Clinicians' perspectives and experiences of providing cervical ripening at home or in-hospital in the United Kingdom

Induction of labour, or starting labour artificially, is offered when the risks of continuing pregnancy are believed to outweigh the risks of the baby being born. In the United Kingdom, cervical ripening is recommended as the first stage of induction. Increasingly, maternity services are offering th...

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Published in:PloS one 2023-05, Vol.18 (5), p.e0284818-e0284818
Main Authors: Yuill, Cassandra, Harkness, Mairi, Wallace, Chlorice, Cheyne, Helen, Black, Mairead, Modi, Neena, Pasupathy, Dharmintra, Sanders, Julia, Stock, Sarah J, McCourt, Christine
Format: Article
Language:English
Subjects:
Biology and Life Sciences
Case studies
Cervical Ripening
Complications and side effects
Coronaviruses
COVID-19
Data collection
Engineering and Technology
Female
Focus groups
Health aspects
Health risks
Hospitals
Humans
Labor, Induced
Maternal child nursing
Medical personnel
Medicine and Health Sciences
Midwifery
Midwives
Outpatients
Oxytocics
People and Places
Pregnancy
Pregnant women
Professional ethics
Research ethics
Ripening
Womens health
Workload
Workloads
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creator Yuill, Cassandra
Harkness, Mairi
Wallace, Chlorice
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Stock, Sarah J
McCourt, Christine
description Induction of labour, or starting labour artificially, is offered when the risks of continuing pregnancy are believed to outweigh the risks of the baby being born. In the United Kingdom, cervical ripening is recommended as the first stage of induction. Increasingly, maternity services are offering this outpatient or 'at home', despite limited evidence on its acceptability and how different approaches to cervical ripening work in practice. There is also a paucity of literature on clinicians' experiences of providing induction care in general, despite their central role in developing local guidelines and delivering this care. This paper explores induction, specifically cervical ripening and the option to return home during that process, from the perspective of midwives, obstetricians and other maternity staff. As part of a process evaluation involving five case studies undertaken in British maternity services, interviews and focus groups were conducted with clinicians who provide induction of labour care. The thematic findings were generated through in-depth analysis and are grouped to reflect key points within the process of cervical ripening care: 'Implementing home cervical ripening', 'Putting local policy into practice', 'Giving information about induction' and 'Providing cervical ripening'. A range of practices and views regarding induction were recorded, showing how the integration of home cervical ripening is not always straightforward. Findings demonstrate that providing induction of labour care is complex and represents a significant workload. Home cervical ripening was seen as a solution to managing this workload; however, findings highlighted ways in which this expectation might not be borne out in practice. More comprehensive research is needed on workload impacts and possible lateral effects within other areas of maternity services.
doi_str_mv 10.1371/journal.pone.0284818
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In the United Kingdom, cervical ripening is recommended as the first stage of induction. Increasingly, maternity services are offering this outpatient or 'at home', despite limited evidence on its acceptability and how different approaches to cervical ripening work in practice. There is also a paucity of literature on clinicians' experiences of providing induction care in general, despite their central role in developing local guidelines and delivering this care. This paper explores induction, specifically cervical ripening and the option to return home during that process, from the perspective of midwives, obstetricians and other maternity staff. As part of a process evaluation involving five case studies undertaken in British maternity services, interviews and focus groups were conducted with clinicians who provide induction of labour care. The thematic findings were generated through in-depth analysis and are grouped to reflect key points within the process of cervical ripening care: 'Implementing home cervical ripening', 'Putting local policy into practice', 'Giving information about induction' and 'Providing cervical ripening'. A range of practices and views regarding induction were recorded, showing how the integration of home cervical ripening is not always straightforward. Findings demonstrate that providing induction of labour care is complex and represents a significant workload. Home cervical ripening was seen as a solution to managing this workload; however, findings highlighted ways in which this expectation might not be borne out in practice. More comprehensive research is needed on workload impacts and possible lateral effects within other areas of maternity services.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37200369</pmid><doi>10.1371/journal.pone.0284818</doi><tpages>e0284818</tpages><orcidid>https://orcid.org/0000-0003-4308-856X</orcidid><orcidid>https://orcid.org/0000-0002-3918-5917</orcidid><oa>free_for_read</oa></addata></record>
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source ProQuest - Publicly Available Content Database; PubMed Central; Coronavirus Research Database
subjects Biology and Life Sciences
Case studies
Cervical Ripening
Complications and side effects
Coronaviruses
COVID-19
Data collection
Engineering and Technology
Female
Focus groups
Health aspects
Health risks
Hospitals
Humans
Labor, Induced
Maternal child nursing
Medical personnel
Medicine and Health Sciences
Midwifery
Midwives
Outpatients
Oxytocics
People and Places
Pregnancy
Pregnant women
Professional ethics
Research ethics
Ripening
Womens health
Workload
Workloads
title Clinicians' perspectives and experiences of providing cervical ripening at home or in-hospital in the United Kingdom
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