Supplementing provider counseling with an educational video prior to scheduled induction of labor

Abstract

Background

Induction of labor (IOL) is common with one in four labors being induced in the United States (US). IOL has been associated with lower birth satisfaction. Video education can address gaps in education and promote anticipatory guidance. Prior studies in obstetrics have focused on randomized designs in English-speaking patients, leaving opportunities to explore how these tools perform in a pragmatic fashion with diverse patient populations. Our objective was to evaluate the effects of a video education tool on patient satisfaction and knowledge of IOL experience in English and Spanish-speaking patients scheduled for IOL at a tertiary care hospital.

Methods

This was a single site pragmatic implementation of a quality improvement measure at an academic hospital. A bilingual survey was developed to evaluate the impact of an educational video on birth satisfaction and knowledge of IOL procedures. The video is freely available in English and Spanish. Baseline postpartum surveys were collected from June to July 2021. The video was subsequently recommended by providers when scheduling IOLs. Post-intervention surveys were collected from September to November 2021 after an implementation period. Groups were compared using t-tests for satisfaction scores and chi-square analyses for categorical variables.

Results

Thirty-two participants completed the baseline survey and 72 completed the post-implementation survey with response rates of 88.9% and 91.1%, respectively. There were no statistically significant changes between mean total satisfaction scores (26.9 vs 28.0 out of 40.0, p = 0.290). 61 participants were English speaking (58%) and 43 Spanish (42%). Thirty (42%) patients reported watching the video.

Correct identification of amniotomy use improved in the post-intervention group (p = 0.002). No changes were seen in anticipated duration of labor nor in whether patients would choose to be induced again.

Conclusions

Recommendation of video education before scheduled IOL was associated with little improvement in knowledge about IOL, but no significant improvement in patient satisfaction. While video education has improved these measures in randomized trials, our study demonstrated that real-world implementation and patient uptake may be initially difficult. This study may help providers emphasize direct education and counseling and promote optimal implementation of innovative educational media.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-024-06842-z.

Background

Induction of labor (IOL) in the United States has increased as data demonstrate its safety and benefits on obstetric outcomes. Approximately one in four labors are induced, with higher rates for first-time births [1]. In a brief clinic visit, managing IOL expectations is challenging [2]. This can lead to patients feeling surprised by the process [3–5]. Additional factors that lower satisfaction include longer labor duration and ultimate cesarean delivery [3]. Qualitative studies show that patients wish to be part of decision making during IOLs [6, 7]. If patients better understand IOL processes prior to admission, there is potential to notably impact birth satisfaction. Higher birth satisfaction has positive cascading effects, including postpartum visit attendance and improved emotional health [8]. 

Videos are a unique way to supplement provider counseling. This medium has demonstrated positive effects on quality measures in several specialties [9–12]. A video about cesarean section anesthesia increased satisfaction and decreased anxiety [10, 12]. Similarly, a randomized trial found that providing a brief video on admission for IOL improved knowledge and birth satisfaction [11]. We sought to implement this proven tool at our institution as a quality improvement measure for English and Spanish speaking patients.

The objective of this study was to assess birth satisfaction in English and Spanish-speaking patients scheduled for term IOL after recommendation of an educational video at clinic appointments prior to admission. Our secondary aim was to evaluate knowledge of agents received and expected duration correctness.

Methods

Study design

This is a pragmatic implementation of a quality improvement measure using an educational video for patients scheduled for IOL. This is a single site study at Eskenazi Hospital, the county hospital in Indianapolis, Indiana. 2547 deliveries occurred in 2021, approximately 25% were scheduled IOL and 16% were primary cesarean deliveries. Pre-implementation surveying took place over a four-week period and post-implementation over an eight-week period, from June to July and September to November 2021, respectively. There was a delay between completion of pre- and post-implementation collection to allow implementation of the video into clinic workflow.

