Outcomes for Labor Induction Compared With Expectant Management Among Women Receiving Hospital-Based, Midwifery-Led...

Use of labor induction has increased rapidly for medical and nonmedical reasons, raising questions about its impact on cesarean birth rates. With growing incidence of elective induction of labor (IOL) at 39 weeks, uncertainty remains about how care practices associated with IOL influence outcomes. Observational studies have reported varied cesarean birth rates following IOL. This issue is particularly relevant for midwives, who prioritize physiologic labor and recognize benefits of spontaneous labor in achieving vaginal birth. This study evaluated cesarean birth rates after labor induction in midwifery-led practice settings.

We conducted a retrospective cohort study (2017-2023) of term births (N = 7345) with midwifery-led intrapartum care in 4 practice groups across 3 hospitals. Outcomes were stratified by parity and gestational age. We compared cesarean birth rates between labor induction and expectant management (EM) for each week of gestation, replicating prior methodology. Logistic regression was used to calculate odds ratios for cesarean following IOL, adjusting for relevant covariates.

The overall cesarean birth rate was 10.7%; the nulliparous, term, singleton, vertex cesarean birth rate was 18.4%. Labor induction occurred in 28.8% of births. Cesarean birth rates following IOL ranged from 10.5% at 39 weeks to 31.1% at 42 weeks. No significant differences in cesarean birth rates were observed between IOL and EM groups across gestational ages in adjusted analyses. Secondary outcomes, including postpartum hemorrhage, Apgar scores, and neonatal intensive care unit admission showed no significant differences across groups. Time from admission to birth was significantly longer following IOL, averaging 31.5 compared with 12.6 hours for spontaneous labor at 37 weeks.

Among patients receiving exclusive midwifery care, labor induction did not increase cesarean birth rates. Findings suggest that clinical context, including midwifery-led care and collaborative practice environments, may influence outcomes. Further research is needed to explore impact of IOL practices on risks for cesarean birth.