Short-termism, induction, and adverse outcomes

In contemporary maternity care, interventions are often justified on the basis of immediate risk reduction.

The focus is on lowering perinatal mortality by a small (sometimes tiny) margin, or reducing the occurrence of a particular complication, often without regard for the wider consequences of this.

Preventing immediate adverse outcomes matters, of course.

But these are not the only outcomes that matter.

The problem with short-termism

When we talk about short-termism, we are describing an approach where people focus on immediate profit or objectives at the expense of long-term health or security. This is really problematic, and such an approach comes at significant cost.

When we focus almost exclusively on what happens in the hours or days around birth, we risk overlooking what happens months, years, or even decades later.

We also risk overlooking the wider human context in which birth takes place.

The induction problem

The medical model’s approach to induction of labour (IOL) provides a particularly clear example of this short-termism. As I have discussed in my books, the focus is on short-term outcomes, and induction is pushed even when there is a marginal difference in outcomes, or sometimes no difference at all.

And this comes at a significant cost to women and babies.

It might sound frivolous to some people to talk about the social costs of induction, but women’s experiences matter.

We know, to cite just one example, that women really dislike the way that induction separates them from their partner and family, sometimes for days.

And there is growing evidence showing that the way that women are treated can lead to long-term consequences, including birth trauma.

This is no small matter.

Induction, interventions, and adverse outcomes

A few years ago, an important study confirmed that induction is associated with more interventions and adverse outcomes.

That was the finding of a group of researchers who, “…compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births.” (Dahlen et al 2021).

Their findings were concerning, although not surprising to those who have been concerned about this issue for years.

Part of the concern is because induction is being offered to more and more healthy women without good medical reason.

The research

The researchers in this study, “…used population linked data from New South Wales, Australia (2001–2016) for healthy women giving birth at 37+0 to 41+6 weeks. Descriptive statistics and logistic regression were performed for intrapartum interventions, postnatal maternal and neonatal outcomes, and long-term child outcomes adjusted for maternal age, country of birth, socioeconomic status, parity and gestational age.” (Dahlen et al 2021).

They, “…compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births.” (Dahlen et al 2021).

This is a useful approach because it shows what happens in the real world, and the data set was really large. It included 474,652 births. Of those women, 69,397 (15%) had their labour induced for non-medical reasons.

The results

The results showed that induction of labour leads to more intervention and more adverse maternal, neonatal, and child outcomes.

“Women with uncomplicated pregnancies who had their labour induced had higher rates of epidural/spinal analgesia, CS (except for multiparous women induced at between 37 and 40 weeks gestation), instrumental birth, episiotomy and PPH than women with a similar risk profile who went into labour spontaneously.” (Dahlen et al 2021).

Furthermore, although the induction rate has tripled in some groups in the past 16 years, Dahlen et al (2021) found that there has been no reduction in stillbirth.

More problems in children

This study also highlighted that children born after induction had a higher chance of problems, both around and after the time of birth.

“Between birth and 16 years of age, and controlled for year of birth, their children had higher odds of birth asphyxia, birth trauma, respiratory disorders, major resuscitation at birth and hospitalisation for infection.” (Dahlen et al 2021).

The authors noted that, in their study, “…only hospital admissions were examined and hence more serious illnesses.” (Dahlen et al 2021).

It’s therefore possible that the chance of more minor illness might be increased as well, but we can’t know that from this particular study.

No point at which the risks are lower after IOL

Another key finding is that, “Though this risk varied by gestational age of labour onset, there was no gestational age for which any of these risks were significantly lower for those born after IOL when compared with those born after spontaneous labour onset.” (Dahlen et al 2021).

That’s important, especially in the light of moves to offer earlier induction to more and more women without good medical reason.

The researchers conclude that, “IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed.” (Dahlen et al 2021).

Extending the lens

More recently, a population-based linked cohort study by Burger et al (2026) extended the timeframe even further.

Their study, Education attainment at age 25 after induction of labor versus non-intervention at term, examined 327,365 live-born children from low-risk singleton pregnancies in the Netherlands (1995–1997).

They excluded pregnancies complicated by hypertensive disorders, diabetes, very small babies, congenital anomalies, and planned caesarean sections.

They linked perinatal registry data with national education records and examined educational attainment at age 25.

How they did the research

Using a fetus-at-risk approach, Burger et al (2026) compared induction at each gestational week (37–41 weeks) with non-intervention (spontaneous labour that week plus births at later gestations). Analyses were adjusted for a wide range of confounders, including maternal age, parity, socio-economic status, maternal education and birthweight centile.

At every week between 37 and 41 weeks, induction was associated with lower educational attainment at age 25.

