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Research project: A randomised controlled trial of outpatient cervical priming for induction of labour

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As part of a randomised controlled trial to compare cervical priming for induction of labour (inpatient care with outpatient priming in a day assessment unit) a discrete choice experiment survey tests the hypothesis that key aspects of priming are more preferred for women receiving outpatient care.

This is the first study of its kind to comprehensively evaluate outpatient priming for induction, which will be adequately powered to reveal significant differences in important clinical outcomes. Critically it is the first investigation of its kind to consider women's preferences. We hypothesize that outpatient priming will prove efficacious and that demedicalising this procedure will increase women's satisfaction without increasing their anxiety about their own safety or the safety of their baby. There may be a physiological benefit to allowing women to rest at home, presenting to hospital when in active labour, or after a pre determined period. If admitted to hospital in active labour, there may be less chance of medical intervention and analgesia use. Outpatient priming may have some economic benefits as well as benefits in relation to the midwife's role. The results of the trial
will be used by health service planners and policy makers to formulate evidence based guidelines of appropriate protocols for induction of labour. The results will also be used by pregnant women to help them make informed choices regarding their pregnancy care.

The trial is a prospective non-blinded randomised trial conducted at the Women’s and Children’s Hospital Adelaide and Flinders medical centre, the two tertiary maternity care centres in South Australia. Clinical outcomes are by a retrospective case note review. Psychosocial outcomes by a brief anxiety instrument at the time of randomisation and a 7-week questionnaire (to ascertain satisfaction, postnatal depression and method of infant feeding). A discrete choice experiment is used to examine the attributes that are of importance to women in the treatment for induction of labour delivered in outpatient and inpatient settings. Midwives complete several measures of job demands and autonomy, work place support, and job satisfaction. The results of the trial will be used by health service planners and policy makers to formulate evidence based guidelines of appropriate protocols for induction of labour. The results will also be used by pregnant women to help them make informed choices regarding their pregnancy care.

Project team

Professor Deborah Turnbull (University of Adelaide)
Dr Chris Wilkinson (Women's and Children's Hospital, Adelaide)
Dr Karen Gerard, Reader in Health Economics and NIHR Career Development Fellow Assoc Professor Phil Ryan (University of Adelaide)
Assoc Professor Robert Bryce (University of Adelaide)
Dr Georgina Stamp (Flinders University)
Dr Kirsten Howard (University of Sydney)

Project funder

National Health and Medical Research Council, Australia

Associated research themes

Service evaluation, clinical trial

Related research groups

Complex Healthcare Processes
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