practice across the UK through the development and implementation of standardised guidance and pathways.