Induction of labour: Experiences of care and decision-making of women and clinicians.

BACKGROUND: There has been a rise in induction of labour over recent decades. There is some tension in the literature in relation to when induction is warranted and when not, with variability between guidelines and practice. Given these tensions, the importance of shared decision-making between clinicians and women is increasingly highlighted as paramount, but it remains unclear to what extent this occurs in routine care. METHOD: Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question "What are the views, preferences and experiences of women and clinicians in relation to induction of labour more broadly, and practices of decision-making specifically?" To identify studies, the databases PubMed, Maternity and Infant Care, CINAHL and EMBASE were searched from 2008 to 2018, and reference lists of included studies were examined. FINDINGS: 20 papers met inclusion criteria, in relation to (a) women's preferences, experiences and satisfaction with IOL; (b) women's experience of shared-decision making in relation to induction; (c) interventions that improve shared decision-making and (d) factors that influence decision-making from the perspective of clinicians. Synthesis of the included studies indicates that decision-making in relation to induction of labour is largely informed by medical considerations. Women are not routinely engaged in the decision making process with expectations and preferences largely unmet. CONCLUSION: There is a need to develop strategies such as decision aids, the redesign of antenatal classes, and clinician communication training to improve the quality of information available to women and their capacity for informed decision-making.

Improvement in iodine status of pregnant Australian women 3 years after introduction of a mandatory iodine fortification programme.

INTRODUCTION: In order to address population-level mild iodine deficiency in Australia, a mandatory iodine fortification programme of salt used in bread was introduced in late 2009. METHODS: A before-after study was conducted to assess changes in median urinary iodine concentration (MUIC) measurements, according to supplement use, in convenience samples of pregnant women attending a public antenatal clinic in a regional area of New South Wales, Australia in 2008 (n=139), 2011 (n=147) and 2012 (n=114). Knowledge and practices related to iodine nutrition were investigated in 2012, using self-administered questionnaires. RESULTS: The mild iodine deficiency confirmed pre-fortification (MUIC (IQR)=87.5 (62-123.5; n=110)) has steadily improved to 145.5 µg/L (91-252) in 2011 (n=106) and 166 (97-237) in 2012 (n=95) (sufficiency ≥ 150 µg/L). However, only women taking supplements containing iodine had MUIC indicative of sufficiency in both years surveyed post fortification (2011: 178 µg/L vs. 109 µg/L, P<0.001; 2012: 202 µg/L vs. 124 µg/L, P<0.05). Despite bread being the vehicle for iodine fortification, dairy foods remained major contributors to total iodine intake (58%). Overall knowledge regarding health implications of iodine deficiency was poor. CONCLUSIONS: Iodine status of women has improved since the introduction of mandatory iodine fortification; however supplementation is indicated during pregnancy.

Poor knowledge and practices related to iodine nutrition during pregnancy and lactation in Australian women: pre- and post-iodine fortification.

A before-after review was undertaken to assess whether knowledge and practices related to iodine nutrition, supplementation and fortification has improved in Australian women since the introduction of mandatory iodine fortification in 2009. Surveys of pregnant (n = 139) and non-pregnant (n = 75) women in 2007-2008 are compared with surveys of pregnant (n = 147) and lactating women (n = 60) one to two years post-fortification in a regional area of New South Wales, Australia. A self-administered questionnaire was completed and dietary intake of iodine was assessed using a validated food frequency questionnaire. A generally poor knowledge about the role and sources of iodine in the diet remained after fortification. Post-fortification, iodine-containing supplements were being taken by 60% (up from 20% pre-fortification) and 45% of pregnant and lactating women, respectively. Dairy foods were the highest contributors to dietary iodine intake (57%-62%). A low intake of fish and seafood resulted in this food group contributing only 3%-8% of total intake. A low level of public awareness regarding the role of iodine in health supports the need for public health strategies in addition to fortification, such as an accompanying consumer education campaign, increased uptake of supplementation, and on-going monitoring.