Background Rising caesarean section rates are frequently attributed to the medicalization of childbirth. Induction of labour (IOL) is a common obstetric intervention. NICE recommend IOL should be offered for post-dates pregnancy between 41⁺⁰ and 42⁺⁰ weeks gestation.¹

Objectives To compare caesarean rates following IOL for post-dates pregnancy, with those delivering spontaneously at the equivalent gestation at Hinchingbrooke Hospital during a 12 month period.

Methods Data were reviewed for all women delivering live singleton, term babies throughout 2012. Planned caesarean deliveries were excluded.

Results Of the eligible 2101 deliveries, 28.9% delivered at or beyond 41⁺⁰ weeks. When indicated for post-dates at or beyond 41⁺⁰ weeks, IOL was associated with significantly higher rates of caesarean section than deliveries at the equivalent gestation following spontaneous labour (12% and 26% respectively). Even when carried out from 41⁺¹⁰ weeks, caesarean rates were higher following IOL (37%) than after spontaneous labour (26%).

Conclusion In contrast to evidence-based literature,² post-dates IOL was associated with an increased risk of caesarean section. The rationale for post-dates IOL is to reduce risks to the baby, although the absolute risk is small. Given that over a quarter of women delivered from 41⁺⁰ weeks, offering IOL from this gestation significantly contribute to avoidable caesarean sections, thus increasing risks to the mother, and their future offspring. All obstetric units should audit their outcomes to review if a policy of later IOL may be more appropriate.

References

1. National Institute for Health and Care Excellence (2013) Induction of Labour (CG70). London: National Institute for Health and Excellence

2. Gulmezoglu A, et al. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews 2012