Decision-making and knowledge around inductions of labor: A survey study in Ireland

Background: One in five births is induced worldwide. There is increasing agreement on the importance of informed decision-making throughout pregnancy and birth. However, research suggests that birthing persons are not fully involved in the decision-making process regarding induction of labor (IOL) or receiving all the necessary information and options regarding the risks, benefits, and alternatives. This study aimed to understand women's experiences of the decision-making process around an IOL and to analyse the demographic factors influencing their experiences and knowledge. Methods: An online survey collecting quantitative and qualitative data from women who gave birth between 2018 and 2023 in Ireland was conducted. Descriptive, bivariate and multivariate analyses were performed to analyse a subset of data from the survey, focusing on decision-making and knowledge around inductions of labor. Results: Of 1091 respondents, 49.3% reported not feeling fully involved in the decision around induction, 66.8% felt insufficiently informed about inductions, and 30% did not know that they could decline an induction. Age, parity, and type of maternity care were significantly associated with involvement in decision-making and knowledge of inductions and informed refusal. Involvement in decision-making, knowledge around inductions and informed refusal was significantly higher among women with previous pregnancies, and maternity care in private health care. Discussion: A significant proportion of women did not feel well-informed on the benefits, risks, and alternatives around IOL. Suggested improvements include promoting care that respects maternal choices, preferences, and autonomy, and remains unbiased and nonjudgemental, while facilitating trusting relationships and open communication between patients and providers as a core foundation for consent and informed decision-making.