Association between induction of labor and birth experience: A national population-based study

Because induction of labor (IOL) is increasingly frequent in high-income countries, studying its impact on birth experience needs further attention. Our objective was to assess the association between IOL and birth experience, compared with spontaneous onset of labor (SOL), in routine practice using a national population-based survey.

The French National Perinatal Survey (Enquête Nationale Périnatale (ENP)) is a nationwide study aimed at monitoring maternal and neonatal health in 2021. Women from mainland France, with live births, face-to-face interviews, and who participated at the 2-month follow-up were included. At 2 months, women answered the question 'What kind of memories do you have about your childbirth?' and were classified into two groups: 'positive' and 'negative' birth experiences. We used univariate and multivariable logistic regression to compare birth experiences between women with SOL and IOL. We performed three sensitivity analyses: (1) with the onset of labor as a three-class variable (SOL, IOL, cervical ripening), (2) according to the presence of a medical indication for IOL, and (3) among a subgroup of low-risk women. Finally, we identified potential mediators on the pathway between IOL and a negative birth experience (birth with complication or operative delivery, pain at delivery, labor duration) and used mediation modeling to estimate indirect and residual effects.

Among the 6200 women included, 1777 (28.7%) had an IOL. Women with IOL reported negative birth experiences more often than women with SOL (16.4% vs. 8.8%, p < 0.001). In the case of cervical ripening, the rate of negative birth experience increased to 18.8% (p < 0.001). After adjustment, the association between IOL and negative birth experience remained significant (aOR = 1.78, 95% CI [1.47-2.16]). We found similar results according to medical indication for IOL and among women at low risk. We estimated that 26% (95% CI, 12%-41%) of the association between IOL and a negative birth experience was mediated by birth with complications or operative delivery.

Women with IOL had a significantly higher risk of negative birth experience, compared with those with SOL. Our findings underline the need for appropriate antenatal information for women about IOL, shared decision-making, and better follow-up for women at risk of negative birth experience.