IDEAS & RESOURCES FOR IMPROVING INDUCTION OF LABOUR PRACTICE

Induction of labour (IOL) rates are rising and there are capacity issues within maternity services resulting in delays for women in the process of IOL. This has led to safety concerns and poor experience for women and their families. 

Following a workshop at the British Intrapartum Care Society (BICS) annual conference in September 2022, the issue was identified as a priority. A subsequent national workshop was organised by the maternity theme of the Applied Research Collaboration West Midlands (ARC WM) to facilitate further collaboration, aiming to share local quality improvement (QI) projects aimed at tackling common problems identified throughout IOL pathways. 

Maternity units nationwide were contacted to submit their current quality improvement work for inclusion in this national workshop. In person participants were selected based on area (England, Scotland and Northern Ireland), region, size, induction rate and the QI focus. ARC WM hosted the collaborative workshop in January 2023, with representatives from the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM), Regional Obstetricians and BICS alongside clinicians from 40 maternity units from across the UK. Participants consisted of academics, obstetricians, midwives and midwifery leads. Service users representatives also joined the group to share personal experiences and influence local quality improvement work with women’s views and expectations. 

The quality improvement work which was submitted by all the trusts who attended was divided in to five key themes 

· Improving women’s experiences throughout the IOL pathway and process.

· Developing tools to support informed consent for IOL or expectant management.

· Prioritising women within the IOL queue.

· Reducing delays within the IOL process.

· Using technology to support the IOL pathway. 

These were discussed in a table-top discussion format in the morning, with the projects felt to be most useful being shared with the entire group in the afternoon. This document contains summaries of QI projects from across the UK. Examples within the five themes include development of a decision aid and information leaflet for women, increasing outpatient induction, co-design of facilities for induction of labour, development of a RAG rating system for prioritising women admitted to hospital and transferring to Labour ward (LW) (see note below), introducing ‘safe gestational ranges’ for induction, introduction of a Flow and Capacity co-ordinator, improving induction within the Electron Patient Record and Virtual Outpatient induction.

The ideas within this document vary in complexity, with relatively simple solutions which may be easy to implement, to system level change. Please remember that this document is not a guideline of best practice. It is a summary of QI initiatives that are being undertaken that may be useful ‘starting points’ and will need to be adapted to local context. It is anticipated that maternity units will use this document to consider what might be relevant to their circumstances and utilise the tips provided to adapt and support the use of QI in the local implementation. 

Ultimately the goal is to improve the process of induction of labour for both women, service users and service providers.

Note

The term ‘Delivery suite’ is used within the case studies that are contained within this document but the RCM and the RCOG request that this is not the most appropriate term and should no longer be used. The Re:Birth Project found women request that the term ‘birth’ should now replace ‘delivery’ and in the future ‘delivery suite’ be replaced by Birthing suite’. Please refer to https://www.rcm.org.uk/rebirth-hub/rebirth-summary-2022/