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

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Midwifery Care

Background:

• Labor induction rates are rising, prompting investigation into their effect on cesarean birth rates.
• Elective induction of labor (IOL) at 39 weeks is increasingly common, yet its impact on outcomes requires further clarification.
• Midwifery care prioritizes physiologic labor, making understanding IOL outcomes in these settings crucial.

Purpose of the Study:

• To evaluate cesarean birth rates following labor induction within midwifery-led practice settings.
• To compare cesarean birth rates between labor induction and expectant management (EM) across different gestational ages.
• To assess the influence of midwifery care on labor induction outcomes.

Main Methods:

• Retrospective cohort study of 7345 term births with midwifery-led intrapartum care (2017-2023).
• Outcomes stratified by parity and gestational age, comparing IOL versus EM.
• Logistic regression used to calculate adjusted odds ratios for cesarean birth after IOL.

Main Results:

• Overall cesarean birth rate was 10.7%; for nulliparous, term, singleton, vertex births, it was 18.4%.
• Cesarean birth rates following IOL ranged from 10.5% (39 weeks) to 31.1% (42 weeks).
• No significant differences in cesarean rates were found between IOL and EM groups in adjusted analyses; secondary outcomes also showed no significant differences.

Conclusions:

• Labor induction did not increase cesarean birth rates among patients receiving exclusive midwifery care.
• Clinical context, including midwifery-led care and collaborative environments, may positively influence labor induction outcomes.
• Further research is warranted to fully understand the impact of specific IOL practices on cesarean birth risks.