Offering women a choice in induction of labour: a prospective cohort study

Purpose 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. Methods We conducted a comparative, prospective cohort study of 520 women who chose their preferred method for labour induction, in a French tertiary hospital, from July 2019 to October 2020. Before and after the delivery, they were asked to argument their choice and to evaluate their satisfaction through the use of questionnaires. The primary outcome was 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 the 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.