Eligibilty criteria

Patients were eligible for the study if 18 years and older, admitted to the postpartum unit, able to read English or Spanish, and had been scheduled for a term medically-indicated IOL (≥ 37 weeks) or elective IOL (patient requested at ≥ 39 weeks). Patients were excluded if admitted for IOL from triage or directly from clinic given lack of time to watch the video. Survey instructions explicitly stated that completion of the survey implied the participant’s informed consent. This study was approved by the medical school Institutional Review Board and the hospital Research Committee.

Participants were screened by reviewing the induction schedule and assessing eligibility criteria. Research team members distributed surveys to eligible participants while admitted to the postpartum unit 24–72 h after delivery. Postpartum patients are routinely admitted approximately 48 h post-vaginal delivery and 72 h post-cesarean. Written instructions described the participant’s implied consent and explained data extraction and confidentiality procedures. Patients were able to withdraw from the study at any time. Surveys were collected prior to discharge and responses entered into a REDCap database after anonymization. Incomplete surveys were omitted. Paper copies were securely destroyed in compliance with federal patient information privacy laws.

Intervention

At our institution, IOL counseling is provided by obstetricians, family medicine physicians, and women’s health nurse practitioners. There is not a standardized counseling process or form. The video used in this study was evaluated in a randomized trial in 2019 [11]. A Spanish version was subsequently created by that team and allowed for use in this study. Permission to use the video in this study was obtained from the creators. The video uses animations to explain reasons for IOL, typical duration, mechanisms of available IOL agents, and indications for cesarean delivery (Appendix A). It is approximately three minutes long and concludes with advice for patients preparing for IOL. Per the prior trial, informal feedback was obtained from nurses, patients, and obstetric providers during design. 67% of the trial participants stated they would recommend the video to others [11].

Our hospital has eight sites for outpatient obstetric care. Providers were notified of intervention start via e-mail and verbally at staff meetings. Bilingual handouts with instructions and a QR-code linking to the video were provided to clinic managers and medical assistants to distribute to patients scheduled for IOL with check-out paperwork (Fig. 1). Staff were to encourage the video to all scheduled patients regardless of meeting study eligibility criteria. The research team also sent electronic versions of the video handout a week in advance via the patient-provider messaging application to scheduled patients.

Fig. 1.

QR-Code for English IOL Educational Video with Provided Instructions

A bilin14-item survey was developed to evaluate study objectives. There are no validated knowledge assessments for IOL to our knowledge; therefore, two questions regarding agents used and duration were written by the authors and have not been externally validated. The post-implementation survey included a question about whether the participant watched the video. These questions were translated by certified Spanish interpreters and reverse translated to English to confirm fidelity (Appendix B).

The next survey section consisted of the Birth Satisfaction Scale-Revised (BSS-R), a 10-question psychometric survey validated in several languages, including American English and Spanish [13, 14]. The survey is written at the sixth grade reading level and validated for use in the first 10 days postpartum. An item from the Listening to Mothers questionnaire inquiring whether the respondent would opt for induction in future pregnancies was used. Last was a free text area for comments on what participants would have liked to know prior to arrival.

Outcomes

To assess knowledge on IOL agents used, we compared patient selections on the list of induction agents to those documented as administered in the electronic medical record. The BSS-R is scored on a Likert scale of 0 to 4. The BSS-R is scored out of a total of 40 where a higher score indicates higher satisfaction. There are three subsets of the BSS-R: stress experienced during labor (items 3, 4, 9, 11), women’s personal attributes (6, 10), and quality of care provisions (5, 7, 8, 12). There is no standard score set for ‘satisfied’ versus ‘dissatisfied,’ rather it is a global perception of care [13]. The Listening to Mothers item about opting for future induction was scored on a Likert scale of 0 to 3.

