What are some factors driving use of induced labor in the United States?: A Listening to Mothers III Data Brief
There has been growing attention to the use of induction of labor when it is medically inappropriate (such as prior to 39 weeks in a woman without a medical indication) and the high rate of apparently “elective” induction of labor. Research studies cannot easily discern women’s knowledge and preferences underpinning rates of induced labor. Listening to Mothers surveys provide a unique perspective on labor induction trends, that of mothers themselves.
SUMMARY OF KEY FINDINGS
Most women do not know when in pregnancy the baby is full term and ready to be born, and thus are vulnerable to making uninformed decisions about induction when there is not a medical reason. Due to consistent growing evidence of increased risks of elective delivery before 39 weeks’ gestation, a growing number of maternity care leaders and organizations discourage earlier labor induction unless there is a well-established medical reason. However, just 21% of survey participants correctly identified 39 weeks or beyond as the earliest week in pregnancy when it is safe to deliver a baby should complications not require earlier delivery. See Figure.
Most survey participants were uninformed about induced labor. Survey respondents were asked about their level of agreement with two facts about induced labor, and in neither case did a majority of mothers choose the correct response. Only 42% of mothers agreed that inductions might increase the chance for a cesarean. A substantial majority agreed, contrary to best evidence and current clinical guidelines, that if a baby appeared large at the end of pregnancy, it made sense to induce labor (57%). Mothers who experienced an attempted medical induction were more likely to agree with the statement concerning large babies, while having experienced an induction had little relationship to attitudes about the likelihood of a cesarean following an induction.
Some common reasons women cited for induction are not established medical reasons for this procedure, including “baby was full term/it was close to my due date” (44%), “a care provider was concerned about the size of the baby” (16%), and “I wanted to get the pregnancy over with” (19%). See Figure.
Many women report experiencing pressure from a care provider to have an induction. Overall, 15% of mothers reported experiencing pressure from a care provider to have labor induced. This rose to 25% among mothers who experienced a medical induction compared with 8% among those who did not have an induction.
Discussion about giving birth when a baby might be getting large steers many women toward an induction of labor, even though research and professional guidelines do not support routine use of labor induction in this case. The survey looked at decision-making processes among women whose care providers discussed induction of labor (but not planned cesarean) because the baby might be getting quite large. The providers presented no information at all about reasons not to induce labor to 29% of the women in this situation, versus presenting no information about reasons to induce labor to just 1% of the women. Almost 1 in 5 women in this situation reported that the discussion had not been framed as a matter of choice. Among the 81% of care providers who expressed an opinion about the decision, 80% recommended induction of labor. Ultimately, 67% of women in this situation had a medical induction, and 37% tried a self-induction.