Overdue Choices: How Information and Role in Decision-Making Influence Women’s Preferences for Induction of Labour

This study aimed to determine the effect of healthcare providers’ communication on women’s preferences for a common obstetric intervention, induction of labour for prolonged pregnancy (>41 weeks gestation). We predicted that directive information (biased towards induction) and a lack of encouragement for patient decision-making would lead to the greatest preferences for induction, due to the heightened risk and lack of choice they implied. It was thought that this effect would be reduced for participants with prior knowledge on induction, non-medicalised views of childbirth, and low trust in doctors. A total of 595 women (19-71 years) completed an online questionnaire featuring a hypothetical scenario, in which an obstetrician discusses induction of labour with a pregnant patient. Within the scenario, communication of information about the consequences of available decisions (non-directive vs. directive) and patient role in decision-making (choice vs. compliance) were manipulated, and participants were randomly allocated to one of four experimental conditions (non-directive choice, nondirective compliance, directive choice, directive compliance). Participants were asked to imagine themselves in the patients’ position and report whether they preferred an induction or not. As predicted, directive communication of information led to significantly higher preferences for induction, than non-directive communication and this effect was smaller for participants with low trust in doctors. These results suggest that a pregnant woman’s ability to make informed health decisions can be affected by variations in communication of information about likely decisional consequences. Overall findings from this research highlight the need for the development of interventions to increase the prevalence of informed decision-making in maternity care settings, to ensure that women are able to make the best possible choices