Associations Among Intrapartum Interventions and Cesarean Birth in Low‐Risk Nulliparous Women with Spontaneous Onset of Labor

Iobst, Stacey; Bingham, Debra; Storr, Carla L.; Zhu, Shijun; Johantgen, Meg

doi:10.1111/jmwh.12975

Cited by 6 publications

(9 citation statements)

References 46 publications

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“…The association has also been found even when controlling for pregnancy risk [20] and other different interventions associated with oxytocin administration [9].…”

Section: Discussionmentioning

confidence: 91%

“…In Spain, a study to evaluate the implementation of the Normal Birth Care Strategy shows a rate of 19.4% IOL and 53.3% AOL, amply surpassing its recommendations [6]. A Swedish study observed a 33% oxytocin use [7], while a French study showed a rate above 60% [8] and in the United States, Iobst et al reported that 44% of low-risk nulliparous women had oxytocin administered during labor [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes

Espada-Trespalacios

Ojeda

Perez-Botella

et al. 2021

IJERPH

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Background: In recent years, higher than the recommended rate of oxytocin use has been observed among low-risk women. This study examines the relationship between oxytocin administration and birth outcomes in women and neonates. Methods: A retrospective analysis of birth and neonatal outcomes for women who received oxytocin versus those who did not. The sample included 322 women with a low-risk pregnancy. Results: Oxytocin administration was associated with cesarean section (aOR 4.81, 95% CI: 1.80–12.81), instrumental birth (aOR 3.34, 95% CI: 1.45–7.67), episiotomy (aOR 3.79, 95% CI: 2.20–6.52) and length of the second stage (aOR 00:18, 95% CI: 00:04–00:31). In neonatal outcomes, oxytocin in labor was associated with umbilical artery pH ≤ 7.20 (OR 3.29, 95% CI: 1.33–8.14). Admission to neonatal intensive care unit (OR 0.56, 95% CI: 0.22–1.42), neonatal resuscitation (OR 1.04, 95% CI: 0.22–1.42), and Apgar score <7 (OR 0.48, 95% CI: 0.17–1.33) were not associated with oxytocin administration during labor. Conclusions: Oxytocin administration during labor for low-risk women may lead to worse birth outcomes with an increased risk of instrumental birth and cesarean, episiotomy and the use of epidural analgesia for pain relief. Neonatal results may be also worse with an increased proportion of neonates displaying an umbilical arterial pH ≤ 7.20.

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“…The association has also been found even when controlling for pregnancy risk [20] and other different interventions associated with oxytocin administration [9].…”

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes

Espada-Trespalacios

Ojeda

Perez-Botella

et al. 2021

IJERPH

View full text Add to dashboard Cite

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“…Furthermore, birth interventions impact the pregnant women's satisfaction with childbirth. 4,5 Considering these negative effects, the timing of admission to the delivery room is crucial. This study found that multiparous pregnant women experienced higher labor satisfaction compared to primiparous women, and women who desired their pregnancy reported higher labor satisfaction than those who did not.…”

Section: Discussionmentioning

confidence: 99%

“…4 Preventing unnecessary cesarean sections and other invasive deliveries can largely be achieved by delaying hospital admission until the onset of the active labor phase. 5 Traditional criteria for admitting pregnant women to the delivery room include complete cervical effacement, dilation of 3 cm or more, other cervical changes, and spontaneous rupture of membranes. 6 However, it has been observed that obstetric interventions during labor are fewer when cervical dilation is 6 cm or more.…”

Section: Introductionmentioning

confidence: 99%

Determining the Impact of Cervical Dilation at Admission on Intrapartum Interventions and Labor Satisfaction in Pregnant Women