Other measures and variables

We collected baseline demographic characteristics including age, preferred language, race and ethnicity, BMI on admission, parity, indication for induction, initial cervical dilation, medical comorbidities, delivery mode, duration of labor, analgesia use, infant APGARs, and postpartum Edinburg Perinatal Depression Scale scores (collected routinely during postpartum inpatient care). This information was collected by research team members and electronically entered into REDCap under a study identification number to maintain confidentiality.

Sample size

We modeled our anticipated degree of change from the previous randomized control trial that employed this tool. That study noted a difference in means of 0.6 based on a 1 to 5 Likert score scale responses with a standard deviation of 0.9. We extrapolated this difference to the scoring of the BSS-R, an increase of approximately four points. Utilizing this difference, we required at least 20 participants for each group. If the difference of means were smaller for our study given the practical implementation design, we opted to enroll at least 30 participants for each group. Based on volume at our hospital, we estimated that approximately 30 patients in each group could be enrolled over six to eight week collection periods.

Statistical analysis

The primary objective of this study was to compare change in satisfaction as measured by mean total BSS-R scores between the pre- and post-implementation groups, which is reported as a continuous value between 0 and 40. The secondary outcome of IOL agent knowledge was individually assessed by each agent rather than a total percent correct. This analysis was selected to credit those who correctly identified agents that were not used and account for the variety of combinations patients may receive. Continuous variables are reported with mean and associated standard deviations. Baseline categorical characteristics were compared with chi-square tests while continuous baseline characteristics with Mann–Whitney U tests. Knowledge items were evaluated using chi-square analyses and satisfaction items evaluated using t-tests. Alpha was set at 5% for all testing and SPSS was used for analyses. Sub-analyses were used to compare these differences in the post-group between those who watched the video and those who did not, mode of delivery, and participant language.

Results

From June to July 2021, there were 55 patients scheduled for IOL. Forty nine patients were eligible and 36 were approached. We collected 32 completed surveys (88.9%). After implementation of the video implementation, we screened 152 scheduled patients from September to November 2021 and 112 were eligible. We were able to approach 79 patients and collected 72 completed surveys (91.1%) (Fig. 2). The most common exclusion criteria included age, non-English or Spanish speaking, and direct admissions for unscheduled IOL. Baseline characteristics of patients in the pre- and post-implementation groups are shown in Table 1. Self-reported race and ethnicity were abstracted from the electronic medical record. There was an unexpected statistically significant difference in BMI between the pre- and post-implementation groups with the pre-group being higher at 36.8 versus 32.8.

Fig. 2.

Screening process for eligible participants

Table 1.

