Quality statement 2: Safety and support for women having labour induced as outpatients

Quality statement

Women only have their labour induced as outpatients if safety and support procedures, including audit, are in place.

Rationale

Women who have their labour artificially started using pharmacological techniques sometimes leave hospital to return home (or to a setting where they do not have immediate access to the hospital), but they will return to the hospital for the delivery. Women should only leave hospital after induction is started if it is in their interests and if there are safety and support procedures in place. Continual audit of the practice of induction of labour for women who return home will allow service providers and clinical teams to ensure that this process is used for clinically appropriate reasons and to monitor outcomes for women and their babies.

Quality measures

Structure

a) Evidence of local arrangements to ensure that women who have their labour induced as outpatients are induced with safety and support procedures in place.

b) Evidence of local arrangements to ensure that the practice of outpatient induction is audited continually.

Data source: Local data collection.

Process

a) Proportion of women who are induced as outpatients who are monitored for a period of time before they go home.

Numerator – the number of women in the denominator who are monitored for a period of time before they go home.

Denominator – the number of women who are induced as outpatients.

b) Proportion of women who are induced as outpatients who are given instructions on who to contact if they experience regular contractions or have concerns.

Numerator – the number of women in the denominator who are given instructions on who to contact if they experience regular contractions or have concerns.

Denominator – the number of women who are induced as outpatients.

Data source: Local data collection.

Outcome

a) Maternal safety.

b) Newborn safety.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that safety and support procedures, including audit, are in place for women who have their labour induced as outpatients.

Healthcare professionals follow the safety and support procedures that are in place for women who have their labour induced as outpatients and take part in continual audit of the process of induction.

Commissioners ensure that they commission services from providers that can demonstrate that safety and support procedures, including audit, are in place for women who have their labour induced as outpatients.

What the quality statement means for women offered induction of labour and their partners, families and carers

Women who have induction of labour (labour that is artificially started using a pessary, tablet or gel) started in a hospital maternity unit and then go home to wait for the induction to work are offered monitoring for a time before they leave the unit, and given information about who to contact if contractions start or they have any concerns, and about the types of pain relief available.

Source guidance

Definitions of terms used in this quality statement

Outpatient

Outpatient in this context refers to women who start the process of having their labour induced in hospital and are then discharged either to home or to a setting without immediate access to inpatient care (such as an outreach antenatal clinic or a birthing centre). Women will return to hospital for delivery of the baby. [Expert consensus]

Safety and support procedures

When women have their labour induced as outpatients, safety and support procedures should include:

  • Monitoring women for a period of time before they go home.

  • Giving women instructions on who to contact (and ensuring they have immediate access to advice) if they experience contractions, if they do not experience contractions after 6 hours, or if they have any concerns.

  • Ensuring that women are told about the pain relief options available in different settings.

  • Continual audit of the process of induction.

[Adapted from Induction of labour (NICE full clinical guideline 70)]