Association of admission unit and birth satisfaction during induction of labor

Abstract

Objective As induction of labor (IOL) becomes more common, hospitals must adjust to accommodate longer length of stays on labor and delivery. An alternative to reduce the length of time spent on labor and delivery during an IOL is to perform cervical ripening on an antepartum unit. However, this may affect patient satisfaction and knowledge about the birthing process. This study aimed to evaluate whether cervical ripening conducted in an antepartum unit, rather than on a labor and delivery unit, was associated with changes in patient satisfaction with birth experience and baseline knowledge about IOL. Additionally, the study aimed to understand how patients would prefer to receive education on the IOL process. Methods This prospective observational study recruited English and Spanish-speaking patients at or after 39 weeks and 0 days gestation who were admitted for IOL. Consenting patients completed a preliminary survey containing sociodemographic and obstetric information as well as a previously validated survey on IOL knowledge on admission. Within 48 h of delivery, patients completed a follow-up survey including a validated birth satisfaction survey, the Birth Satisfaction Scale-Revised, and questions eliciting their preferred IOL education method. Data analyses compared patients who were admitted to antepartum for IOL to those admitted directly to labor and delivery. Multivariate analyses adjusted for sociodemographic and obstetric differences between the two groups. The primary outcomes were scores on the Birth Satisfaction Scale-Revised and on a test examining IOL knowledge. Secondary outcomes included preferred method of IOL education, obstetric outcomes, and neonatal outcomes. Results A total of 277 eligible patients were approached from October 2020 to March 2021. Of the 216 (78%) that consented, 159 (74%) completed the follow-up survey and were subsequently included in this analysis. Individuals admitted directly to antepartum (n = 122) more commonly self-identified as Latina, Latin American, or Hispanic (27.9% vs. 8.1%, p = .01) and were nulliparous (68.0% vs. 21.6%, p < .001) compared to participants admitted to labor and delivery for IOL (n = 37). Patients admitted to labor and delivery were more likely to undergo elective induction (29.7% vs. 9.8%, p = .006). Admission unit was not associated with differences in birth satisfaction scores or obstetric or neonatal outcomes. However, after controlling for potential confounders, patients admitted to the antepartum unit correctly answered a greater percentage of questions assessing IOL knowledge compared to patients admitted to labor and delivery (73.9% vs. 62.3%, adjusted mean difference (aMD) 12.6 [95% CI 7.2, 18.0]). Patients in both groups indicated preference for reviewing an induction checklist with a provider during prenatal care (59.1%) or using a technology-based intervention (37.1%) over attending in-person classes (3.1%) to learn more about IOL. Conclusion Unit of admission for IOL is not associated with satisfaction with birth experience but is associated with patient knowledge of IOL. This suggests that IOL may be initiated in less acute units than labor and delivery without altering birth experience and may potentially allow for increased patient knowledge. Additionally, IOL checklists or technology-based education may help to further increase patient knowledge about IOL.