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

Yuill, Cassandra, Harkness, Mairi, Wallace, Chlorice, Cheyne, Helen, Black, Mairead, Modi, Neena, Pasupathy, Dharmintra, Sanders, Julia ORCID: https://orcid.org/0000-0001-5712-9989, Stock, Sarah J. and McCourt, Christine 2023. Clinicians’ perspectives and experiences of providing cervical ripening at home or in-hospital in the United Kingdom. PLoS ONE 18 (5) , e0284818. 10.1371/journal.pone.0284818

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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 a 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.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Healthcare Sciences
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/
Publisher:	Public Library of Science
Date of First Compliant Deposit:	19 May 2023
Date of Acceptance:	9 April 2023
Last Modified:	20 May 2023 08:05
URI:	https://orca.cardiff.ac.uk/id/eprint/159682

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