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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2017

Open Access 01-12-2017 | Research article

Variation in clinical decision-making for induction of labour: a qualitative study

Authors: Tanya A. Nippita, Maree Porter, Sean K. Seeho, Jonathan M. Morris, Christine L. Roberts

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

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Abstract

Background

Unexplained variation in induction of labour (IOL) rates exist between hospitals, even after accounting for casemix and hospital differences. We aimed to explore factors that influence clinical decision-making for IOL that may be contributing to the variation in IOL rates between hospitals.

Methods

We undertook a qualitative study involving semi-structured, audio-recorded interviews with obstetricians and midwives. Using purposive sampling, participants known to have diverse opinions on IOL were selected from ten Australian maternity hospitals (based on differences in hospital IOL rate, size, location and case-mix complexities). Transcripts were indexed, coded, and analysed using the Framework Approach to identify main themes and subthemes.

Results

Forty-five participants were interviewed (21 midwives, 24 obstetric medical staff). Variations in decision-making for IOL were based on the obstetrician’s perception of medical risk in the pregnancy (influenced by the obstetrician’s personality and knowledge), their care relationship with the woman, how they involved the woman in decision-making, and resource availability. The role of a ‘gatekeeper’ in the procedural aspects of arranging an IOL also influenced decision-making. There was wide variation in the clinical decision-making practices of obstetricians and less accountability for decision-making in hospitals with a high IOL rate, with the converse occurring in hospitals with low IOL rates.

