Abstract
Background
Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK.
Method
We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach.
Findings
Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women’s response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women.
Conclusions
The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.
Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK.
Method
We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach.
Findings
Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women’s response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women.
Conclusions
The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.
| Original language | English |
|---|---|
| Article number | 310 |
| Number of pages | 8 |
| Journal | BMC Pregnancy and Childbirth |
| Volume | 21 |
| Issue number | 1 |
| Early online date | 19 Apr 2021 |
| DOIs | |
| Publication status | Published - 19 Apr 2021 |
Bibliographical note
AcknowledgementsThanks are due to the staff who completed the survey. The authors would also like to thank the CHOICE Study Team: Dr. Amarnath Bhide, Consultant Obstetrician, St George’s University Hospitals Trust; Miss Dikshyanta Rana, Research Assistant, University of Glasgow; Professor Julia Sanders, Professor of Clinical Nursing & Midwifery, Cardiff University; Miss Neelam Heera, Patient and Public Involvement Representative; Mrs. Jane Huddleston, Patient and Public Involvement Representative; Professor Fiona Denison, Reader/Honorary Consultant in Maternal and Fetal Medicine, University of Edinburgh; Professor Neena Modi, Professor of Neonatal Medicine, Imperial College London; Professor John Norrie, Professor of Medical Statistics and Trial Methodology / Director of Edinburgh Clinical Trials Unit / Co-Head of Centre for Population Health Sciences, University of Edinburgh.
Funding
CHOICE is funded by the National Institute of Healthcare Research Health Technology and Assessment (NIHR HTA) NIHR 127569. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Keywords
- Induction of labour
- cervical ripening
- COVID-19
- Choice