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An evaluation of three models of care for in-patient induction of labour: an observational study
  1. A Yulia,
  2. J Moody,
  3. S Kitson,
  4. A Fawcus,
  5. P Ayuk
  1. Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom

Abstract

Induction of labour is a common obstetric intervention. However, its management may pose challenges to busy obstetric units. Delays frequently occur and can reduce patient satisfaction. The impact of delays on outcome is unknown.

Methods We undertook a prospective observational study of 1133 women undergoing induction of labour between 03/2009 and 08/2010 using three different models of in-patient care applied sequentially. Model A: no specific induction midwife and women admitted and treated as delivery suite work-load permitted (pre-existing model). Model B: Induction of labour midwife working 40h/week. Model C: Induction of labour midwife working 84h/week. For models B and C, women were given specific appointments and treated irrespective of delivery suite work-load. Outcome measures were admission-to-delivery interval and caesarean section rate.

Compared to Model A, model B resulted in a significant reduction in admission to delivery interval from 1405 (843.5 – 1805) minutes to 1124 (753 – 1542) minutes (p < 0.0001). Model C resulted in a significant reduction in admission to delivery interval when compared to models A and B [839.5 (608.5 – 1414) minutes, p < 0.0001]. The caesarean section rates were 27.4%, 25.1% and 18.7% for models A, B and C respectively (p = 0.014). The main contributor to reduced caesarean section rate was a reduction in caesarean sections for non-progressive first stage of labour.

Conclusions The availability of a dedicated induction of labour midwife is associated with shorter admission to delivery intervals and lower caesarean section rates.

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