Participant demographic and clinical characteristics

Characteristic	Pre-implementation (n = 32)	Post-implementation group together (n = 72)	Post-implementation (Video) (n = 30)	Post-implementation (No video) (n = 39)	P-value
Maternal age	28.2 (6.3)	28.8 (6.6)	28.7 (7.0)	28.7 (6.5)	0.31 / 0.98
Language					0.92 / 0.85
English	19 (59.4%)	42 (58.3%)	17 (56.7%)	23 (59.0%)
Spanish	13 (40.6%)	30 (41.7%)	13 (43.3%)	16 (41.0%)
Race/ethnicity					0.052 / 0.58
Black	15 (46.9%)	31 (43.1%)	12 (40%)	18 (46.2%)
Hispanic	12 (37.5%)	37 (51.4%)	17 (56.7%)	18 (46.2%)
White	2 (6.3%)	4 (5.6%)	1 (3.3%)	3 (7.7%)
Other	3 (9.4%)	0	0	0
Maternal BMI on admission, Median	36.8 (7.7)	32.8 (6.4)	32.2 (6.4)	32.8 (6.4)	0.02 / 0.71
Nulliparity	13 (40.6%)	27 (37.5%)	15 (50%)	12 (30.8%)	0.76 / 0.10
Indication for Induction					0.73 / 0.79
Elective	20 (62.5%)	38 (52.8%)	15 (50.0%)	21 (53.8%)
Fetal	1 (3.1%)	4 (5.6%)	1 (3.3%)	3 (7.7%)
Maternal	10 (31.3%)	25 (34.7%)	12 (40.0%)	12 (30.8%)
Postdate	1 (3.1%)	5 (6.9%)	2 (6.7%)	3 (7.7%)
Cervical dilation at induction start					0.058 / 0.79
< 1 cm	3 (9.4%)	22 (30.6%)	8 (26.7%)	12 (30.8%)
1–2 cm	19 (59.4%)	30 (41.7%)	14 (46.7%)	15 (38.5%)
≥ 3 cm	10 (31.3%)	20 (27.8%)	8 (26.7%)	12 (30.8%)
Gestational Diabetes	3 (9.4%)	10 (13.9%)	5 (16.7%)	5 (12.8%)	0.52 / 0.65
Pregestational Diabetes	1 (3.1%)	0 (0%)	0	0	0.13 / NA
Chronic Hypertension	4 (12.5%)	4 (5.6%)	0	3 (7.7%)	0.22 / 0.12
Hypertensive Disorder of Pregnancy	9 (28.1%)	19 (27.1%)	11 (36.7%)	8 (21.6%)	0.92 / 0.17
Epidural Use	25 (78.1%)	53 (75.7%)	22 (75.9%)	29 (76.3%)	0.79 / 0.97
Opioid Use during labor	15 (46.9%)	37 (51.4%)	19 (63.3%)	16 (41.0%)	0.67 / 0.07
Duration of Labor (hours)	17.4 (9.3)	20.4 (12.4)	20.9 (13.0)	19.8 (12.5)	0.22 / 0.71
Vaginal Delivery	27 (84.4%)	61 (84.7%)	25 (83.3%)	33 (84.6%)	0.96 / 0.88

P values are for the comparison of pre- and post-group using all post-group together / p values comparing the participants in the post-group who did and did not watch the video

Data are presented as n (%) for discrete variables or mean (standard deviation) for continuous variables

Birth Satisfaction (Table 2): There were no statistically significant changes in mean total BSS-R scores (26.9 vs 28.0, p = 0.29) or sub-domains between groups. In the post-implementation group, when comparing those who did not watch the video to those who did, there was a statistically significant increase in the quality-of-care provision scores (15.4 vs 14.5, p = 0.024). This subset is scored out of 16 points.

Table 2.

Mean BSS-R scores compared between groups

Satisfaction Assessment
	Pre-implementation (n = 32)	Post-implementation group together (n = 72)	Post-implementation (Video) (n = 30)	Post-implementation (No video) (n = 42)	P-Value*
Total BSS-R Score (40 points total)	26.87 (4.76)	28.03 (5.18)	28.97 (4.06)	27.36 (5.81)	0.29 / 0.20
Domain of BSS-R
Stress experienced (questions 3, 4, 9, 11: 16 points)	8.26 (3.15)	9.40 (3.14)	9.43 (2.83)	9.38 (3.38)	0.09 / 0.95
Quality of care (5, 7, 8, 12: 16 points)	14.81 (1.69)	14.88 (1.91)	15.43 (1.04)	14.48 (2.27)	0.87 / 0.035*
Women’s personal attributes (6, 10: 8 points)	3.75 (2.03)	3.83 (1.91)	4.10 (1.58)	3.64 (2.12)	0.84 / 0.32
If you knew then what you know now, do you think you would make the same decision about having labor induction?
Definitely yes or probably yes
	25 (78%)	57 (79%)	24 (80%)	33 (78.6%)	0.9 / 0.7

Data are presented as n (%) for discrete variables or mean (standard deviation) for continuous variables

BSS-R Birth Satisfaction Scale-Revised

 *p-value < 0.05

IOL Agent Knowledge (Table 3, Fig. 3): Compared to the pre-implementation group, there was a statistically significant improvement in correct identification that amniotomy was or was not used (p = 0.002). The correct identification that this method was not used improved to 33.3% from 28.1%. The proportion of incorrect selections decreased from 46.9% to 15.3%. Lastly, 51.4% correctly indicated that amniotomy was used versus 25% in the pre-group. Although not statistically significant, the proportion of respondents who correctly selected which agents were and were not used increased from 31.3% to 40% in the post-implementation group (p = 0.38). There were no additional statistically significant differences among remaining agents.

