‘My research is a recent collaboration between Deakin University researchers and Western Health maternity clinicians who evaluated the impact of an induction of labour (IOL) improvement initiative,’ said Dr Vasilevski.
‘Induction of labour is the process of using medicine or other methods to start labour, because a woman wishes to birth sooner, or because waiting for labour to occur naturally may be a risk for a woman or her baby.’
Inducing labour can be lifesaving, however it doesn’t come without risks and there is a lot of debate about the timing and reasons for inducing labour. Maternity care settings with inconsistent IOL recommendations among clinicians tend to have the highest induction rates and reduced care satisfaction of women.
In Australia, more than one in three women had an induction in 2022. This has increased from one in four in 2010. Induction of labour rates continue to rise globally.
‘The IOL improvement initiative was implemented at Western Health to ensure that induction was being recommended for the right reasons and to ensure women were fully informed about the process and the risks of the procedures before agreeing to undertake them,’ says Dr Vasilevski.
The initiative included two elements: guidelines about the indications and timing for inducing labour and the implementation of an IOL Liaison Midwife.
The guidelines about the indications and timing for inducing labour aligned with current evidence about avoiding induction for indicators such as advanced maternal age, diabetes, IVF pregnancy and maternal request when no additional risk factors were present; and the preferred cervical ripening method to reduce the risk of foetal distress and to reduce the time women needed in hospital.
The IOL Liaison Midwife is responsible for reviewing all referrals for inducing labour to ensure recommendations align with the revised guidelines and managing IOL bookings.
The IOL Liaison Midwife contacts all women by phone when booking their induction to provide information about their procedure (including the type of IOL they would be having, what to expect and potential risks), to address women’s concerns and to gain informed consent.
Prior to the implementation of the initiative, over half the women surveyed did not know why or how they would be induced.
The evaluation explored the impact of the initiative on staff practices and women’s experiences of inducing labour.
‘Induction is not without risks, and it is important that clinician recommendations for induction are appropriate, and that women are fully informed before agreeing to go ahead with the procedure,’ says Dr Vasilevski.
‘As both a staff member and a consumer of Western Health’s services, I want to do work that ensures that the delivery of care is of the highest standard for women and families in our community.’
‘Our evaluation included an audit of clinical data, focus groups with midwives and doctors and surveys and interviews with women before and after they had an induction.’
Following implementation of the initiative, the induction rate significantly reduced by 5% and midwives and doctors showed increased guideline adherence.
‘Our study showed that women’s understanding of induction and why it was recommended for them improved after having the conversation with the midwife. They described feeling prepared for the procedure,’ says Dr Vasilevski.
‘Clinicians described the value of the initiative for supporting their practice and perceived it to improve women’s experiences of induced labour.’
The research team included Deakin University’s Professor Linda Sweet, Hayley Pohatu from Western Health, Dr Sara Holton and Dr Karen Wynter from Monash University.
With the project now complete, the initiative continues to be standard practice at Western Health.
Read more about Dr Vidanka Vasilevski’s research
Read Dr Vidanka Vasilevski’s latest paper titled: Evaluating the impact of the induction of labour improvement initiative on clinical outcomes, women’s care satisfaction, and clinician experiences
