Stina Lou1,2, Lone Hvidman3,4, Niels Uldbjerg3,4, Lone Neumann5, Trine Fritzner Jensen5, Joke-Gesine Haben3, Kathrine Carstensen1. 1. DEFACTUM -Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark. 2. Center for Fetal Diagnostics, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark. 3. Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark. 4. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 5. Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.
Abstract
BACKGROUND: Over the last decade, induction of labor (IOL) in postterm pregnancies has increased. Studies have shown the medical advantages of postterm IOL, but less is known about the perspectives of the pregnant women. This review aimed to summarize the current qualitative evidence on women's experience of postterm IOL. METHODS: A systematic literature search was performed in three databases. A total of 3193 publications were identified, but only eight studies met the inclusion criteria. Thematic analysis guided the data extraction and synthesis. The Confidence in the Evidence for Reviews of Qualitative research (CERQual) approach was used to assess confidence in the findings. RESULTS: Three major findings were identified. First, for some women, IOL required a shift in expectations because the hope of spontaneous labor had to be given up. Second, the IOL decision was considered a recommendation from health care professionals and was experienced as a nondecision. Finally, the induction process was experienced as a sequential set of steps where the women were expected to fit into the existing hospital organization. The CERQual assessment suggested moderate confidence in all findings. DISCUSSION: The negative experiences identified in this review can be greatly reduced by a communicative and patient-centered approach. To support informed choice and shared decision making, women need high-quality, unbiased information about IOL, alternative options, and potential outcomes, in addition to time for reflection on their personal values and preferences. Women may need a professionally initiated and supported opportunity to re-evaluate their hopes and expectations before IOL.
BACKGROUND: Over the last decade, induction of labor (IOL) in postterm pregnancies has increased. Studies have shown the medical advantages of postterm IOL, but less is known about the perspectives of the pregnant women. This review aimed to summarize the current qualitative evidence on women's experience of postterm IOL. METHODS: A systematic literature search was performed in three databases. A total of 3193 publications were identified, but only eight studies met the inclusion criteria. Thematic analysis guided the data extraction and synthesis. The Confidence in the Evidence for Reviews of Qualitative research (CERQual) approach was used to assess confidence in the findings. RESULTS: Three major findings were identified. First, for some women, IOL required a shift in expectations because the hope of spontaneous labor had to be given up. Second, the IOL decision was considered a recommendation from health care professionals and was experienced as a nondecision. Finally, the induction process was experienced as a sequential set of steps where the women were expected to fit into the existing hospital organization. The CERQual assessment suggested moderate confidence in all findings. DISCUSSION: The negative experiences identified in this review can be greatly reduced by a communicative and patient-centered approach. To support informed choice and shared decision making, women need high-quality, unbiased information about IOL, alternative options, and potential outcomes, in addition to time for reflection on their personal values and preferences. Women may need a professionally initiated and supported opportunity to re-evaluate their hopes and expectations before IOL.
Authors: Helena Nilvér; Anna Wessberg; Anna Dencker; Henrik Hagberg; Ulla-Britt Wennerholm; Helena Fadl; Jan Wesström; Verena Sengpiel; Ingela Lundgren; Christina Bergh; Anna-Karin Wikström; Sissel Saltvedt; Helen Elden Journal: BMJ Open Date: 2021-04-07 Impact factor: 2.692