AUTHOR=von Dadelszen Peter , Tohill Susan , Wade Julie , Hutcheon Jennifer A. , Scott Janet , Green Marcus , Thornton James G. , Magee Laura A. ,  the WILL Pilot Trial Study Group 

TITLE=Labor induction information leaflets—Do women receive evidence-based information about the benefits and harms of labor induction?

JOURNAL=Frontiers in Global Women's Health

VOLUME=3

YEAR=2022

URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2022.936770

DOI=10.3389/fgwh.2022.936770

ISSN=2673-5059

ABSTRACT=<sec><title>Objectives</title><p>To determine the extent to which a sample of NHS labor induction leaflets reflects evidence on labor induction.</p></sec><sec><title>Setting</title><p>Audit of labor induction patient information leaflets—local from WILL trial (When to Induce Labor to Limit risk in pregnancy hypertension) internal pilot sites or national-level available online.</p></sec><sec><title>Methods</title><p>Descriptive analysis [<italic>n</italic> = 21 leaflets, 19 (one shared) in 20 WILL internal pilot sites and 2 NHS online] according to NHS “Protocol on the Production of Patient Information” criteria: general information (including indications), why and how induction is offered (including success and alternatives), and potential benefits and harms.</p></sec><sec><title>Results</title><p>All leaflets described an induction indication. Most leaflets (<italic>n</italic> = 18) mentioned induction location and 16 the potential for delays due to delivery suite workloads and competing clinical priorities. While 19 leaflets discussed membrane sweeping (17 as an induction alternative), only 4 leaflets mentioned balloon catheter as another mechanical method. Induction success (onset of active labor) was presented by a minority of leaflets (<italic>n</italic> = 7, 33%), as “frequent” or in the “majority”, with “rare” or “occasional” failures. Benefits, harms and outcomes following induction were not compared with expectant care, but rather with spontaneous labor, such as for pain (<italic>n</italic> = 14, with nine stating more pain with induction). Potential benefits of induction were seldom described [<italic>n</italic> = 7; including avoiding stillbirth (<italic>n</italic> = 4)], but deemed to be likely. No leaflet stated vaginal birth was more likely following induction, but most stated Cesarean was not increased (<italic>n</italic> = 12); one leaflet stated that Cesarean risks were increased following induction. Women's satisfaction was rarely presented (<italic>n</italic> = 2).</p></sec><sec><title>Conclusion</title><p>Information provided to pregnant women regarding labor induction could be improved to better reflect women's choice between induction and expectant care, and the evidence upon which treatment recommendations are based. A multiple stakeholder-involved and evidence-informed process to update guidance is required.</p></sec>