Labor induction information leaflets-Do women receive evidence-based information about the benefits and harms of labor induction?

Peter von Dadelszen; Susan Tohill; Julie Wade; Jennifer A Hutcheon; Janet Scott; Marcus Green; James G Thornton; Laura A Magee; WILL Pilot Trial Study Group

doi:10.3389/fgwh.2022.936770

Labor induction information leaflets-Do women receive evidence-based information about the benefits and harms of labor induction?

Front Glob Womens Health. 2022 Nov 21:3:936770. doi: 10.3389/fgwh.2022.936770. eCollection 2022.

Authors

Peter von Dadelszen^{1

2}, Susan Tohill³, Julie Wade³, Jennifer A Hutcheon², Janet Scott⁴, Marcus Green⁵, James G Thornton⁶, Laura A Magee^{1

2}; WILL Pilot Trial Study Group

Affiliations

¹ Institute of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
² Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
³ Maternity Services, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
⁴ Sands, The Stillbirth and Neonatal Death Charity, London, United Kingdom.
⁵ Action on Pre-eclampsia, Evesham, United Kingdom.
⁶ Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham, United Kingdom.

Abstract

Objectives: To determine the extent to which a sample of NHS labor induction leaflets reflects evidence on labor induction.

Setting: Audit of labor induction patient information leaflets-local from WILL trial (When to Induce Labor to Limit risk in pregnancy hypertension) internal pilot sites or national-level available online.

Methods: Descriptive analysis [n = 21 leaflets, 19 (one shared) in 20 WILL internal pilot sites and 2 NHS online] according to NHS "Protocol on the Production of Patient Information" criteria: general information (including indications), why and how induction is offered (including success and alternatives), and potential benefits and harms.

Results: All leaflets described an induction indication. Most leaflets (n = 18) mentioned induction location and 16 the potential for delays due to delivery suite workloads and competing clinical priorities. While 19 leaflets discussed membrane sweeping (17 as an induction alternative), only 4 leaflets mentioned balloon catheter as another mechanical method. Induction success (onset of active labor) was presented by a minority of leaflets (n = 7, 33%), as "frequent" or in the "majority", with "rare" or "occasional" failures. Benefits, harms and outcomes following induction were not compared with expectant care, but rather with spontaneous labor, such as for pain (n = 14, with nine stating more pain with induction). Potential benefits of induction were seldom described [n = 7; including avoiding stillbirth (n = 4)], but deemed to be likely. No leaflet stated vaginal birth was more likely following induction, but most stated Cesarean was not increased (n = 12); one leaflet stated that Cesarean risks were increased following induction. Women's satisfaction was rarely presented (n = 2).

Conclusion: Information provided to pregnant women regarding labor induction could be improved to better reflect women's choice between induction and expectant care, and the evidence upon which treatment recommendations are based. A multiple stakeholder-involved and evidence-informed process to update guidance is required.

Keywords: Morecombe Bay Report; Ockenden Report; evidence-to-implementation gap; labor induction; patient information.