The demographic data of the women in both groups is described in Table 1Out of 300 induced women, 196 (65%) were aware or had prior information about induction.249(84%)women knew the reason for their induction. 57% (170) were aware of the benefits of induction of labour, whereas 15%(45) had been informed about the adverse effects. 57% (172) were aware of the vaginal route of induction. Only 8% knew about the intravenous or oral route. (Table 2)
76% (227) of women were satisfied with the information provided, felt that time given to decide was adequate, while 27% (82) observed they were not allowed to discuss enough. 47% (141) of women thought that induced labour was not natural and 34% (103) had a feeling that they could have waited for spontaneous labour. 60% (189) and 63% (190) felt that induction is for the safety of themselves and their baby respectively.
40% (119) women hoped that they would deliver within 6 hours, 31% (92) felt that they would deliver within 12 hours, and 14% (44) thought it might go beyond 12 hours. Only 25% (71) were worried about the duration of labour and 21% (58) about the mode of delivery. 13% (37) worried about the discomfort related to induction. 28% (78) women were apprehensive about the pain and 19% (53) about the health of the baby.
61% (177) had a positive attitude towards labour, whereas 14% (40) had a negative attitude. 26% (75) were neutral.
After delivery, 52% (156) of women felt labour was more difficult while 29% (88) felt it was less difficult than expected. 57% (159) were willing for induction in the subsequent pregnancy and 43% (122) were not willing for the same.
Analgesia was given on demand, mostly in the latent phase of labour and in the active phase if delivery was not imminent. Injection tramadol was given intramuscularly.
54% (162/300) of women felt analgesia given was not satisfactory. 42% (126) demanded better pain relief. When feedback about the process of induction was obtained, 11% (33) felt oral medication was preferable to vaginal, 21% (64) wished for a shorter duration of labour, and 10% (31) felt the number of vaginal examination could be reduced.
45% (135) of induced women felt that the process was unbearable. When we studied factors that could have influenced this aspect, only the mode of delivery (vaginal 49% or caesarean 36%) and duration of latent phase greater than 8 hours (61%) had an impact of statistical significance (p-value < 0.04 and0.04 respectively)(Table 3). Various other factors like induction to delivery interval, parity, duration of latent phase, active phase and second stage, sex of baby, NICU admission and caesarean for failed induction didn't show any statistical significance.
Table 1
Demographic data comparison between spontaneous and Induced group
Variable
|
Induction
|
Spontaneous
|
Age (Mean ± SD)
|
27 (± 3)
|
27 (± 3)
|
Parity (n)
primi
multi
|
217 (72%)
83 (28%)
|
189 (63%)
111 (37%)
|
Period of gestation at delivery (Mean ± SD)
|
39
|
38.4
|
BMI (Mean ± SD)
|
24.2(± 4.6)
|
23.8(± 4.29)
|
Table 2
Knowledge and Awareness among the Induced Women
Question
|
Number n-300
|
Percent%
|
Awareness
Indication
Benefits
Adverse effects
|
196
249
170
45
|
65.3
83.8
56.6
15
|
► Route of induction
Oral
Vaginal
Intravenous
|
26
172
24
|
8.6
57.3
8
|
71% of women who needed instrumental delivery felt labour was unbearable compared to 47% when an instrument was not used, even though this was not statistically significant. 60% of women with third stage complication felt labour was unbearable compared to 43% of women who had no complication.
As the second part of the study, we compared the labour experience between induced women and 300 spontaneously labouring women. 68%(203) in the spontaneous group claimed to have mild to no discomfort compared to 52% (155) induced women, on the other hand, 32% (94) women in spontaneous labour felt labour unbearable compared to 45% (126) induced women which was statistically significant (p value 0.001). Both spontaneous and induced women were satisfied with the support provided during labour that is 87% and 85% respectively. Less than half the women in both groups felt that pain relief was satisfactory 45% (135) in spontaneous and 46% (138) in the induced group.. Very few women 4% (12) in spontaneous and 5% (15) in the induced group felt pain relief was unsatisfactory. (Table 4).
Table 3
Factors influencing the pain during labour process
Factor
|
Unbearable
|
Not unbearable
|
p-value
|
Latent phase
< 8(hrs)
> 8.1
|
77 (44%)
27 (61%)
|
97 (56%)
17 (39%)
|
0.04
|
Mode
Vaginal
Caesarean
|
97 (49%)
36 (36%)
|
102 (51%)
65 (64%
|
0.04
|
Instrumental delivery
Yes
No
|
10 (71%)
87 (47%)
|
4 (29%)
98 (53%)
|
0.078
|
Third stage complications
Yes
No
|
15 (60%)
118 (43%)
|
10 (40%)
157 (57%)
|
0.09
|
Women in both groups were provided with a visual analogue scale to describe their mood during the process of labour.
The parameters considered were whether they were sad or happy, worried or trusting, felt frightened or safe, tired or energetic. While comparing the two, more induced women felt sad (p < 0.001) and tired (p = 0.01) compared to the spontaneous group. (Table 5) There was no difference between the two groups among the other parameters.
Table 4
Comparison among Spontaneous and Induced Women
|
Spontaneous
|
Induction
|
Significance
|
Process of labor
1. No discomfort
2. Mild discomfort
3. Unbearable
|
119 (39.6%)
86 (28.8%)
95 (31.6%)
|
39 (13%)
126 (42%)
135 (45%)
|
< 0.001
|
Support during labor
1. satisfactory
2. neutral
3. unsatisfactory
|
260 (87%)
24 (8%)
13 (4%)
|
257 (85%)
17 (6%)
12 (4%)
|
0.69
|
Pain relief
1.satisfactory
2. not much
3. unsatisfactory
|
135 (45%)
115(51%)
12 (4%)
|
138 (46%)
147 (49%)
15 (5%)
|
0.68
|
Table 5
VAS
|
Spontaneous
|
Induced
|
Significance
|
1.depression to happy
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
|
29 (10%)
48 (17%)
53 (19%)
109 (38%)
47 (16%)
|
25 (9%)
60 (21%)
114 (40%)
53 (19%)
29 (11%)
|
< 0.001
|
2. worried to trusting
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
|
25 (9%)
59 (20%)
68 (24%)
95 (33%)
41 (14%)
|
27 (10%)
68 (24%)
51 (18%)
84 (30% )
50 (18%)
|
0.93
|
3.frightened to safe
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
|
37 (13%)
68 (24%)
60 (21%)
80 (28%)
39 (14%)
|
28 (10%)
79 (28%)
64 (23%)
68 (24%)
41 (15%)
|
0.96
|
4 tired to energetic
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
|
51 (18%)
92 (32%)
47 (16%)
67 (23%)
29 (10%)
|
47 (17%)
102 (37%)
60 (22%)
51 (18%)
18 (6%)
|
0.14
|