Women’s health team of the yearBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2030 (Published 30 April 2015) Cite this as: BMJ 2015;350:h2030
- Nigel Hawkes, freelance journalist, London, UK
Improving induction of labour
Induction of labour is increasingly common, says Sabrina O’Dwyer, a specialty registrar at Barts Health NHS Trust, but is “infamous” for being poorly managed, to the irritation of women and at the risk of increasing the caesarean section rate. “We have an ageing maternal population, more medical problems, more fertility treatments, more diabetes in pregnancy, and all lead to a higher induction of labour rate,” she says. “But it is elective work, it doesn’t take priority, and it can be neglected a bit. It features a lot in complaint letters.”
A study launched at Whipps Cross Hospital in north London, part of the Barts trust, found inconsistent and outdated guidelines, poor patient information, a lack of coordination, and no feedback to staff. “Caesarean rates were high—we were an outlier,” she says.
One big change was to implement outpatient induction of labour in low risk women, using Propess, a single administration prostaglandin that works over 24 hours. Strong conditions were enforced, such as insisting that women had access to a phone, good English, and the competence to remove the pessary as instructed. An induction of labour suite with a dedicated midwife was also introduced, and the programme involved effective and continued engagement of all the staff involved.
The results show a reduction in active labour from the time of admission, and a fall in the caesarean section rate from 30% to 20%, as well as …