Abstract
BackgroundThe rate of induction of labor in the U.S. has risen from 9.6% in 1990 to 25.7% in 2018, including 31.7% of first-time births. Recent studies that have examined inductions have been small qualitative studies or relied on either medical records or administrative data. This study examines induction from the perspective of those women who experienced it, with a particular focus on the prevalence and predictors of inductions for nonmedical indications, women’s experience of pressure to induce labor and the relationship between the attempt to medically initiate labor and cesarean section.MethodsStudy data are drawn from the 2119 respondents to the Listening to Mothers in California survey who were planning to have a vaginal birth in 2016. Mothers were asked if there had been an attempt to medically initiate labor, if it actually started labor, if they felt pressured to have the induction, if they had a cesarean and the reason for the induction. Reasons for induction were classified as either medically indicated or elective.ResultsAlmost half (47%) of our respondents indicated an attempt was made to medically induce their labor, and 71% of those attempts initiated labor. More than a third of the attempts (37%) were elective. Attempted induction overall was most strongly associated with giving birth at 41+ weeks (aOR 3.28; 95% C.I. 2.21–4.87). Elective inductions were more likely among multiparous mothers and in pregnancies at 39 or 40 weeks. The perception of being pressured to have labor induced was related to higher levels of education, maternal preference for less medical intervention in birth, having an obstetrician compared to a midwife and gestational ages of 41+ weeks. Cesarean birth was more likely in the case of overall induction (aOR 1.51; 95% C.I. 1.11–2.07) and especially following a failed attempt at labor induction (aOR 4.50; 95% C.I. 2.93–6.90).ConclusionClinicians counselling mothers concerning the need for labor induction should be aware of mothers’ perceptions about birth and engage in true shared decision making in order to avoid the maternal perception of being pressured into labor induction.
Highlights
The rate of induction of labor in the U.S has risen from 9.6% in 1990 to 25.7% in 2018, including 31.7% of first-time births
The survey was developed through a collaboration of investigators from the National Partnership for Women & Families, Boston University School of Public Health and University of California, San Francisco (UCSF) Center on Social Disparities in Health, who worked with Quantum Market Research to plan and carry out the survey
Attempt at induction was more likely among nulliparas (52%) compared to multiparas (43%), those who were obese prior to beginning pregnancy (56%) compared to those who were underweight (44%) and women attended by obstetricians (50%) compared to those attended by midwives (41%)
Summary
The rate of induction of labor in the U.S has risen from 9.6% in 1990 to 25.7% in 2018, including 31.7% of first-time births. Recent studies that have examined inductions have been small qualitative studies or relied on either medical records or administrative data. This study examines induction from the perspective of those women who experienced it, with a particular focus on the prevalence and predictors of inductions for nonmedical indications, women’s experience of pressure to induce labor and the relationship between the attempt to medically initiate labor and cesarean section. Published research [4, 5] examining elective induction at 39 weeks, published after these data were collected, has suggested multiple benefits of the intervention, including lower rates of hypertensive disorders and fewer cesareans. The multiple studies that have examined inductions in recent years have relied primarily on medical records or administrative data [12]. Einerson terms elective inductions as, “... induction in the absence of a medical or obstetric indication for delivery,“ [22] while Little adds the caveat that they occur, “.... in healthy women with a singleton pregnancy.” [23] Laughon et al reporting one third of first time mothers and nearly half of multiparas having either elective inductions or inductions for no recorded indication [24]
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