Labor Induction versus Expectant Management in Low-Risk Nulliparous Women

Grobman, William A.; Rice, Madeline Murguia; Reddy, Uma M.; Tita, Alan T.N.; Silver, Robert M.; Mallett, Gail; Hill, Kim; Thom, Elizabeth; El‐Sayed, Yasser Y.; Perez-Delboy, Annette; Rouse, Dwight J.; Saade, George R.; Boggess, Kim; Chauhan, Suneet P.; Iams, Jay D.; Chien, Edward K.; Casey, Brian M.; Gibbs, Ronald S.; Srinivas, Sindhu K.; Swamy, Geeta K.; Simhan, Hyagriv N.; Macones, George A.

doi:10.1056/nejmoa1800566

Cited by 764 publications

(537 citation statements)

References 27 publications

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“…Given the recent evidence showing a decreased likelihood of cesarean birth associated with elective induction of labor, 30 it is noteworthy that the published cesarean rate among term, nulliparous women undergoing induction of labor in the Consortium on Safe Labor was 23.8%. One limitation is that the Consortium on Safe Labor was a sample of urban hospitals; therefore, our results may not reflect practice patterns in rural areas of the United States.…”

Section: Discussionmentioning

confidence: 99%

Associations among cervical dilatation at admission, intrapartum care, and birth mode in low‐risk, nulliparous women

Iobst

Breman

Bingham

et al. 2019

Birth

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Background Admission in early labor is associated with increased likelihood of cesarean birth, but the context in which this occurs is unclear. Previous research has explored the relationship between dilatation at admission and the use of single intrapartum interventions; however, the majority of women in the United States receive multiple intrapartum interventions. The objective of this study was to examine the associations among cervical dilatation at admission, intrapartum care, and birth mode in low‐risk, nulliparous women with spontaneous onset of labor. Methods This was a cross‐sectional, observational study of 21 858 nulliparous, singleton, term vertex births that occurred from 2002 to 2007 across nine hospitals in the Consortium on Safe Labor. Outcome measures included the individual and combined use of intrapartum interventions (amniotomy, epidural anesthesia, oxytocin augmentation) and birth mode. Results In this sample, 92.0% of women received at least one intrapartum intervention and 22.7% received all three interventions. After propensity score adjustment, women were more than twice as likely to receive the combination of amniotomy‐epidural‐oxytocin when admitted at 0‐3 cm (RR 2.83 [95% CI 2.45‐3.27]) and 4‐5 cm (2.49 [2.15‐2.89]) compared to 6‐10 cm. Adjusted likelihood of cesarean birth was five times greater for women admitted at 0‐3 cm (5.26 [4.36‐6.34]) and two times greater for women admitted at 4‐5 cm (2.27 [1.86‐2.77]) compared to 6‐10 cm. Conclusions To promote normal physiologic birth, low‐risk, nulliparous women should be engaged in shared decision‐making about timing of admission after spontaneous onset of labor.

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Section: Discussionmentioning

confidence: 99%

Associations among cervical dilatation at admission, intrapartum care, and birth mode in low‐risk, nulliparous women

Iobst

Breman

Bingham

et al. 2019

Birth

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“…The Robson approach does not evaluate reasons for induction of labor, so our results do not identify if labor inductions differed by indication between the groups. Until the 2018 release of a large trial regarding labor induction versus expectant management, evidence suggested that induction of labor without medical indication was associated with an increased rate of cesarean birth . Future research examining the effect of labor induction practices and cultures of perinatal care in broader populations, including understanding the effect of interprofessional versus non‐interprofessional teams, is essential for informing safe and effective labor induction practices.…”

Section: Discussionmentioning

confidence: 99%

Using the Robson 10‐Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

Smith

Phillippi

Lowe

et al. 2019

J Midwife Womens Health

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Introduction: The Robson 10-group classification system stratifies cesarean birth rates using maternal characteristics. Our aim was to compare cesarean birth utilization in US centers with and without midwifery care using the Robson classification. Methods: We used National Institute of Child and Human Development Consortium on Safe Labor data from 2002 to 2008. Births to women in centers with interprofessional care that included midwives (n = 48,857) were compared with births in non-interprofessional centers (n = 47,935). To compare cesarean utilization, births were classified into the Robson categories. Cesarean birth rates within each category and the contribution to the overall rate were calculated. Maternal demographics, labor and birth outcomes, and neonatal outcomes were described. Logistic regression was used to adjust for maternal comorbidities. Results: Women were less likely to have a cesarean birth (26.1% vs 33.5%, P Ͻ .001) in centers with interprofessional care. Nulliparous women with singleton, cephalic, term fetuses (category 2) were less likely to have labor induced (11.1% vs 23.4%, P Ͻ .001), and women with a prior uterine scar (category 5) had lower cesarean birth rates (73.8% vs 85.1%, P Ͻ .001) in centers with midwives. In centers without midwives, nulliparous women with singleton, cephalic, term fetuses with induction of labor (category 2a) were less likely to have a cesarean birth compared with those in interprofessional care centers in unadjusted comparison (30.3% vs 35.8%, P Ͻ .001), but this was reversed after adjustment for maternal comorbidities (adjusted odds ratio, 1.21; 95% CI, 1.12-1.32; P Ͻ .001). Cesarean birth rates among women at risk for complications (eg, breech) were similar between groups. Discussion: Interprofessional care teams were associated with lower rates of labor induction and overall cesarean utilization as well as higher rates of vaginal birth after cesarean. There was consistency in cesarean rates among women with higher risk for complications.

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“…8,14, 16 We also analyzed neonatal intensive care unit (NICU) admission after birth. Individually, these adverse neonatal outcomes occurred too rarely in the sample to be modeled.…”

Section: Methodsmentioning

confidence: 99%

Influence of midwifery presence in United States centers on labor care and outcomes of low‐risk parous women: A Consortium on Safe Labor study

Carlson

Neal

Tilden

et al. 2018

Birth

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Background: Sixty percent of United States births are to multiparous women. Hospitallevel policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. Results: There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. Conclusions: Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes. K E Y W O R D Scesarean, culture, induced labor, midwifery, multiparous, obstetrics, oxytocin, parturition 488 | CARLSON et AL.

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Labor Induction versus Expectant Management in Low-Risk Nulliparous Women

Cited by 764 publications

References 27 publications

Associations among cervical dilatation at admission, intrapartum care, and birth mode in low‐risk, nulliparous women

Associations among cervical dilatation at admission, intrapartum care, and birth mode in low‐risk, nulliparous women

Using the Robson 10‐Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

Influence of midwifery presence in United States centers on labor care and outcomes of low‐risk parous women: A Consortium on Safe Labor study

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