Induction associated with more interventions and adverse outcomes

Another study has 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 are concerning, although not surprising to those who have been concerned about this issue for years. It’s even more concerning that 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 show 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 note 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).

 

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 is absolutely the right decision for some woman and families, regardless of these risks. 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 figuring 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 want to read it urgently, or don’t have time to wait for the mail, it’s also available electronically for a number of devices.

And here are some more resources on my website.

 

If you’re a midwife or birth worker and you’d like to better understand the issues and develop your confidence with research, we’re looking at a number of aspects of induction of labour in Gathering in the Knowledge 2021.
And as always, if you’d like to be among the first to hear my thoughts on new studies and to get updates about my work, new birth-related research and thinking, make sure you’re subscribed to our free newsletter list, which means you’ll get our monthly Birth Information Update and details of my current projects