Inter-hospital and inter-disciplinary variation in planned birth practices and readiness for change: a survey study

Dominiek Coates,Maralyn Foureur,Natasha Donnolley,Amanda Henry

doi:10.1186/s12884-021-03844-z

Abstract

BackgroundHow the application of evidence to planned birth practices, induction of labour (IOL) and prelabour caesarean (CS), differs between Australian maternity units remains poorly understood. Perceptions of readiness for practice change and resources to implement change in individual units are also unclear.AimTo identify inter-hospital and inter-professional variations in relation to current planned birth practices and readiness for change, reported by clinicians in 7 maternity units.MethodCustom-created survey of maternity staff at 7 Sydney hospitals, with questions about women’s engagement with decision making, indications for planned birth, timing of birth and readiness for change. Responses from midwives and medical staff, and from each hospital, were compared.FindingsOf 245 completed surveys (27% response rate), 78% were midwives and 22% medical staff. Substantial inter-hospital variation was noted for stated planned birth indication, timing, women’s involvement in decision-making practices, as well as in staff perceptions of their unit’s readiness for change. Overall, 48% (range 31–64%) and 64% (range 39–89%) agreed on a need to change their unit’s caesarean and induction practices respectively. The three units where greatest need for change was perceived also had least readiness for change in terms of leadership, culture, and resources. Regarding inter-disciplinary variation, medical staff were more likely than midwifery staff to believe women were appropriately informed and less likely to believe unit practice change was required.ConclusionPlanned birth practices and change readiness varied between participating hospitals and professional groups. Hospitals with greatest perceived need for change perceived least resources to implement such change.

Highlights

While it is increasingly recognised that evidence is not routinely implemented into practice [1, 2], it is less clear which evidence-based practices have been adopted and which are specified in policies and guidelines but not translated into everyday care [3, 4]
As is standard for Australian public maternity units, midwives are the primary accoucheurs for the majority of births, with medical staff involved if intervention is required
Few studies have assessed the uptake of evidence in maternity units in Australia, and our study demonstrates variation in the uptake of evidence-based guidelines between hospitals

Summary

Introduction

While it is increasingly recognised that evidence is not routinely implemented into practice [1, 2], it is less clear which evidence-based practices have been adopted and which are specified in policies and guidelines but not translated into everyday care [3, 4]. Inconsistent uptake of evidence has resulted in unwarranted variation in practices, across all areas of healthcare [3, 4], including maternity care [2]. Practice variation in relation to planned birth, i.e. induction of labour (IOL) and prelabour caesarean section (CS), is of increasing concern [2]. The extent to which planned birth is warranted remains unclear, with widespread variation in the incidence of planned birth between countries and hospitals [10,11,12,13,14,15,16]. How the application of evidence to planned birth practices, induction of labour (IOL) and prelabour caesarean (CS), differs between Australian maternity units remains poorly understood. Perceptions of readiness for practice change and resources to implement change in individual units are unclear

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