Table 3.

Proportion of correct selections of induction agent and actual IOL duration between groups

Knowledge Assessments
Survey Question	Pre-Implementation (Total) n = 32	Post-Implementation (Total) n = 72	Post-Implementation (Video) n = 30	Post-Implementation (No Video) n = 42	P-value Pre vs post / Video vs no video
1. Which interventions did you receive during your induction of labor? Circle all that apply
All methods correct	10 (31.3%)	29 (40.3%)	12 (40%)	17 (40.5%)	0.38 / 0.97
a. Misoprostol	21 (65.7%)	54 (75%)	21 (70%)	33 (78.1%)	0.19 / 0.45
b. Dinoprostone	32 (100%)	66 (91.7%)	28 (93.3%)	38 (90.5%)	0.19 / 0.63
c. Cervical Ripening Balloon	28 (87.5%)	66 (91.7%)	29 (96.7%	37 (88.1%)	0.33 / 0.396
d. Provider broke your water	17 (53%)	61 (84.7%)	25 (83.3%)	36 (85.7%)	0.002* / 0.96
e. Oxytocin	18 (56.3%)	47 (65.3%)	18 (60%)	29 (69%)	0.50 / 0.63
2. Approximately how long did you expect your induction of labor to take (from beginning until delivery of your baby)? a. 1 to 8 h b. 8 to 16 h c. 16 to 24 h d. More than 24 h
Number identifying the correct time interval to what occurred	9 (28.1%)	18 (25%)	10 (33.3%)	8 (19%)	0.74 / 0.17

Data are presented as n (%) for discrete variables or mean (standard deviation) for continuous variables

^*p-value < 0.05

Fig. 3.

Comparison of IOL agent correctness between pre and post-implementation groups

Duration of Labor Correctness (Table 3): A higher number of participants in the post-implementation group correctly anticipated the duration of their induction course compared to the pre-implementation group, though this difference was not significant (33% vs 19%, p = 0.17).

Future Repeat IOL (Table 3): There were no significant differences between groups on whether participants would elect to be induced in a future pregnancy. In both groups, approximately 80% of patients would probably or definitely choose to be induced again.

Feasibility: After implementation of the video education tool in the office setting starting in July 2021, 30 out of 72 respondents reported having watched the video prior to induction. This indicates an early implementation success rate of 42%.

Comments: Informal review of feedback demonstrate themes of pain control, IOL duration, autonomy, and expectations versus experience. Time was the most commented on aspect of induction in both groups. Among participants who watched the video, there was one comment on long induction duration versus 10 among those who did not watch the video. Three comments in the post-group who did not watch the video requested to know more beforehand, such as “all the pros and cons,” “explain everything I wanted to know,” and “so much more I would have wanted to know.” One participant wrote: “I would have wanted to be informed by the doctors or have watched videos on different forms of induction.”

Subgroup Analyses (Table 4): Analysis by participant language demonstrated similar mean satisfaction scores in Spanish and English speakers (27.74 vs 27.62, p = 0.91). Spanish speakers reported significantly higher quality-of-care scores compared to English speakers (15.3 vs 14.5, p = 0.021). Spanish speakers were slightly less likely to watch the video compared to English speakers, despite the distribution of Spanish promotional materials (43.3% vs 56.7%, p = 0.8).

Table 4.

