Inducing labour in the United Kingdom: A feminist critical discourse analysis of policy and guidance

Induction of labour (IOL), the process of starting labour artificially, is one of the most commonly performed procedures in maternity care in the United Kingdom (UK), yet there is debate whether inducing labour at ‘term’, in the absence of specific medical indication, is beneficial and reduces risk of stillbirth. Moreover, rates of routine IOL are rapidly rising in the UK, despite uncertainty about the evidence base and parents reporting receiving a lack of balanced information about the process. As a contested area of maternity care, the language used to debate, describe and discuss IOL takes on added significance and requires in-depth examination and analysis. To address this, we conducted a feminist critical discourse analysis on policy and professional writing about IOL in the UK, focusing on how these both reflect and construct social practices of pregnancy and birth. Our analysis identified a double discourse about IOL, which we term ‘explicit-implicit discourse of care’, revealing the differences between what is expected to be said and what is really said. Though most texts displayed an explicit discourse of care, which espoused women-centred care and informed choice, they also conveyed an implicit discourse of care, primarily composed of three key dimensions: women as absent actors, disembodiment, and evidence as a primary actor. We argue that this explicit-implicit discourse functions to preserve healthcare professionals' control over maternity care and further alienate women from their own bodies while maintaining a discursive position of women-centred care and informed choice

Clinicians’ perspectives and experiences of providing cervical ripening at home or in-hospital in the United Kingdom

Acknowledgements We are grateful to those who gave their time for interviews and focus groups despite the severe workload pressures and ongoing COVID-19 pandemic. CHOICE is funded by the National Institute of Healthcare Research Health Technology and Assessment (NIHR HTA) NIHR 127569. SJS is funded by a Wellcome Trust Clinical Career Development Fellowship (209560/Z/17/Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of the National Institute of Healthcare Research or the Department of Health and Social Care.Peer reviewedPublisher PD

Exposing racial bias in midwifery education: a content analysis of images and text in Myles Textbook for Midwives

Background Race is well documented as a factor in perinatal outcomes. Inherent racial bias has been identified in healthcare learning materials. Myles Textbook for Midwives is used by thousands of midwives globally. Aims To determine how people of different skin colours are represented within Myles. Methods Content analysis of text and images in Myles Textbook for Midwives 17th Edition, 2020 Findings The images overwhelmingly depict light skinned people of White European appearance. Descriptions of skin colour in context of clinical assessment often applied mostly or solely to people with light colour skin. This text often referred to conditions associated with severe morbidity or mortality. Key conclusions Myles Textbook for Midwives presents a light skinned White European norm and often fails to include information that is clinically relevant to the assessment of people with darker skin colours. This may lead to disparity in midwifery education and contribute to poorer outcomes for women and babies

Exposing racial bias in midwifery education: a content analysis of images and text in Myles Textbook for Midwives

Background Race is well documented as a factor in perinatal outcomes. Inherent racial bias has been identified in healthcare learning materials. Myles Textbook for Midwives is used by thousands of midwives globally. Aims To determine how people of different skin colours are represented within Myles. Methods Content analysis of text and images in Myles Textbook for Midwives 17th Edition, 2020 Findings The images overwhelmingly depict light skinned people of White European appearance. Descriptions of skin colour in context of clinical assessment often applied mostly or solely to people with light colour skin. This text often referred to conditions associated with severe morbidity or mortality. Key conclusions Myles Textbook for Midwives presents a light skinned White European norm and often fails to include information that is clinically relevant to the assessment of people with darker skin colours. This may lead to disparity in midwifery education and contribute to poorer outcomes for women and babies

Experience of induction of labour:a cross-sectional postnatal survey of women at UK maternity units

OBJECTIVES: This study explored women's views and experiences of key elements of the induction of labour (IOL) process, including at home or in hospital cervical ripening (CR). DESIGN: A questionnaire-based postnatal survey undertaken as part of the CHOICE Study process evaluation. The questionnaire was administered online and included fixed response and free-text options. SETTING: National Health Service maternity units in the UK. PARTICIPANTS: 309 women who had an IOL. OUTCOME MEASURES: The primary outcome measure was experience of IOL. Few women returned home during CR, meaning that statistical comparison between those who experienced home-based and hospital-based CR was not possible. Findings are reported as descriptive statistics with content analysis of women's comments providing context. RESULTS: Information to support choice and understand what to expect about IOL is often inadequate or unavailable. Having IOL can create anxiety and remove options for birth that women had hoped would enhance their experience. Although it can provide a more comfortable environment, home CR is not always an acceptable solution. Women described maternity care negatively impacted by staffing shortages; delays to care sometimes led to unsafe situations. Women who had a positive experience of IOL described supportive interaction with staff as a significant contribution to that. CONCLUSIONS: Women do not experience IOL as a benign and consequence free intervention. There is urgent need for research to better target IOL and optimise safety and experience for women and their babies. Relatively few women were offered CR at home and further research is needed on this experience