Introduction

This quality standard covers the induction of labour in hospital outpatient or inpatient settings. The quality standard does not cover the induction of labour for women with diabetes or multiple pregnancies, or augmentation (acceleration) of established labour. For more information see the topic overview.

Why this quality standard is needed

Induction of labour is a relatively common procedure. Every year in the UK approximately 1 in 5, or 122,000, labours are induced.

Labour is induced when it is thought that the outcome of the pregnancy will be better if labour is artificially started. A variety of clinical circumstances may indicate the need for induction of labour, with a greater or lesser degree of urgency. The essential judgement that the clinician and the pregnant woman must make is whether the interests of the mother or the baby, or both, will be better served by inducing labour or continuing the pregnancy. The woman's wishes must be taken into account, and the relative risks of continuing the pregnancy compared with inducing labour discussed with her.

Induction of labour has an impact on birth experience and the health of women and their babies, and so needs to be clinically justified. It may be less efficient and is usually more painful than spontaneous labour. Epidural analgesia and assisted delivery are more likely to be needed if labour has been induced.

The quality standard is expected to contribute to improvements in the following outcomes:

  • fewer complications during labour, for example the proportion of instrumental deliveries

  • birth experience of mothers who have their labour induced

  • satisfaction of mothers with their participation in making the decision to induce labour.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1–2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014–15

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

Improvement area

Reducing deaths in babies and young children

1.6i Infant mortality*

1.6ii Neonatal mortality and stillbirths

4 Ensuring that people have a positive experience of care

Overarching indicator

4c Friends and family test (placeholder)

Improvement area

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a Patient safety incidents reported

5b Safety incidents involving severe harm or death

Improvement area

Improving the safety of maternity services

5.5 Admission of full-term babies to neonatal care

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

Table 2 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.1 Infant mortality*

4.3 Mortality from causes considered preventable**

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework

** Indicator complementary with NHS Outcomes Framework

Coordinated services

The quality standard for induction of labour specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole induction of labour care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to pregnant women for, and with whom, induction of labour is considered.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality induction of labour service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating pregnant women who may have their labour induced should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of partners, families and carers

Quality standards recognise the important role partners, families and carers have in supporting pregnant women who have their labour induced. If appropriate, healthcare professionals should ensure that partners, family members and carers are involved in the decision-making process about investigations, treatment and care.