Subgroup analysis of mean satisfaction scores by language and mode of delivery

Participant Language	English	Spanish	p-value	Vaginal	Cesarean	p-value
Total BSS-R (40 points)	27.63 (5.50)	27.74 (4.41)	0.913	28.07 (5.21)	25.56 (3.61)	0.069
BSS-R Stress (16 points)	9.12 (3.41)	8.98 (2.85)	0.826	9.36 (3.17)	7.44 (2.73)	0.025*
BSS-R Quality (16 points)	14.54 (2.17)	15.30 (1.10)	0.021*	14.82 (1.91)	15.06 (1.48)	0.627
BSS-R Personal (8 points)	4.05 (1.97)	3.47 (1.87)	0.131	3.94 (1.99)	3.06 (1.48)	0.095

Data are presented as mean (standard deviation)

BSS-R, Birth Satisfaction Scale-Revised

*p-value < 0.05

Evaluating scores by mode of delivery revealed a nonsignificant trend toward higher satisfaction in patients who had a vaginal versus cesarean delivery (28.07 vs 25.56, p = 0.07). This difference was driven by worse stress subset scores in the cesarean group (7.44 vs 9.26, p = 0.025).

Discussion

Our study found that implementation of an educational video for patients before scheduled IOL was associated with small, though not statistically significant, increases in mean satisfaction scores as measured by the BSS-R. Spanish speakers were less likely to watch the video. There was a significant increase in quality-of-care scores in patients who reported watching the video and in Spanish speakers compared to English speakers. Patients who ultimately had a cesarean delivery reported worse stress scores; the cesarean rate was overall low (19.4%) providing a small sample size, which limits generalizability. However, these results are consistent with prior studies on the impact of unplanned cesarean delivery on birth satisfaction [15].

We noted that the post-implementation group who watched the video tended to better estimate labor duration and correctly identify the agents used during their induction, particularly for amniotomy. While not statistically significant, an improvement of 9% and 5.2%, respectively, may be clinically significant. Our data demonstrated that most patients would choose to be induced again. This is reassuring in our patient population, where we have noted an increase in the number of elective IOLs. Setting realistic expectations for patients can go a long way toward strengthening shared decision-making with the care team [16].

Prior studies examining video education demonstrate robust improvements in patient knowledge of diagnoses and procedures, as well as satisfaction [9–12]. A video explaining prenatal genetic tests resulted in increased knowledge scores, decreased testing uptake, and decreased decisional regret [17]. Another study evaluated a coaching video for pushing provided at the initiation of the second stage of labor, which improved patient comfort during birth and positive feelings toward their physician team [18]. However, current studies available on this topic are randomized in which participants watch videos during hospitalizations or clinic visits immediately prior to the relevant procedure. To our knowledge, there are no published studies designed as a pragmatic outpatient implementation to evaluate feasibility and real-world results. Our study demonstrates that patient uptake may be initially difficult. We plan to continue utilizing the video and assessing barriers to patient engagement.

Secondly, to our knowledge, obstetric-related video education studies in the US have exclusively been conducted in English speaking patients. The Hispanic birth rate is 63.1 out of 1,000 births in the US [1]. A focus group study assessing barriers to prenatal care in Spanish speaking patients identified that language poses significant difficulty to effective communication with English speaking providers [19]. The Spanish version is recorded in Spanish rather than relying on translated captions. Our study was not powered to directly compare English and Spanish speaking participants; however, provides useful information for opportunities to improve pre-procedure counseling in this growing population and prioritizing culturally competent care.

Although our study did not demonstrate robust increases in quality measures as previously reported, we continue to use this tool. The cost-effectiveness and convenience of a free online video cannot be overstated. This is illustrated by the creation of a Spanish version since the initial randomized trial evaluating this video. There is potential for translation into several languages to serve the diversifying US obstetric population. Further, it is a patient-controlled media, empowering the user to replay, adjust playback speed, and share with support persons.

