Women's perceptions, expectations and satisfaction with induced labour - A questionnaire-based study

Objectives: To evaluate the understanding and expectations of women undergoing tabour induction, to assess their actual experience of the process, and to compare their satisfaction with tabour to those labouring spontaneously.

Study design: Four hundred and fifty women at term undergoing induction of tabour and cervical ripening with prostaglandinE2 vaginal tablets and 450 women labouring spontaneously were recruited into the study. The induction group were requested to complete a questionnaire prior to the start of their induction process and another questionnaire post-delivery. The post-delivery questionnaire contained two sections, one pertaining to issues to do with the induction and the second with the actual tabour process. The spontaneously labouring group was requested to complete a questionnaire post-delivery, which only contained the section pertaining to the actual tabour process. The main outcome measures were satisfaction with tabour, perception of pain and length of tabour between the induced and spontaneous tabour groups, and issues that the women might wish changed about their induction.

Results: In the induction group, 34.7% were not satisfied with the information they received about the induction prior to the procedure and 27.2% expected to deliver within 12 h of the administration of the inducing agent. Post-induction, 40% of the women felt the most important aspect they would like to change about their induction were they to have another one, would be the speed of the induction, 13.6% felt they might wish to take the inducing agent orally, 7% to have fewer vaginal examinations and 9% to have fewer complications. Among the women who returned questionnaires, 26.3% had a caesarean delivery in the induction group and 21.4% in the spontaneous tabour group. Significantly more women were satisfied with their tabour in the spontaneous tabour group 79.5% versus 70.4%, RR 0.89, 95% CI 0.8-0.96, P = 0.006).

Conclusions: Labour that is artificially induced does result in lower satisfaction rates as compared to that following spontaneous onset. The longer time delay between the start of the induction and the delivery plays a significant part in this, with the mode of administration of the inducing agent, more vaginal examinations and the increase in caesarean deliveries being perceived as secondary issues. There is a need to improve the information provided to women undergoing tabour induction, to counter unrealistic expectations and thereby improve satisfaction. (C) 2005 Elsevier Ireland Ltd. All rights reserved.