Conclusion

Improved communication, standardised risk assessment and accountability for IOL offer potential for reducing variation in hospital IOL rates.
Literature
1.
Wennberg JE. Forty years of unwarranted variation--and still counting. Health Policy. 2014;114(1):1–2.CrossRefPubMed
2.
McCulloch P, Nagendran M, Campbell WB, Price A, Jani A, Birkmeyer JD, et al. Strategies to reduce variation in the use of surgery. Lancet. 2013;382(9898):1130–9.CrossRefPubMed
3.
Li Z, Zeki R, Hilder L, Sullivan EA. Australia's mothers and babies, 2011. Perinatal statistics series no. 28. Cat. no. PER 59. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit; 2013.
4.
Hospital Episode Statistics Analysis. NHS Maternity Statistics - England, 2012–13. Leeds: Health and Social Care Information Centre; 2014.
5.
EURO-PERISTAT Project with SCPE and EUROCAT. European Perinatal Health Report. The health and care of pregnant women and babies in Europe in 2010. May 2013.
6.
Lutomski JE, Morrison JJ, Lydon-Rochelle MT. Regional variation in obstetrical intervention for hospital birth in the Republic of Ireland, 2005–2009. BMC Pregnancy Childbirth. 2012;12:123.CrossRefPubMedPubMedCentral
7.
Nippita TA, Trevena JA, Patterson JA, Ford JB, Morris JM, Roberts CL. Variation in hospital rates of induction of labour: a population-based record linkage study. BMJ Open. 2015;5(9):e008755.CrossRefPubMedPubMedCentral
8.
RCOG. Patterns of Maternity Care in English NHS Hospitals 2011/12. London: Royal College of Obstetricians and Gynaecologists; 2013.
9.
Sebastiao YV, Womack L, Vamos CA, Louis JM, Olaoye F, Caragan T, et al. Hospital variation in cesarean delivery rates: contribution of individual and hospital factors in Florida. Am J Obstet Gynecol. 2016;214(1):123.e121–18.CrossRef
10.
Bibeau AM. Interventions during labor and birth in the United States: a qualitative analysis of women's experiences. Sex Reprod Healthc. 2014;5(4):167–73.CrossRefPubMed
11.
Henderson J, Redshaw M. Women’s experience of induction of labor: a mixed methods study. Acta Obstet Gynecol Scand. 2013;92(10):1159–67.PubMed
12.
Moore JE, Low LK, Titler MG, Dalton VK, Sampselle CM. Moving toward patient-centered care: women’s decisions, perceptions, and experiences of the induction of labor process. Birth. 2014;41(2):138–46.CrossRefPubMed
13.
Nippita TA, Trevena JA, Patterson JA, Ford JB, Morris JM, Roberts CL. Inter-hospital variations in labor induction and outcomes for nullipara: a population-based linkage study. Acta Obstet Gynecol Scand. 2016;95(4):411–9.CrossRefPubMed
14.
15.
Horton R, Samarasekera U. Stillbirths: ending an epidemic of greath. Lancet. 2016;387(10018):515–6.CrossRefPubMed
16.
Boerma TMC, AbouZahr C, Chatterji S, Hogan D, Stevens G. Health in 2015: from MDGs (Millenium Development Goals) to SDGs (Sustainable Develoment Goals). Geneva: WHO Press; 2015.
17.
Gulmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2012;6:CD004945.PubMedCentral
18.
Hedegaard M, Lidegaard O, Skovlund CW, Morch LS, Hedegaard M. Perinatal outcomes following an earlier post-term labour induction policy: a historical cohort study. BJOG. 2015;122(10):1377–85.CrossRefPubMed
19.
Smith G. Labour should be induced at term: FOR: the balance of risks versus benefits favours offering term induction to all women. BJOG. 2015;122(7):982.CrossRefPubMed
20.
Patterson JA, Roberts CL, Ford JB, Morris JM. Trends and outcomes of induction of labour among nullipara at term. Aust N Z J Obstet Gynaecol. 2011;51(6):510–7.CrossRefPubMed
21.
Schwarz C, Schafers R, Loytved C, Heusser P, Abou-Dakn M, Konig T, et al. Temporal trends in fetal mortality at and beyond term and induction of labor in Germany 2005-2012: data from German routine perinatal monitoring. Arch Gynecol Obstet. 2016;293(2):335–43.CrossRefPubMed
22.
Little SE, Robinson JN, Puopolo KM, Mukhopadhyay S, Wilkins-Haug LE, Acker DA, et al. The effect of obstetric practice change to reduce early term delivery on perinatal outcome. J Perinatol. 2014;34(3):176–80.CrossRefPubMed
23.
24.
Nicholson JM, Kellar LC, Ahmad S, Abid A, Woloski J, Hewamudalige N, Henning GF, Lauring JR, Ural SH, Yaklic JL. US term stillbirth rates and the 39-week rule: a cause for concern? Am J Obstet Gynecol. 2016;214(5):621.e621–9.CrossRef
25.
26.
Wood S, Cooper S, Ross S. Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes. BJOG. 2014;121(6):674–85.CrossRefPubMed
27.
Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis. CMAJ. 2014;186(9):665–73.CrossRefPubMedPubMedCentral
28.
Jacquemyn Y. Labour should be induced at term: AGAINST: No proof of benefit. BJOG. 2015;122(7):982.CrossRefPubMed
29.
Birkmeyer JD, Reames BN, McCulloch P, Carr AJ, Campbell WB, Wennberg JE. Understanding of regional variation in the use of surgery. Lancet. 2013;382(9898):1121–9.CrossRefPubMedPubMedCentral
30.
31.
Cooper M, Warland J. Improving women’s knowledge of prostaglandin induction of labour through the use of information brochures: a quasi-experimental study. Women Birth. 2011;24(4):156–64.CrossRefPubMed
32.
Nuutila M, Halmesmaki E, Hiilesmaa V, Ylikorkala O. Women’s anticipations of and experiences with induction of labor. Acta Obstet Gynecol Scand. 1999;78(8):704–9.CrossRefPubMed
33.
O'Connor AM, Pennie RA, Dales RE. Framing effects on expectations, decisions, and side effects experienced: the case of influenza immunization. J Clin Epidemiol. 1996;49(11):1271–6.CrossRefPubMed
34.
Dugas M, Shorten A, Dube E, Wassef M, Bujold E, Chaillet N. Decision aid tools to support women’s decision making in pregnancy and birth: a systematic review and meta-analysis. Soc Sci Med. 2012;74(12):1968–78.CrossRefPubMed
35.
Reime B, Klein MC, Kelly A, Duxbury N, Saxell L, Liston R, et al. Do maternity care provider groups have different attitudes towards birth? BJOG. 2004;111(12):1388–93.CrossRefPubMed
36.
Blais R, Lambert J, Maheux B, Loiselle J, Gauthier N, Framarin A. Controversies in maternity care: where do physicians, nurses, and midwives stand? Birth. 1994;21(2):63–70.CrossRefPubMed
37.
Taylor N, Clay-Williams R, Hogden E, Braithwaite J, Groene O. High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Serv Res. 2015;15:244.CrossRefPubMedPubMedCentral
38.
Bradley EH, Curry LA, Webster TR, Mattera JA, Roumanis SA, Radford MJ, et al. Achieving rapid door-to-balloon times: how top hospitals improve complex clinical systems. Circulation. 2006;113(8):1079–85.CrossRefPubMed
39.
Lyndon A, Johnson MC, Bingham D, Napolitano PG, Joseph G, Maxfield DG, O’Keeffe DF. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint. Obstet Gynecol. 2015;125(5):1049–55.CrossRefPubMed
40.
Oshiro BT, Kowalewski L, Sappenfield W, Alter CC, Bettegowda VR, Russell R, et al. A multistate quality improvement program to decrease elective deliveries before 39 weeks of gestation. Obstet Gynecol. 2013;121(5):1025–31.CrossRefPubMed
Metadata
Title
Variation in clinical decision-making for induction of labour: a qualitative study
Authors
Tanya A. Nippita
Maree Porter
Sean K. Seeho
Jonathan M. Morris
Christine L. Roberts
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1518-y

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