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Background: Maternal health outcomes in the United States are far worse than peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted care variations. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the United States. Methods:This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. Through two sequential web-based surveys, participants submitted and ranked implementation research topics with five areas specific to implementation research: practices to prioritize for (1) broader implementation or (2) de-implementation, and research questions about (3) determinants of implementation, (4) implementation strategies, and (5) research methods/measures. Results:Eighty-two researchers, predominantly female (90%) and white (75%), volunteered to participate. Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. Conclusions: Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the maternity care quality in the United States. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.

Background Standardized labor induction protocols improve obstetric outcomes. However, these protocols are complex. The Consolidated Framework for Implementation Research describes intervention components as “core” and “adaptable periphery.” We aimed to identify core components by investigating the individual components of an evidence-based protocol most associated with effectiveness. We planned to utilize this information to simplify our protocol prior to multi-site implementation. Methods This is a secondary analysis of an RCT comparing time to delivery among four labor induction methods. All patients enrolled in the trial had their labor managed with a multidisciplinary-developed, evidence-based labor induction protocol. For each patient’s induction, we assessed fidelity to 7 components of the protocol. Primary effectiveness outcomes included cesarean delivery, maternal morbidity, and neonatal morbidity. Bivariate analyses assessed association of each component with each primary effectiveness outcome. Multivariable logistic regression determined independent predictors of each outcome while controlling for demographic and clinical factors known to be related to our outcomes. Results The 491 patients enrolled in the RCT were included in this analysis. While multiple components were associated with each outcome in bivariate analysis, few were found to be independent predictors of effectiveness in multivariable analysis. For cesarean delivery, only one component “for women in active labor, all cervical exams were performed ≤2.5 hours apart” was an independent predictor. For maternal morbidity, only one “if an intracervical Foley catheter was utilized for cervical ripening, it was removed within 12 hours of placement” remained significant. For neonatal morbidity, two components “all cervical exams performed in latent labor were performed ≤4.5 hours apart” and “for women in active labor, all cervical exams were performed ≤2.5 hours apart” remained independent predictors. Of the independent predictors of effectiveness, most reflected the overarching concept of “frequent exams in labor will allow for more frequent intervention when no change is made”.Conclusions This study demonstrates a novel strategy to identify which components of an evidence-based intervention should be “core” and which are “adaptable periphery”; this provides valuable information when designing for dissemination and implementation. With an understanding of the relationship between fidelity to individual protocol components and effectiveness, we can systematically simplify interventions prior to large-scale implementation, a potential strategy to increase implementation success. These data will be used to streamline our protocol to best target cesarean rate and maternal/neonatal morbidity prior to a planned type I hybrid effectiveness-implementation trial.

Background Decreased birth satisfaction has been associated with labor induction. Yet, there is a paucity of data evaluating risk factors for decreased satisfaction associated with labor induction. We aimed to determine what factors impact low birth satisfaction in labor induction and evaluate racial disparities in birth satisfaction. Methods We performed a prospective cohort study of women with term, singleton gestations undergoing labor induction at our institution from Jan 2018 to Jun 2018. Women completed the validated Birth Satisfaction Scale-Revised postpartum, which is subdivided into 3 domains: (1) quality of care provision, (2) women’s personal attributes, and (3) stress experienced during labor. A total satisfaction score above the mean was classified as “satisfied”, and below as “unsatisfied.” Domain and item scores were compared by race. Results Three hundred thirty of 414 (79.7%) eligible women were included. There was no significant difference in birth satisfaction by age, body mass index, Bishop score, or labor induction agent. Black women were 75% more likely to be unsatisfied than non-Black women (54.0% vs. 37.2%, OR 1.75 [95% CI 1.11–2.76], p = 0.037), nulliparas were 71% more likely to be unsatisfied than multiparas (54.2% vs. 40.9%, OR 1.71 [95% CI 1.09–2.67], p = 0.019), and women whose labor resulted in cesarean birth were almost 3 times more likely to be unsatisfied than women with a vaginal birth (67.4% vs. 42.3%, OR 2.82 [95% CI 1.69–4.70], p (p = 0.003). By race, domain 3 scores, which reflect preparedness for labor, were lower for Black women. No differences were seen for domain 1 or 2. Conclusions Black race, cesarean birth, and increasing labor length were identified as risk factors for low birth satisfaction among women who underwent labor induction. Further studies should explore interventions to target women at risk for low birth satisfaction.

Background: Decreased birth satisfaction has been associated with labor induction. Yet, there is a paucity of data evaluating risk factors for decreased satisfaction associated with labor induction. We aimed to determine what factors impact low birth satisfaction in labor induction and evaluate racial disparities in birth satisfaction.Methods: We performed a prospective cohort study of women with term, singleton gestations undergoing labor induction at our institution from 1/2018-6/2018. Women completed the validated Birth Satisfaction Scale-Revised postpartum, which is subdivided into 3 domains. A total satisfaction score above the mean was classified as “satisfied”, and below as “unsatisfied.” Domain and item scores were compared by race. Results: 330 of 414 (79.7%) eligible women were included. There was no significant difference in birth satisfaction by age, body mass index, Bishop score, or induction agent. Black women were more 75% likely to be unsatisfied than non-Black women (54.0% vs. 37.2%, OR 1.75 [95%CI 1.11-2.76], p=0.037), nulliparas were more 71% likely to be unsatisfied than multiparas (54.2% vs. 40.9%, OR 1.71 [95%CI 1.09-2.67], p=0.019), and women whose labor resulted in cesarean birth were more almost 3 times more likely to be unsatisfied than women with a vaginal birth (67.4% vs. 42.3%, OR 2.82 [95%CI 1.69-4.70], p