Elective Induction of Labor or Expectant Management: Outcomes Among Nulliparous Women with Uncomplicated Pregnancies

Cesarean birth rates among women who are nulliparous with uncomplicated full-term pregnancies have been shown to decrease if labor is electively induced. The purpose of this study was to compare the cesarean birth rate for women with pregnancies at 39.0 weeks' gestation or later admitted for spontaneous labor or medically indicated induction of labor (IOL) with that of women receiving elective IOL at term.

A retrospective cohort study was conducted by searching electronic health records of all nulliparous women with uncomplicated pregnancies who gave birth between January 2018 through February 2020 at one academic medical center. Select maternal demographic data and approach to labor management were the primary variables analyzed in determining the odds of cesarean birth.

A total of 1528 women were included in this study. Among these, 158 received elective IOL, and 1370 did not. The cesarean birth rates (31.0% vs 23.9%, elective induction of labor vs expectant management, respectively, P = .048), neonatal intensive care admissions (9.5% vs 7.6%, P = .41), and Apgar scores were similar among women in both management groups, respectively (P = .08). Accounting for other potential risk factors, the odds of having cesarean birth were not statistically different between management groups (adjusted odds ratio, 0.73; 95% CI, 0.5-1.1; P = .09). There were 2 fetal deaths among women whose labor was not electively induced. In the total cohort, women who were older, who had higher body mass index (BMI), and who identified as non-Hispanic Black had an increased odds of experiencing a cesarean birth. The associations between women in management groups and cesarean birth were not modified by age, BMI, race, or ethnicity (P = .33, .67, and .87, respectively).

Elective IOL was not associated with lower cesarean rates in this study. Further research is needed before implementing clinical practice changes that encourage more use of IOL.