Abstract
Objective
To describe and examine the EXIT (EXperiences of Induction Tool), and report on the
experience of women undergoing PGE2 vaginal gel IOL, who were participants in a randomized
controlled trial comparing early amniotomy with repeat-PGE2.
Study design
Following an evening dose of PGE2 vaginal gel, 245 women with live singleton term
pregnancies were randomized to amniotomy or repeat-PGE2. Women’s experience of IOL
was a secondary outcome measure, assessed using the self-report EXIT administered
by phone at 7–9 days post-partum. The 10-item EXIT assessed women’s experiences in multiple domains
using a 5-point agreement scale. Principal components analysis with orthogonal varimax
rotation was undertaken to examine the scale structure. Internal consistency, face,
content, construct and discriminant validity were also assessed.
Results
The final 3-component solution comprised 8 of the 10 EXIT items, explained 76.1% of
the variance and had a good fit to model (p < 0.001). The three resulting components were representative of women’s experience of
the time taken to give birth, discomfort with IOL, and subsequent contractions. The
items loading to each component showed good internal consistency for time taken to give birth (α = 0.88), discomfort with IOL (α = 0.78), and experience of subsequent contractions (α = 0.87). Women in the repeat-PGE2 group reported a less favorable experience with the
time taken to give birth (mean (SD): 3.5 (1.4) vs 3.9 (1.2); p = 0.04) and more discomfort with IOL (2.9 (1.1) vs 2.5 (1.0); p = 0.04) compared to women in the amniotomy group. At the individual item level, women
in the amniotomy group responded more positive about the time taken to have their
baby (median (IQR): 4 (3–5) vs 3 (2–5); p < 0.01); and less negative to the question about the number of vaginal examinations
(2 (1–3) vs 2 (1–4); p = 0.05).
Conclusions
The EXIT shows promise as an instrument for assessing women’s experience of IOL. Women
undergoing PGE2 vaginal gel IOL reports a more positive experience with an early amniotomy
rather than with repeat-PGE2.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A systematic review of evidence on the links between patient experience and clinical safety and effectiveness.BMJ Open. 2013; 3
- What determines quality in maternity care: comparing the perceptions of childbearing women and midwives.Birth. 1998; 25: 85-93
- Satisfaction with pregnancy and birth services: the quality of maternity care services as experienced by women.Midwifery. 2011; 27: e231-7
- Morning compared with evening induction of labor: a nested randomized controlled trial: a nested randomized controlled trial.Obstet Gynecol. 2006; 108: 350-360
- Programmed induction of labor for primiparous women to ensure daytime delivery.Asia Oceania J Obstet Gynaecol. 1987; 13: 405-415
- Induction of labour in nulliparous women with an unfavourable cervix: a randomised controlled trial comparing double and single balloon catheters and PGE2 gel.BJOG. 2009; 116: 1443-1452
- Outpatient Foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial.BMC Pregnancy Childbirth. 2013; 13: 25
- Inpatient versus outpatient cervical priming for induction of labour: therapeutic landscapes and women's preferences.Health Place. 2011; 17: 379-385
- The home as an appropriate setting for women undertaking cervical ripening before the induction of labour.Midwifery. 2011; 27: 30-35
- Women’s acceptance of a double-balloon device as an additional method for inducing labour.Eur J Obstet Gynecol Reprod Biol. 2013; 168: 30-35
- Australia’s mothers and babies.AIHW, 2010
- Induction of Labour Clinical Guideline.Health NCCfWsaCs, London2008
- ACOG practice bulletin No. 107: induction of labor.Obstet Gynecol. 2009; 114: 386-397
- WHO Recommendations for Induction of Labour.Department of Reproductive Health and Research, Geneva2011
- The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature.Health Technol Assess. 2002; 6: 1-244
- Patient satisfaction: a review of issues and concepts.Soc Sci Med. 1997; 45: 1829-1843
- Moving toward patient-centered care: women’s decisions, perceptions, and experiences of the induction of labor process.Birth. 2014; 41: 138-146
- Prostaglandin vaginal gel induction of labor comparing amniotomy with repeat prostaglandin gel.Am J Obstet Gynecol. 2015; 213 (e1-9): 859
- Principal components and factor analysis.Using multivariate statistics. 4th edition. Massachusetts Allyn & Bacon, 2001
- A Step-by-Step Approach to Using the SAS System for Factor Analysis and Structural Equation Modeling.SAS Institute, 1994
- Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis.Pract Assess Res Eval. 2005; 10: 1-9
- Measures of satisfaction with care during labour and birth: a comparative review.BMC Pregnancy Childbirth. 2013; 13: 108
- Ten common misunderstandings, misconceptions, persistent myths and urban legends about likert scales and likert response formats and their antidotes.J Soc Sci. 2007; 3: 106-116
- Likert scales: how to (ab)use them.Med Educ. 2004; 38: 1217-1218
- Likert scales, levels of measurement and the laws of statistics.Adv Health Sci Educ Theory Pract. 2010; 15: 625-632
Health Round Table Induction of Labour Report. Sydney; (2014).
- Differences in the evaluation of postnatal midwifery support by multiparous and primiparous women in the first two weeks after birth.Women Birth. 2003; 16: 18-24
- Induction of labour with a viable infant: a randomised clinical trial comparing intravaginal misoprostol and intravaginal dinoprostone.BJOG. 2001; 108: 1255-1262
- Cervical ripening with a Foley catheter: the role of pre- and postripening ultrasound examination of the cervix.Am J Obstet Gynecol. 2007; 196: 41 4e1-7
- Her master’s voice? Amniotomy in Dublin.Br J Midwifery. 2000; 8: 110
- Induction of labour with an unfavourable cervix.Best Pract Res Clin Obstet Gynaecol. 2003; 17: 777-794
- Women’s perceptions, expectations and satisfaction with induced labour-a questionnaire-based study.Eur J Obstet Gynecol Reprod Biol. 2005; 123: 56-61
- Women's anticipations of and experiences with induction of labor.Acta Obstet Gynecol Scand. 1999; 78: 704-709
- Maternal attitudes to amniotomy and labor duration: a survey in early pregnancy.Birth. 1999; 26: 211-214
- Women’s concerns and satisfaction with induced labour at term in a Nigerian population.Niger Postgrad Med J. 2013; 20: 1-4
- Induction of labor using prostaglandin vaginal gel: cost analysis comparing early amniotomy with repeat prostaglandin gel.Eur J Obstet Gynecol Reprod Biol. 2016; 199: 96-101
Article info
Publication history
Published online: December 28, 2016
Accepted:
December 23,
2016
Received in revised form:
November 20,
2016
Received:
July 30,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
