Quality standard

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

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 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.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

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

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

Process

a) Proportion of women who are induced as outpatients who agree a review plan before they go home.

Numerator – the number in the denominator who agree a review plan before they go home.

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

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Proportion of women who are induced as outpatients who are given information on when to contact their midwife, maternity unit or obstetrician.

Numerator – the number in the denominator who are given information on when to contact their midwife, maternity unit or obstetrician.

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

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

a) Maternal safety.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The NHS Digital Maternity Services Data Set includes data on maternal safety including a maternal critical incident indicator.

b) Newborn safety.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The NHS Digital Maternity Services Data Set includes data on newborn safety including a neonatal critical incident indicator.

What the quality statement means for different audiences

Service providers ensure that safety and support procedures 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.

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

Women who have induction of labour (labour that is artificially started, for example, using a pessary, tablet or gel) started in a hospital maternity unit and then go home to wait for the induction to work agree a review plan before they leave the unit. They are given information about contacting their midwife, maternity unit or obstetrician when contractions start, if there are no contractions, if their membranes rupture, if they develop bleeding or if they have any concerns. They are also given information about the types of pain relief available.

Source guidance

Inducing labour. NICE guideline NG207 (2021), recommendations 1.6.2, 1.6.3 and 1.6.4

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:

  • Agreeing a review plan with the woman before she returns home.

  • Giving women information about when to contact their midwife, maternity unit or obstetrician, such as:

    • when contractions begin

    • if there are no contractions (in an agreed timeframe, depending on the method used)

    • if her membranes rupture

    • if she develops bleeding

    • if she has any other concerns (such as reduced or altered fetal movements, excessive pain or uterine contractions, side-effects or loss of the pessary or device).

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

[NICE's guideline on inducing labour, recommendations 1.5.7, 1.6.3 and 1.6.4]