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

Cassandra Yuill* (Corresponding Author), Mairi Harkness, Chlorice Wallace, Helen Cheyne, Mairead Black, Neena Modi, Dharmintra Pasupathy, Julia Sanders, Sarah J Stock, Christine McCourt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
2 Downloads (Pure)

Abstract

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 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.
Original languageEnglish
Article numbere0284818
Number of pages15
JournalPloS ONE
Volume18
Issue number5
DOIs
Publication statusPublished - 18 May 2023

Bibliographical note

Acknowledgements
We are grateful to those who gave their time for interviews and focus groups despite the severe workload pressures and ongoing COVID-19 pandemic.
CHOICE is funded by the National Institute of Healthcare Research Health Technology and Assessment (NIHR HTA) NIHR 127569. SJS is funded by a Wellcome Trust Clinical Career Development Fellowship (209560/Z/17/Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of the National Institute of Healthcare Research or the Department of Health and Social Care.

Data Availability Statement

The full data set cannot be shared publicly because of ethical concerns (data contains potentially identifying and sensitive participant and patient information). Data are available from the Yorkshire and the Humber - Sheffield Research Ethics Committee (contact [email protected]) for researchers who meet the criteria for access to confidential data.

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