Kaplan Doğan

2024

J Educ Res Nurs

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Background: Admission to the delivery room with a low level of cervical dilation is associated with an increased likelihood of cesarean birth, additional birth interventions, and a negative impact on the woman's birth experience and satisfaction.Aim: This study aimed to evaluate the effect of cervical dilation levels at admission to the delivery room on intrapartum interventions and labor satisfaction.Methods: This study was conducted as a cross-sectional study and involved 285 pregnant women. It was carried out in the delivery rooms of Cengiz Gökçek Obstetrics and Pediatrics Hospital in Gaziantep, Türkiye, utilizing the "Personal Information Form" and the "Birth Satisfaction Scale" for data collection. T-test, ANOVA test and linear regression test was used for data analysis. Results:The findings indicate that pregnant women with cervical dilation of 6-10 cm had lower cesarean section rates and reduced use of oxytocin and epidosin. Additionally, episiotomy incisions, vacuum applications, and amniotomy attempts were found to be less frequent in this group. It was discovered that the total mean score on the birth satisfaction scale for multiparous pregnant women was higher than that for primiparous pregnant women (P=0.001), and higher for those who had desired pregnancies compared to women with undesired pregnancies (P=0.037). Satisfaction with delivery was found to be lower among pregnant women with cervical dilation of 0-3 cm (P=0.012), those who received oxytocin induction, and those who underwent an episiotomy (P=0.001). A significant correlation was observed between the level of cervical dilation, parity, desire for pregnancy, and birth interventions with birth satisfaction (R=0.39, R 2 =0.33, P<0.001). These factors together explain 33% of the total variance in birth satisfaction. Conclusion:Low levels of cervical dilation at the time of admission to the delivery room are associated with an increase in birth interventions and a decrease in birth satisfaction.

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“…Although women admitted for induction of labor require some interventions to initiate and maintain labor progression, those admitted after spontaneous onset of labor have already begun the physiologic processes of labor and should not require the same level of intervention. For this reason, high rates of interventions among women admitted after spontaneous onset of labor raise concern because evidence shows an association between the use of multiple intrapartum interventions and cesarean birth …”

Section: Introductionmentioning

confidence: 99%

Variation of intrapartum care and cesarean rates among practitioners attending births of low‐risk, nulliparous women

Iobst

Storr

Bingham

et al. 2020

Birth

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Background: Variation in hospital cesarean birth rates across the United States is likely because of differences in practitioner practice patterns. Yet, few studies conducted in the last twenty years have examined the relationships between practitioner characteristics and the use of intrapartum interventions and cesarean birth. The objective of this study was to examine associations among practitioner characteristics and the use of amniotomy, epidural, oxytocin augmentation, and cesarean birth in low-risk women with spontaneous onset of labor. Methods: A secondary analysis was performed using data collected by the Consortium on Safe Labor. The sample included nulliparous term singleton vertex (NTSV) births with spontaneous onset of labor (n = 13 196) from 2002 to 2007 across eight hospitals. Generalized linear mixed models were conducted to examine outcomes. Results: The cesarean birth rate ranged from 7.2% to 18.9% across hospitals and from 0% to 53.3% across physicians. Practice type (P < .05) and specialty type (P < .0001) were associated with physician cesarean birth rates. Compared with obstetrician/gynecologists, midwives were nearly twice as likely to use no intrapartum interventions (relative risk 1.80 [CI 95 1.45-2.24]) and 26% less likely to use amniotomy-epidural-oxytocin (0.74 [0.62-0.89]). Family practice physicians had a 21% lower likelihood of using amniotomy-epidural-oxytocin (0.79 [0.67-0.94]) and a 53% lower likelihood of performing cesarean births (0.47 [0.35-0.63]). Conclusions: Wide variation in hospital and physician cesarean birth rates was observed in this sample of low-risk, nulliparous women. Practitioner practice type and specialty were significantly associated with the use of intrapartum interventions. Interprofessional practitioner education could be one strategy to reduce variation of intrapartum care and cesarean birth. K E Y W O R D S cesarean birth, intrapartum interventions, practitioner 228 | IOBST eT al. How to cite this article: Iobst SE, Storr CL, Bingham D, Zhu S, Johantgen M. Variation of intrapartum care and cesarean rates among practitioners attending births of low-risk, nulliparous women. Birth.

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Associations Among Intrapartum Interventions and Cesarean Birth in Low‐Risk Nulliparous Women with Spontaneous Onset of Labor

Cited by 6 publications

References 46 publications

Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes

Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes

Determining the Impact of Cervical Dilation at Admission on Intrapartum Interventions and Labor Satisfaction in Pregnant Women

Variation of intrapartum care and cesarean rates among practitioners attending births of low‐risk, nulliparous women

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