8/25/2015

Women’s Perspectives on the Elective Induction Decision

Molly Beinfeld, MPH, Solution Strategist

Editor’s Note: Join us as we explore important pregnancy topics that consumers and organizations are facing. Check back for additional posts, we’ll have a new one each week.

Induction of labor has increased steadily over the last 20 years and is now used in over 20% of births annually. Research suggests that maternal and fetal indications for induction are on the rise as well as an expansion of elective induction, or when there is no medical reason. According to a recent study of Medicaid data, approximately 9% of births involved early elective induction. More and more organizations are implementing quality improvement initiatives to reduce or eliminate elective inductions, particularly before 39 weeks of gestation. Engaging patients about the risks and benefits of induction can help ensure the success of these initiatives, but it is important to first understand where women are coming from.

To inform the development of patient decision support materials for elective induction, we conducted two focus groups to explore the patient perspectives on this decision. We recruited 12 women who had undergone an induction for a nonmedical reason within the last two years to speak to us about their experiences and to share their knowledge gaps, misperceptions, fears, and perceptions of the decision. IRB approval was obtained.

In general, we found that the induction procedure has become very “normal” and attractive for a variety of reasons, but that there were many misconceptions and myths that needed to be addressed.

Specifically:

Reasons for wanting an elective induction:

• They wanted to give birth with their own doctor.
• They had scheduling issues (e.g., returning to work, taking care of children, spouse’s schedule).
• They were uncomfortable and wanted their pregnancy to be over with.
• They wanted to avoid the pain of labor altogether and were offered an epidural at the same time as induction.

Perceptions of the benefits of elective induction:

• It is a reasonable, convenient option that will make their lives easier.
• It is commonly done and safe.
• It makes it easier to plan, especially if you have other children.

Misconceptions about elective induction:

• Many did not know what the procedure entailed.
• The risks of the procedure were misunderstood or the impact of these risks were minimized (such as cesarean).
• The understanding of what full-term gestation means (between 37 and 40 weeks) varied greatly.

In conclusion, there are many misconceptions and fears that need to be addressed in order to effectively engage women about the decision of whether to be induced for a nonmedical reason. Evidence-based, women-centered decision support materials are one powerful way to enable shared decision making between a woman and her care team.