Evaluation of a bespoke training to increase uptake by midwifery teams of NICE Guidance for membrane sweeping to reduce induction of labour: a stepped wedge cluster randomised design

Table 3 Primary and secondary outcomes, sub-group by trust and process outcomes

	Before training (n =1417)	After training (n = 1356)	RR (95% CI)	P value
Primary outcomes
Women offered and accepting membrane sweeping^a	629 (44.4%)	634 (46.8%)	0.90 (0.71–1.13)	0.37
Mean average (SD) number of membrane sweeps per woman	0.603 (0.795)	0.627 (0.787)	Rate ratio: 0.83 (0.67–1.01)	0.068
Secondary outcomes
Onset of labour^b
Induced	323 (22.8%)	328 (24.2%)	1.04 (0.80–1.34)	0.77
Mode of birth^c
Instrumental	235 (16.6%)	233 (17.2%)	1.06 (0.75–1.48)	0.75
Emergency CS	187 (13.2%)	177 (13.1%)	0.89 (0.63–1.26)	0.52
Sub-group by Trust
BWNFT – Adherence to Trust guidance
All women swept at 40 weeks (39 + 4 – 40 + 3)	245/921 (26.6%)	253/868 (29.1%)	0.91 (0.64–1.29)	0.596
All eligible women swept for a second time at 41 weeks^d (40 + 4 – 41 + 3)	78/504 (15.5%)	62/509 (12.2%)	0.75 (0.41–1.36)	0.339
BHH – Adherence to Trust (NICE) guidance
Nulliparous women swept at 40 weeks (39 + 4 – 40 + 3)	47/174 (27.0%)	59/173 (34.1%)	1.81 (0.84–3.92)	0.131
All eligible nulliparous women swept for second time at 41 weeks^c (40 + 4 – 41 + 3)	10/80 (12.5%)	17/88 (19.3%)	2.28 (0.59–8.87)	0.232
Multiparous women swept at 41 weeks (40 + 4 – 41 + 3)	38/152 (25.0%)	46/160 (28.8%)	0.78 (0.32–1.88)	0.574
Process outcomes
Sweeps offered but declined	80 (5.6%)	97 (7.2%)
No record of sweeping	708 (50.0%)	625 (46.1%)
Reason if abandoned
Os closed	30 (4.8%)	28 (4.4%)
Unable to reach	38 (6.0%)	20 (3.2%)
Unable to sweep	50 (7.9%)	42 (6.6%)
Other	13 (2.1%)	9 (1.4%)
Location of sweep
Community	400 (63.6%)	431 (68.0%)
Hospital	227 (36.1%)	195 (30.8%)

RRs are estimated using a generalised linear mixed model and are adjusted for clustering and underlying temporal trends
^aThe estimated ICC (95% CI) was 0.060 (0.000–0.118) estimated using a one-way analysis of variance on the proportions scale
^bFor onset of labour, the risk of being induced compared to spontaneous and not labouring combined was compared before and after training
^cFor mode of birth, the risk of instrumental birth compared to SVB and CS combined was compared before and after training. Separately, emergency CS was compared to SVB, instrumental and elective CS combined, before and after training
^dEligible women: pregnant at 41 + 3 weeks

ISSN: 1745-6215