Pregnancy and childbirth are monumental experiences for families, and it is our duty to provide them with the best possible memories. The current pandemic has inevitably caused major pressures on the NHS, and obstetrics has not been immune to these. It has encouraged adaptation of procedures to ensure we maintain safe care, with new policies being particularly sensitive to the needs of families.
The recent RCM publication1 discussed the need for outpatient services to be promoted and expanded at every possibility. Many women of childbearing age may have never had the experience of being an inpatient, so the idea of having to spend this possibly anxiety-inducing period away from families can be traumatic. In addition to this, with the current need for restricted visiting, this trauma can be even further amplified, having long term implications for women. Aiming to deliver safe and effective care is not enough, we need to ensure women have the best possible birth experience. For many, we know this means being with families for as much of their journey as possible and we have a duty to utilise every option available to make this happen.
The rapidly growing approach to allow eligible women to undergo part of the induction of labour process at home can meet the criteria for safe and effective care, as well as improving families’ experiences. Dilapan-S® provides a safe and viable option to enable outpatient induction for several reasons which are outlined below.
No associated risk of hyperstimulation and reduced demand for fetal monitoring.
Dilapan-S® does not contain hormones and will not encourage uterine stimulation. This means the fetus is not exposed to the stress of uterine tightenings and the possible emergency scenario caused by true hyperstimulation. This understandably is advantageous for a compromised fetus’, but also offers several other benefits for women that are suitable to go home, such as postdate, GDM, IVF pregnancies and raised maternal age cohort of women. The lack of artificial prostaglandins and uterine stimulation means that CTG monitoring is not indicated by Dilapan-S® itself, allowing women to transfer home after insertion.
In addition, unlike other mechanical methods, Dilapan-S® is fully licenced for use within the induction process. Understandably this is beneficial from a regulatory point of view.
Gentle on the cervix and improved overall comfort.
Dilapan-S® has a localised effect on the cervix, which gradually and gently expands and dilates the cervix (simultaneously). Women are able to rest and sleep at home and do not require the support of clinicians during the ripening period. Women should be educated about the differences and advantages of this process compared to the use of prostaglandins.
Predictable for efficient coordination.
The reduced uterine stimulation and solely mechanical mechanism of Dilapan-S® increases the predictability of the cervical ripening period and therefore, provides the enhanced ability to coordinate an outpatient IOL clinic. The outpatient IOL process becoming a routine procedure helps coordinate workload and flow through the maternity unit, whilst also reducing inpatient bed stay pressures.
We encourage an in-depth risk assessment to be undertaken to assess suitability for outpatient IOL and ensure clinicians and women are educated on the process to ensure that both understand and follow the correct procedures. We can provide information leaflets and brochures to assist with this, and strongly encourage clinicians to get in touch for support.
Dilapan-S® has already been implemented to provide outpatient IOL services in the UK, with a growing number of maternity units seeking advice to achieve this. Please contact me or one of my team to discuss how we may support you to achieve the same benefits delivered by offering a successful outpatient programme.
Please see the following example of an optimised outpatient procedure with Dilapan-S®. This will ensure the required insertion times are adhered to and the best outcomes are achieved.
Please feel free to contact me either by phone or email if you have any questions about Dilapan-S® as a product or if I can help troubleshoot through the implementation process. I will always be happy to discuss it with you.
0203 950 6415
RCM publication ’Induction of labour in a pandemic – A rapid analytic scoping review’ V2 7th April 2020 www.RCM.org.uk