University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Australia; Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia.
National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, UNSW, Sydney, Australia.
Women Birth. 2021 Mar;34(2):e170-e177. doi: 10.1016/j.wombi.2020.02.020. Epub 2020 Mar 4.
Rates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women's mode of birth preferences and experiences of shared decision-making for induction of labour.
An antenatal survey of women booked for an induction at eight Sydney hospitals was conducted. A bespoke questionnaire was created assessing women's demographics, indication for induction, pregnancy model of care, initial birth preferences, and their experience of the decision-making process.
Of 189 survey respondents (58% nulliparous), major reported reasons for induction included prolonged pregnancy (38%), diabetes (25%), and suspected fetal growth restriction (8%). Most respondents (72%) had hoped to labour spontaneously. Major findings included 19% of women not feeling like they had a choice about induction of labour, 26% not feeling adequately informed (or uncertain if informed), 17% not being given alternatives, and 30% not receiving any written information on induction of labour. Qualitative responses highlight a desire of women to be more actively involved in decision-making.
A substantial minority of women did not feel adequately informed or prepared, and indicated they were not given alternatives to induction. Suggested improvements include for face-to-face discussions to be supplemented with written information, and for shared decision-making interventions, such as the introduction of decision aids and training, to be implemented and evaluated.
在许多高收入国家，全球范围内的分娩诱导率一直在上升，高达三分之一的妊娠需要进行分娩诱导。尽管关于诱导的指南以及潜在证据的强度因适应症而异，但越来越多的人认识到共同决策是关键。本研究的目的是确定女性对分娩诱导的分娩方式偏好和共同决策的体验。
对在悉尼的八家医院进行分娩诱导的孕妇进行了一项产前调查。创建了一个定制的问卷，评估女性的人口统计学特征、诱导的适应症、妊娠护理模式、初始分娩偏好以及她们对决策过程的体验。
在 189 名接受调查的受访者（58%为初产妇）中，主要的诱导原因包括妊娠延长（38%）、糖尿病（25%）和疑似胎儿生长受限（8%）。大多数受访者（72%）希望自然分娩。主要发现包括 19%的女性觉得她们没有选择分娩诱导的权利，26%的女性觉得她们没有得到充分的信息（或不确定是否得到了信息），17%的女性没有得到替代方案，30%的女性没有收到任何关于分娩诱导的书面信息。定性回应强调了女性希望更积极地参与决策。
相当一部分女性感到没有得到充分的信息或准备，并且表示没有得到除诱导以外的替代方案。建议的改进措施包括面对面讨论应辅以书面信息，以及实施和评估共同决策干预措施，如引入决策辅助工具和培训。
