Delay in the induction of labour process: a retrospective cohort study and computer simulation of maternity unit workload

Abstract

ObjectivesDelay in the induction of labour (IOL) process is associated with poor patient experience and adverse perinatal outcome. Our objective was to identify factors associated with delay in the IOL process and develop interventions to reduce delay.Design and settingsWe performed a retrospective cohort study of maternity unit workload in a large UK district general hospital. Electronic hospital records were used to quantify delay in the IOL process and linear regression analysis was performed to assess significant associations between delay and potential causative factors. A novel computer maternity unit simulation model, MUMSIM (Maternity Unit Management SIMulation), was developed using real-world data and interventions were tested to identify those associated with a reduction in delay.ParticipantsAll women giving birth at Stoke Mandeville Hospital, Buckinghamshire National Health Service (NHS) Trust in 2018 (n=4932).Primary outcome measureDelay in the IOL process of more than 12 hours.ResultsThe retrospective analysis of real-world maternity unit workload showed 30% of women had IOL and of these, 33% were delayed >12 hours with 20% delayed >24 hours, 10% delayed >48 hours and 1.3% delayed >72 hours. Delay was significantly associated with the total number of labouring women (p=0.008) and the number of booked IOL (p=0.009) but not emergency IOL, spontaneously labouring women or staffing shortfall. The MUMSIM computer simulation predicted that changing from slow release 24-hour prostaglandin to 6-hour prostaglandin for primiparous women would reduce delay by 4% (p<0.0001) and that additional staffing interventions could significantly reduce delay up to 17.9% (p<0.0001).ConclusionsPlanned obstetric workload of booked IOL is associated with delay rather than the unpredictable workload of women in spontaneous labour or emergency IOL. We present a novel maternity unit computer simulation model, MUMSIM, which allows prediction of the impact of interventions to reduce delay.

Validação de escala para mensurar a carga de trabalho das parteiras

“…no noturno, são o acompanhamento fetal, o acompanhamento e a atuação em situações de emergência. Resultados consistentes com outros estudos (12,21) sugerem que as parteiras têm que avaliar e redefinir constantemente o modo de prestação de cuidados, pois a experiência do parto influencia não só a mulher, mas o seu companheiro, a relação com a criança e toda a família. Portanto, a importância da presença contínua da parteira durante o processo de parturi-ção.…”

“…O primeiro fator é referente ao aumento no número de processos agendados, como cesarianas eletivas, versões cefálicas externas e induções ao parto; isso é consistente com a atual pesquisa baseada em evidências. (21,(23)(24)(25) E o segundo fator depende do tipo de paciente atendida, como a etnia subamericana, as nulíparas e as mulheres que apresentam comorbidades médico-obstétricas. Esse aumento da carga de trabalho observado é consistente com os achados de outros estudos, (1,2,8,21,23) pois atualmente enfrentamos um aumento na atenção aos processos crônicos, gerados pelo aumento da gemelaridade, pelo aumento da idade materna, pelos nascimentos prematuros, bem como pelo aumento das técnicas de reprodução assistida.…”

Evidence on the use of Birthrate Plus® to guide safe staffing in maternity services – a systematic scoping review

“…Observational data showed no association between staffing shortfalls and delays in induction in labour, although a simulation model suggested that staffing interventions, including reducing shortfalls would reduce delay. [40] No other evidence of effects on quality of care or outcomes were found. We found no studies that addressed the costs or cost-effectiveness of using Birthrate Plus in relation to any outcome or quality measure or when compared to any ither approach to determining staffing requirements.…”

Timing of induction of labour in the prevention of prolonged pregnancy: Systematic review with meta‐analysis

“…[4][5][6][7][8] Women undergoing induction may also have a longer in-patient stay, with an additional cost to the National Health Service (NHS) of £600 per birth, compared to labours that start spontaneously. 9,10 It is, therefore, essential that any offer of medical intervention for prolonged pregnancy is evidence-based and has been shown to reduce the risk of adverse perinatal outcomes when compared to EM.…”

“…Research has highlighted women's poor experiences of the induction process, including long delays, increased need for pain relief, and lack of information, autonomy, and support 4–8 . Women undergoing induction may also have a longer in‐patient stay, with an additional cost to the National Health Service (NHS) of £600 per birth, compared to labours that start spontaneously 9,10 . It is, therefore, essential that any offer of medical intervention for prolonged pregnancy is evidence‐based and has been shown to reduce the risk of adverse perinatal outcomes when compared to EM.…”