Women‘s experiences of postterm induction of labor: A systematic review of qualitative studies

Abstract

Background: Over the last decade, induction of labor (IOL) in postterm pregnancies has increased. Studies have shown the medical advantages of postterm IOL, but less is known about the perspectives of the pregnant women. This review aimed to summarize the current qualitative evidence on women's experience of postterm IOL. Methods: A systematic literature search was performed in three databases. A total of 3193 publications were identified, but only eight studies met the inclusion criteria.Thematic analysis guided the data extraction and synthesis. The Confidence in the Evidence for Reviews of Qualitative research (CERQual) approach was used to assess confidence in the findings. Results: Three major findings were identified. First, for some women, IOL required a shift in expectations because the hope of spontaneous labor had to be given up.Second, the IOL decision was considered a recommendation from health care professionals and was experienced as a nondecision. Finally, the induction process was experienced as a sequential set of steps where the women were expected to fit into the existing hospital organization. The CERQual assessment suggested moderate confidence in all findings. Discussion: The negative experiences identified in this review can be greatly reduced by a communicative and patient-centered approach. To support informed choice and shared decision making, women need high-quality, unbiased information about IOL, alternative options, and potential outcomes, in addition to time for reflection on their personal values and preferences. Women may need a professionally initiated and supported opportunity to re-evaluate their hopes and expectations before IOL. K E Y W O R D Sexperience, induction of labor, postterm pregnancy, qualitative research, systematic review

Response to ‘Induction of labour at 39 weeks should be routinely offered to low‐risk women’

“…That said, the ARRIVE trial did measure women’s feelings of personal control in childbirth with the Labor Agentry Scale, and found higher levels of control in the induction group (168, interquartile range (IQR) 148–183) compared with the expectant management group (164, IQR 143–181). However, these findings do not match those from the systematic reviews …”

“…We have concerns about a woman’s feelings of choice if IOL is routinely offered to low‐risk women at 39 weeks. A recent systematic review of qualitative and mixed‐method studies on women’s experiences of post‐term IOL found one of the major themes is that many women experienced IOL to be a ‘nondecision’, that is, the decision was presented as the next step in the process with little opportunity for discussion . A broader review of both quantitative and qualitative research on experiences of IOL, and more specifically the decision‐making around it, concluded that ‘women’s expectations and preferences are largely unmet in current clinical practice’ with the decision‐making mainly informed by the clinician’s attitude .…”

The impact of obstetric interventions and complications on women’s satisfaction with childbirth - a population based cohort study including 16000 women.

“…However, a recent systematic review of qualitative studies conclude that the experiences of women with induced labor can likely be improved by supporting their informed choice and shared decision making, by giving high-quality, unbiased information about IOL, alternative options, and potential outcomes [32] The present study has certain strengths. To our knowledge, this study has the largest number of women by the time of date compared to previous studies in the same field, which gave the study sufficient power to evaluate satisfaction with childbirth according to labor characteristics.…”

Maternal Perceptions of the Experience of Attempted Labor Induction and Medically Elective Inductions: Analysis of Survey Results from Listening to Mothers in California

“…12 Studies that have examined women's experiences have been relatively small, in-depth qualitative studies, [12][13][14] relied on survey data [15][16][17] or synthesized multiple qualitative studies. [18][19][20] A common finding has been varying levels of dissatisfaction among mothers concerning their experience of induction. Concerns expressed included a lack of information concerning the process they were about to undertake, 13,19 frustration with the multiple delays involved in waiting for an induction, 17 a sense of a loss of control in a process that they felt was done to them rather than with them, 14 and a sense of being placed on someone else's timetable.…”

“…Concerns expressed included a lack of information concerning the process they were about to undertake, 13,19 frustration with the multiple delays involved in waiting for an induction, 17 a sense of a loss of control in a process that they felt was done to them rather than with them, 14 and a sense of being placed on someone else's timetable. 13,20 There were also concerns with the lack of informed, shared decision-making [18][19][20] and a sense of being pressured to have an induction. 15 A distinction has been made between medically indicated inductions and those not based on medical need, 21 with Laughon et al reporting one third of first time mothers and nearly half of multiparas having inductions for no recorded indication.…”