Our data provide insight into optimizing in-person counseling. Stress and personal attributes were the lowest scoring components of the BSS-R of all participants. These questions revolve around autonomy, perceived support, and communication. Although the video clearly addresses the objective aspects of an IOL, certainly there is room to improve communication techniques and emotional support. Free text comments illustrated that patients wish to understand more about pain control options and the time course of IOL, which can efficiently be integrated into counseling. Less straightforward is adding the possibility of cesarean delivery to pre-admission counseling, as this may lead to IOL incorrectly being perceived as a risk for cesarean delivery and may overshadow important aspects of IOL. The semantics and timing for discussion on unplanned, intrapartum cesarean during IOL is an important area for further exploration to balance these competing goals; however, our results highlight the importance of keeping patients apprised of IOL progress and using shared decision-making.

Future research may focus on more reliable distribution and uptake strategies and capitalizing on patient-captured time, such as providing the video while waiting for clinic appointments or during antenatal surveillance testing. The proportion of patients with access to internet outside of our hospital is unknown, which may have limited accessibility. Evaluation after prolonged implementation of this kind of satisfaction improvement measure may prompt assessment of improved downstream effects, such as postpartum attendance rates or depression scale scores. There are emerging data utilizing virtual reality for coping in labor, which could be extended to prenatal education to take anticipatory guidance to the next level [16].

Strengths of this study include its pragmatic approach, allowing us to assess results of a practical implementation model in an outpatient setting in preparation for scheduled IOL. The video employed was selected as it is free, brief, and previously proven to significantly increase patient satisfaction and IOL agent knowledge, although without use of a validated survey. Most notable was our inclusion of Spanish speaking patients, which comprises a large proportion of our patient population. In general, our study population was diverse (< 10% White) and our data provide information on populations most at risk for negative maternal and neonatal health outcomes. Lastly, our study utilized a validated birth satisfaction tool for both English and Spanish speakers to evaluate the video’s impact.

This study is limited by its small sample size. Based on the difference in means obtained in our study, 325 participants would have to be recruited in each group to achieve statistical significance with a power of 80%. This would require approximately two years to enroll for a small improvement. Our groups were evaluated during distinct times of year and the confounding effects of weather and rotating staff in an academic hospital on patient mood and experience cannot be effectively controlled. Importantly, we appreciate that just over half of the patients in the post-implementation group reported that they did not watch the video, which limits our ability to attribute noted improvements in scores to the video alone. We also note the potential for recall bias in the setting of self-reported video watching and the possibility that selecting ‘yes’ may mean having watched a different video. However, the intention of this study as a pragmatic implementation design prevented our ability to randomize or require participants to watch the video. Lastly, there is likely a component of improved pre-procedural counseling related to a Hawthorne Effect as providers were encouraged to recommend the video.

Conclusions

IOL is a unique opportunity for patient education innovation with its frequency and the demonstrated impacts on birth experience. As we strive to improve obstetric and neonatal outcomes, pre-procedural anticipatory guidance remains of clear importance as an area for actionable improvement. Although practical implementation of video education did not robustly improve already-high satisfaction scores in this study and minimally impacted knowledge, continued efforts to integrate innovative supplemental counseling techniques may still positively impact birth experience.

Abbreviations

BSS-R

Birth Satisfaction Scale-Revised

IOL

Induction of labor

US

United States

Authors’ contributions

KP: conceptualization, survey distribution, data collection, writing – original draft preparation and figure preparation. SF: survey distribution, data collection, writing – reviewing and editing. DH: methodology, writing – reviewing and editing, supervision, formal analysis. All authors read and approved the final manuscript.

Funding

Funding was provided from the Indiana University School of Medicine Department of Obstetrics & Gynecology for the printing of paper products to promote distribution of the educational video.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to protected health information, but are available from the corresponding author on reasonable request. Datasets are stored securely in REDCap.

Declarations

Ethics approval and consent to participate

IRB #11709 approved on June 1, 2021 by the Indiana University Human Research Protection Program.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.