Socioeconomic and reproductive health indicators of the women interviewed (N = 32).

*<p>Four of the medical records had “unknown”.</p

Quality of Care Framework for Severe Maternal Morbidity [13], [14].

<p>Quality of Care Framework for Severe Maternal Morbidity <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0044536#pone.0044536-Bruce1" target="_blank">[13]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0044536#pone.0044536-Hulton1" target="_blank">[14]</a>.</p

Criteria to identify potentially life-threatening conditions and near miss [16].

<p>Criteria to identify potentially life-threatening conditions and near miss <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0044536#pone.0044536-World3" target="_blank">[16]</a>.</p

Guide for in-depth interview.

Induction of labour (IOL) has become a major and vital maternal health intervention to facilitate childbirth and minimize the rising caesarean section rates globally. However, there is limited information to facilitate appropriate client counselling, birth preparedness and informed decision making although the procedure has inherent tendency for adverse maternal/perinatal outcomes. Given the need for optimal client education and shared decision making in maternal health, this study explored women’s knowledge and their lived experiences of IOL. This qualitative study used in-depth interviews, conducted at the largest teaching hospital in Ghana. Purposive sampling was used to recruit the study participants. Data analysis was performed based on thematic content using inductive framework synthesis. We included 17 women who had undergone IOL, delivered and discharged. Most participants(52.9%) were ≥30 years old, married(88.2%), and 41.1% had no previous childbirth experience. The main indications of IOL were postdate(47%), pre-eclampsia(29%) and gestational diabetes mellitus(11.8%). Data synthesis resulted in three broad themes: women’s knowledge on IOL, women’s experiences of care and women’s difficult experiences including coping mechanisms. We determined mixed responses concerning the themes explored: adequate versus inadequate knowledge; positive versus negative experiences of care and satisfaction. Nearly all women mentioned vaginal examination as their most difficult experience due to severe pain, extreme discomfort, and being psychologically traumatic. The main coping strategy the women developed to navigate the traumatic vaginal examination was by “psyching” themselves. Our study indicates women encounter significant negative and positive experiences during IOL and childbirth in Ghana with vaginal examination cited as the most painful experience. Appropriate antenatal counselling, women empowerment and pre-labour education on childbirth processes and expectations are recommended to enhance birth preparedness and complication awareness. Health system improvement and regular refreshers courses for health workers are urgently required to promote positive women’s experiences of care during labour induction and childbirth.</div

Socio-demographic characteristics of women who had induction of labour.

Socio-demographic characteristics of women who had induction of labour.</p

Social demographics of respondents for IDIs and FGDs.

Social demographics of respondents for IDIs and FGDs.</p

Unadjusted odds of accurately reporting emergency cesarean section using two definitions in the Ghana and Dominican Republic samples.

<p>Unadjusted odds of accurately reporting emergency cesarean section using two definitions in the Ghana and Dominican Republic samples.</p

Validation assessment of cesarean section indicators.

*<p>The percentages used in this column are based on the data collected from the reference standard (patient records).</p

Background characteristics of the study population based on women’s exit interviews.

a<p>Pearson’s Chi-square tests and/or Yates correction for continuity (when necessary) are used for bivariate and categorical variables. T-tests are used for continuous variables.</p

Flowchart of participation in Ghana and the Dominican Republic.

<p>Flowchart of participation in Ghana and the Dominican Republic.</p