INDEX (Induction Experience) assessment of how women feel about induced labour: A prospective observational study.

PROBLEM: Women's experience of induction of labour and how to identify risk factors for poor experience had not been evaluated in the literature.

BACKGROUND

The experience of induction can be a source of distress for women. The validated EXIT self-questionnaire assesses maternal satisfaction with labour induction.

AIM: To assess the satisfaction and experience of women who have undergone induction of labour with cervical ripening and so identify risk factors for a poor experience of induction.

METHODS

This was a prospective observational study including pregnant women with cervical ripening before induction. Longitudinal information on meals, sleep, ambulation, vomiting, and pain were collected prospectively using a time-stamped self-questionnaire, and women were asked to fill in the validated EXIT self-questionnaire in the week after birth.

FINDINGS: Women induced with a balloon catheter had a worse experience of time taken to give birth (Estimate: -1.44, p = 0.001) but a better experience of contractions (Estimate: 1.44, p = 0.009) and improved comfort (Estimate: 0.94, p = 0.006). Induction for post-term was a factor of negative experience related to the time to give birth (Estimate: -0.72, p = 0.013). High pain duration (Estimate: -2.73, p = 0.018) and insufficient sleep (Estimate: 0.31, p = 0.059) were risk factors for a negative experience of contractions. A long walking time contributed to comfort during cervical ripening (Estimate: 0.91, p = 0.103).

DISCUSSION: Multivariate models based on our time-stamped self-questionnaire showed that some of these variables were essential to assessing experience during cervical ripening and in particular pain (Estimate: -2.73, p = 0.018), sleep (Estimate: 0.31, p = 0.059), and walking time (Estimate: 0.91, p = 0.102).

CONCLUSION

Recording of these variables by women during induction could help us identify those likely to require support during cervical ripening, thereby improving our practices, and enabling individualized care.