Abstract
Background: In Australia 34% of women have labour induced. The contribution of increased medical indications is substantial, with no significant reductions in stillbirths and neonatal deaths. One study reported women with non-medically indicated IOL incurred increased Odds Ratios for instrumental vaginal birth, Caesarean section, episiotomy, vaginal repair and PPH. We aimed to address concerns over rising IOL and caesarean rates in a metropolitan referral centre and compare practice with regional guidelines.
Methods: Appropriate approvals were granted. Clinical staff completed proformas indicating reasons, processes and outcomes of IOL. The audit was replicated a year later.
Results: Overall the induction rates were 29.3% and 34.3% in 2020 and 2021, respectively. Omitting prelabour CS, the rates were 34.6% and 38.5% respectively. Mean gestational age at IOL was similar in both years (38.9 versus 38.8 weeks). Correct documentation occurred in 9.5% and 13% of cases, 19.1% and 21.7% received written information. Reasons for induction adhered to guidelines, except for ‘spurious labour’,’ IVF pregnancy’. One woman was induced for maternal request (2021). Overall spontaneous birth rates were 66.6% and 63% respectively: for primiparous women this was 50% and 14.3%. Overall emergency CS rates were 33.3% and 27%, but of these, each year, 83.3% were primiparous.
Discussion: IOL is a common intervention with defined procedures, yet these are poorly followed. Midwives must ensure women have information to make decisions, but most had no written or verbal explanations about this process. The high rates of caesarean section in primiparous women following IOL, the majority occurring in late labour, needs addressing if the cumulative impact of repeat CS is to be avoided, but also in consideration of future reproductive health.
Conclusion: IOL is associated with higher intervention rates, especially in primigravidae. Midwives must ensure women are aware of the risks and benefits of this common intervention.
Methods: Appropriate approvals were granted. Clinical staff completed proformas indicating reasons, processes and outcomes of IOL. The audit was replicated a year later.
Results: Overall the induction rates were 29.3% and 34.3% in 2020 and 2021, respectively. Omitting prelabour CS, the rates were 34.6% and 38.5% respectively. Mean gestational age at IOL was similar in both years (38.9 versus 38.8 weeks). Correct documentation occurred in 9.5% and 13% of cases, 19.1% and 21.7% received written information. Reasons for induction adhered to guidelines, except for ‘spurious labour’,’ IVF pregnancy’. One woman was induced for maternal request (2021). Overall spontaneous birth rates were 66.6% and 63% respectively: for primiparous women this was 50% and 14.3%. Overall emergency CS rates were 33.3% and 27%, but of these, each year, 83.3% were primiparous.
Discussion: IOL is a common intervention with defined procedures, yet these are poorly followed. Midwives must ensure women have information to make decisions, but most had no written or verbal explanations about this process. The high rates of caesarean section in primiparous women following IOL, the majority occurring in late labour, needs addressing if the cumulative impact of repeat CS is to be avoided, but also in consideration of future reproductive health.
Conclusion: IOL is associated with higher intervention rates, especially in primigravidae. Midwives must ensure women are aware of the risks and benefits of this common intervention.
| Original language | English |
|---|---|
| Number of pages | 1 |
| Publication status | Published - 2023 |
| Event | International Confederation of Midwives Triennial Congress: Together again: from evidence to reality - Bali, Indonesia Duration: 11 Jun 2023 → 14 Jun 2023 Conference number: 33 https://web.archive.org/web/20231002205646/https://midwives2023.org/ (Conference website) |
Conference
| Conference | International Confederation of Midwives Triennial Congress |
|---|---|
| Country/Territory | Indonesia |
| City | Bali |
| Period | 11/06/23 → 14/06/23 |
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