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Tuesday 1 June 2021

Inductions for no medical reason linked to short and long-term adverse impacts for mothers and babies

UCLan professor plays key role in ground-breaking international study.

Research supported by the University of Central Lancashire (UCLan) and led by Western Sydney University has found an alarming number of mothers were induced for uncomplicated births at increasingly earlier gestations, resulting in higher intervention and poorer outcomes for mothers and their newborns, with first-time mothers the most at risk.

The international research team, which also included the Amsterdam University Medical Centre (Netherlands), the University of Sydney and the University of New South Wales, assessed state-based New South Wales population data of 474,652 uncomplicated births at 37 to 41 weeks between 2001-2016, including data on children admitted to hospital up to 16 years post-birth.

The study – published in BMJ Open today – is one of the first in the world to examine associated child health outcomes for such a sustained period of time after induction.

Lead author Professor Hannah Dahlen from the University’s School of Nursing and Midwifery said the study was unique because it compared induction of labour where no reason could be found with spontaneous labour in a very healthy group of women.

“Our findings show a high rate of induction in uncomplicated births was associated with short and long-term impacts on women and children, such as increased birth intervention and ongoing child health complications,” said Professor Dahlen.

“We looked at the data in several ways; by first-time mothers and subsequent mothers and by each week the labour commenced.

“Particularly for women giving birth for the first time, induction of labour for non-medical reasons was linked with higher rates of birth interventions and resulted in more adverse outcomes.”

"The findings in this paper should be carefully considered by those who are recommending a widespread move towards routine induction of labour and should form part of discussions with women and childbearing people about the best way for their labour to start."

UCLan's Soo Downe, Professor of Midwifery Studies.

In addition, the study found children born through induction to first-time and subsequent mothers had higher odds of birth asphyxia, birth trauma, respiratory disorders, major resuscitation at birth, and hospitalisation for infection.

The findings include:

  • Of 474,652 included births in women who were deemed young and healthy (20-34 years, no smoking, no diabetes, no blood pressure problems and no abnormalities in the baby), 69,397 (15 per cent) had an induction of labour with no medical reason given.
  • The experiences of first-time mothers who were induced compared to spontaneous labour differed significantly for: epidural (71% vs 41.3%); instrumental birth (28.0% vs 23.9%%); intrapartum caesarean section (29.3% vs 13.8%); and episiotomy (41.2% vs 30.5%). Women who gave birth previously had more instrumental vaginal births but fewer caesarean sections.
  • Following induction, incidences of neonatal birth trauma, resuscitation, and respiratory disorders were higher, as were admissions to hospital for infections (ear, nose, throat, respiratory, sepsis) up to 16 years.
  • For first-time mothers (4.2% vs 4.9%) and those who had given birth previously (0.7% vs 1.2%), 3rd and 4th degree perineal tears were slightly lower overall following the induction of labour.

According to Professor Dahlen, induction of labour can be lifesaving for many women, however, trends showing an increase in induction of labour in women who are low risk are a reason for concern.

“Current statistics show 45 percent of first-time mothers in Australia are being induced (it was 25 percent a decade ago) and the rise in induction is very worrying in what we call ‘early term’ infants (37 and 38 weeks),” said Professor Dahlen.

“Those last couple of weeks of being in their mother’s uterus are really important for child neurodevelopment and other physical development, making this a critical issue.”

Professor Dahlen further explained, randomised controlled trials to date looking at induction have been affected by large numbers of women refusing to participate (up to 86 percent). In addition, women and babies in these trials have not been followed up to assess the longer-term risks and benefits.

Co-author UCLan’s Professor Soo Downe added: “There is a shift to recommend routine induction of labour as a way of reducing rates of caesarean section. However, this is happening before we know what the longer-term effects might be.

“The findings in this paper should be carefully considered by those who are recommending a widespread move towards routine induction of labour and should form part of discussions with women and childbearing people about the best way for their labour to start.”

Epidemiologist, Assistant Professor Lilian Peters from Amsterdam University Medical Center (Netherlands), said: “Our study suggests there may be more adverse maternal, neonatal and child outcomes after induction of labour among low-risk women.”

Co-author Professor Ank de Jonge also from Amsterdam University Medical Center, said: “Further studies are needed to understand women’s views and experiences relating to induction as well as the long-term maternal and child health outcomes.”