Abstract
Background
In many well-resourced countries, rising rates of intervention are being observed
during pregnancy, labour and childbirth with induction of labour (IOL) fast becoming
one of the most common. In Australia, the rate of induction of labour has increased
by over 30% since 2007, and today one in three women have their labours induced. We
do not however have a good understanding of the contribution of specific obstetric
populations to this trend.
Methods
We examine the contribution of specific obstetric populations to induction of labour
over a six-year period at one tertiary maternity service, using the Nippita classification
system. Average Annual Percentage Changes (AAPC) were calculated along with 95% confidence
intervals and P values set at 0.05.
Results
The overall rate of induction of labour increased from 21.3% in 2012 to 30.9% in 2017,
representing an Average Annual Percent Change of 8.1, P < 0.0001 (95% CI 7–9.6). The greatest AAPC was seen in group 5 (parous, no previous
caesarean section, 39–40 weeks, single cephalic), followed by group 2 (nulliparous,
39–40 weeks, single cephalic) and 1 (nulliparous, 37–38 weeks, single cephalic).
Conclusions
The use of the Nippita classification system allowed for standardised comparison across
timepoints, facilitating identification of the subpopulations driving changes in rates
of induction of labour. Rates of induction of labour saw a year on year increase which
in this maternity service, it is not being driven by post-dates pregnancies. Further
work is required to understand the role of other potential contributors such as diabetes.
Abbreviations:
AAPC (Average Annual Percentage Change), ACT (Australian Capital Territory), BMI (body mass index), BOS (Birth Outcomes System (clinical database)), CS (caesarean section), GDM (gestational diabetes mellitus), IOL (induction of labour), IRGDM (insulin requiring gestational diabetes mellitus), NICU (neonatal intensive care unit), SCN (special care nursery)Keywords
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Article info
Publication history
Published online: May 22, 2021
Accepted:
May 17,
2021
Received in revised form:
April 26,
2021
Received:
December 10,
2020
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
