title: The impact of outpatient priming for induction of labour on midwives' work demand, work autonomy and satisfaction.
abstract: BACKGROUND
  Induction of labour often begins with the application of a priming agent to soften the cervix, generally requiring women to stay in hospital overnight (inpatient priming). An alternative is outpatient priming by a midwife, where women are allowed to go home following priming. This approach has the potential to impact, either positively or negatively, on the midwives involved.
  
  
  OBJECTIVE
  To what extent did the introduction of outpatient priming influence midwives' work demands, work autonomy, stress and job satisfaction.
  
  
  METHODS
  A before-after study (with two separate cross-sectional samples) was conducted alongside a randomized controlled trial of outpatient versus inpatient priming, conducted at two metropolitan teaching hospitals in Australia. Midwives completed a questionnaire before the introduction of outpatient priming and again approximately two years later.
  
  
  RESULTS
  208 midwives participated (response rates-time 1:81% (87/108); time 2:78% (121/156)). A mixed model analysis test of pre-post intervention differences found no changes in work demand, work autonomy and satisfaction. At time 2, over 80% of midwives reported that the introduction of the practice had reduced or made no difference to their work stress and workload, and 93% reported that outpatient priming had increased or had no impact on their job satisfaction. Furthermore, 97% of respondents were of the opinion that the option of outpatient priming should continue to be offered.
  
  
  CONCLUSIONS
  Results suggest that outpatient priming for induction of labour is viable from a midwifery practice perspective, although more research is needed.
authors.affiliation: School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA 5005, Australia. deborah.turnbull@adelaide.edu.au
authors.forename: Deborah
authors.initials: D
authors.lastname: Turnbull
authors.forename: Pamela
authors.initials: P
authors.lastname: Adelson
authors.forename: Candice
authors.initials: C
authors.lastname: Oster
authors.forename: Judy
authors.initials: J
authors.lastname: Coffey
authors.forename: John
authors.initials: J
authors.lastname: Coomblas
authors.forename: Robert
authors.initials: R
authors.lastname: Bryce
authors.forename: Chris
authors.initials: C
authors.lastname: Wilkinson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007588:Job Satisfaction; D007751:Labor, Induced / Q000379:methods*; D008875:Middle Aged; D010045:Outpatients; D011247:Pregnancy; D017009:Professional Autonomy; D011795:Surveys and Questionnaires; D016526:Workload / Q000523:psychology*
keywords: Cervical ripening; Induced; Job satisfaction; Labor; Midwifery; Outpatients; Professional autonomy