Across the UK, the rate of patients requiring Induction of Labour (IOL) has rapidly increased, from 25% in 2013/14 to 33% in 2022/23. This presents a critical challenge to patient safety and the quality of care in UK maternity services. The primary rationale for IOL remains the reduction of risks to both mother and baby associated with prolonged pregnancy, yet this significant increase in volume, compounded by severe midwifery and clinical staff shortages, is placing substantial pressure on patient flow and capacity within maternity units. Recognising the urgency of this issue, the ARC WM Maternity Theme initiated a national response aimed at mitigating risks and standardising practice.
Initial national data on local policies and practices for IOL was sparse. To address this, we undertook a national survey that confirmed substantial variation in induction rates, processes, and policies across UK maternity services. The survey highlighted that delays were commonly reported, directly impacting women’s experience and raising significant safety concerns.
Following the identification of IOL as a priority issue at the British Intrapartum Care Society (BICS) annual conference in September 2022, a national collaborative workshop was organised by our Maternity Theme, bringing together academics, obstetricians, midwives, and midwifery leads, alongside key regulatory bodies. Critically, service user representatives participated to ensure that women’s personal experiences, views, and expectations directly informed the Quality Improvement work being shared. The collaborative workshop served as a vital mechanism for sharing local projects that tackle common operational and experiential problems within IOL pathways.
The submitted work was categorised into five key themes: improving women’s experiences, developing tools for informed consent or expectant management, prioritising women within the queue, reducing process delays, using technology to support the pathway.
Following discussions, the most effective projects were shared nationally, and published as ‘Ideas and resources for improving Induction of Labour Practices’ on the BICS website. This document is the first of its kind, sharing practical ideas and resources to address common IOL challenges and offering solutions ranging from simple, easy-to-implement changes (such as developing decision aids and information leaflets for women or increasing outpatient induction) to system level change (such as co-designing facilities, introducing a RAG rating system for prioritisation, or introducing a Flow and Capacity co-ordinator). The ultimate beneficiary of this initiative is the women who will experience reduced delays and improved care quality.
The impact of this collaborative effort is evident in its provision of the first national resource for standardising and improving IOL practices. Building on this work, further discussions at the BICS conference in November 2023 highlighted three persistent areas where professional consensus is lacking: defining delay for women awaiting admission for induction; defining delay once labour is progressing and transfer to the Delivery Suite is required; and determining the appropriate response when an induction is unsuccessful.