For example:

• At 37 weeks, 31.9% of those born after induction had completed tertiary education, compared with 38.0% after non-intervention (adjusted OR 0.82, 95% CI 0.77–0.88).
• At 41 weeks, the figures were 34.7% versus 39.1% (adjusted OR 0.83, 95% CI 0.78–0.88). (Burger et al 2026)

Sensitivity analyses excluding non-white women showed similar results.

Appropriate caution

The authors are appropriately cautious. This is an observational study and demonstrates association, not causation. Residual confounding may remain, and not all indications for induction could be accounted for. Obstetric practice has also changed in some ways since the 1990s.

But the only way of avoiding the impact of the passage of time would be for researchers to use a time machine, and those aren’t available.

And their conclusion is striking.

For healthy women whose pregnancies are at term, induction was associated with lower educational attainment in adulthood (Burger et al 2026).

A note on planned ceasarean

The researchers in the more recent study excluded women having planned caesarean. This is understandable, but it would be great if we could see some analysis of this as well. More and more women are responding to the push towards induction by opting for planned caesarean, but there are some things to be aware of here.

First, if we define induction as using medical or other means of bringing on birth sooner than nature (or the baby) intended, then planned caesarean is, in one sense, a form of induction. I know that people will argue about this, and say that induction is about bringing on labour (and not just birth), but I think this misses the point. Planned caesarean is another means of imposing medical timeframes on birth, rather than letting the baby decide when is best to be born.

And, while this particular study excluded women having planned caesareans (CS), we do have quite a lot of data showing that caesareans lead to unwanted outcomes, in the short, medium and long term.

The consequences of caesarean

An important review of the short and long term consequences of caesarean (with lots of useful links to other papers on this topic) showed that:

“…babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported.” (Sandall et al 2018).

This systematic review of the outcomes after caesarean showed, “…increased risks for fertility, future pregnancy, and long-term childhood outcomes”. There is also evidence of worse long-term outcomes for women.

A 2025 review highlighted, “…problems that arise in the immediate and long-term health of mother and child from the improper use of cesarean section“, and a recent study in Taiwan showed that, “…children delivered by CS more commonly developed respiratory tract infections, asthma, allergic rhinitis, atopic dermatitis, obesity than children delivered vaginally. Among these, obesity have a stronger association with cesarean section.”

Just as with induction, caesarean can be a useful and sometimes life-saving intervention. And the idea is not to be criticising women who opt for this. But it is clear that many are doing so without being given the bigger picture, and decent data about the actual consequences, including in the medium and long term, for mothers and babies.

The bigger picture

Taken together, these studies show that, when we widen the lens, different questions and patterns emerge.

If we focus only on short-term perinatal mortality statistics, particularly in healthy (or so-called ‘low-risk’ populations) where absolute risks are already small, induction can appear benign or even beneficial.

But when we examine medium- and long-term outcomes, including childhood morbidity, hospitalisation, school performance, and adult educational attainment, the picture becomes more complex.

Back to the short-termism problem

This is precisely what I mean when I talk about the short-termism problem.

When a system prioritises immediate, measurable, physical outcomes above all else, it risks neglecting downstream physiological consequences, developmental trajectories, mental and social implications of interventions and experiences, and population-level effects that only become visible over decades.

None of this means that induction is “wrong.” There are genuine medical situations in which induction is absolutely the right decision, and in those circumstances the benefits may clearly outweigh the risks.

But as induction is increasingly offered to healthy women without strong medical indication, it becomes even more important that we consider the full range of possible consequences, and not just those that are considered important by medical researchers, or that fit neatly into short-term audit frameworks.

Where next?

If maternity care continues to prioritise short-term endpoints, funding will naturally follow those endpoints. Trials and audits will continue to measure what happens in the hours around birth, rather than what happens in classrooms, clinics, and communities years later.

A shift in focus, away from short-termism and towards a genuinely life-course perspective, could help generate the evidence we need to understand these associations more fully. It could also support more balanced information-sharing with women and families, enabling truly informed decision-making.

In the meantime, these studies serve as an important reminder. Birth is not an isolated clinical event. It is the beginning of a lifelong trajectory. And the way we approach interventions such as induction deserves to reflect that reality.

Weighing it up

As always, it’s important to remember that there are pros and cons to everything. If there are genuine medical reasons for induction, then the benefits can outweigh the risks and possible downsides.

Induction of labour (or planned caesarean) is absolutely the right decision for some woman and families, regardless of these risks and consequences. But many people think it is being offered too often at the moment, and that women and families aren’t being given enough information about the downsides.

The key is in getting informed, and working out what’s right for you.

I have a book on inducing labour which many people have found helpful. It’s called Inducing Labour: making informed decisions.

If you want to read it urgently, or don’t have time to wait for the mail, it’s also available as an eBook.

And here are some more resources on my website, if you’d like to learn more.

Inducing Labour

In Your Own Time

Post-term pregnancy and induction of labour resources

---

---

---

Books to help you become informed and make the decisions that are right for you…

---

---