Offering women a choice in induction of labour in case of an unfavorable
cervix: a prospective cohort study
Abstract
Objective: To evaluate women’s choice in the method of labour induction
between oral misoprostol, PGE2 pessary and the Foley catheter. To
compare women’s satisfaction according to their choice and to identify
factors associated with patient satisfaction. Design: Prospective cohort
study. Setting: Tertiary hospital in Toulouse, France, from July 2019 to
October 2020. Population: All women admitted for labour induction at
term, by either oral misoprostol, PGE2 pessary or Foley catheter.
Methods: Women chose their preferred method. Before and after the
delivery, they were asked to argument their choice and to evaluate their
satisfaction through the use of questionnaires. Main outcome measures:
Global level of satisfaction. Results: Of the 520 women included, 67,5%
of women chose oral Misoprostol compared to 21% PGE2 pessary and 11.5%
the Foley catheter. Regarding global satisfaction, we found no
significant difference between the three groups: 78,4%, 68,8% and
71,2% (p=0,091) for respectively oral misoprostol, PGE2 pessary and
Foley catheter. Factors that seem to improve women’s satisfaction were
nulliparity (OR = 2.03, 95%CI [1.19 - 3.53]), delivery within 24
hours after the start of induction (OR = 3.46, 95%CI. [2.02 -
6.14]) and adequate information (OR = 4.21,95%CI [1.86 - 9.64]).
Factors associated with lower satisfaction rates were postpartum
hemorrhage (OR = 0.51, 95%CI [0.30 - 0.88]) and caesarean section
(OR = 0.31, 95%CI [0.17 - 0.54]). Conclusion: Women satisfaction
rates were not different between the three methods, when chosen by the
patients themselves. These finding should encourage caregivers to
promote shared decision making when possible.