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Figure. Using the Quality Health Outcomes Model for induction of labor.
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Background: Numerous study results vary when analyzing the relationship between labor induction and the likelihood of cesarean delivery; and few have accounted for the multiple influences of maternal sociodemographic characteristics combined with the provider and hospital in subsequent birth outcomes such as cesarean section.
Objective: This study...
Citations
... Studies on synthetic oxytocin induction, the use of which increases with hospitalizations in the latent period, revealed the complication rates of elective induction in pregnant women (hyperstimulation, need for emergency cesarean section, hypotension, antidiuretic effect, neonatal hyperbilirubinemia, uterine rupture, fetal distress, fetal and maternal death, etc.) show an increase [7][8][9][10][11]. At the same time, it was determined that dystocia, cesarean section, amniotomy, episiotomy, and induction rates with ox-ytocin were higher in pregnant women admitted to the delivery room in the latency period compared to pregnant women in the active phase [4,6]. ...
Objectives This study was conducted to determine the effect of endogenous oxytocin release via coitus at home on the delivery process in pregnant women who were not hospitalized in the latent phase.
Background For healthy pregnant women who can deliver spontaneously, it is recommended to be admitted to the delivery room during the active phase of labor. When the pregnant woman is admitted to the delivery room in the latent phase before the active stage, pregnant women spend more time in the delivery room, which makes medical intervention inevitable.
Methods 112 pregnant women for whom hospitalization in the latent phase was recommended were included in the randomized controlled study. They were divided into two groups in which sexual activity in the latent phase was recommended (n=56) and the control group (n=56).
Results In our study, the duration of the 1st stage of labor was found to be significantly shorter in the group in which sexual activity in the latent phase was recommended, compared to the control group (p=0.001). Again, the need for amniotomy, labor induction with oxytocin, analgesics and episiotomy decreased.
Conclusion Sexual activity can be considered as a natural way to speed up labor, reduce medical interventions, and prevent postterm pregnancy.
... However, the increasing number of elective CS (defined later) requires the health system to be equipped for additional work. This entails undertaking training programs for health workers 14 , providing delivery facilities in remote areas, and allocating budget for CS 11 , all of which are financially and logistically challenging for many developing nations 15 . Such a scenario leads to the necessity of estimating the prevalence of deliveries by CS on a national scale and also require studying the sociodemographic determinants of those who consider opting for elective CS as opposed to a normal vaginal delivery. ...
There has been a gradual rise in the number of cesarean sections (CSs) in Bangladesh. The present study identified the cohort of women, who were more likely to opt for an elective CS based on their sociodemographic characteristics, pre-delivery care history, and media exposure, using the Bangladesh Multiple Indicator Cluster Survey-2019. The survey stratification adjusted logistic regression model and interpretable machine learning method of building classification trees were utilized to analyze a sample of 9202 women, alongside district-wise heat maps. One-in-five births (20%) were elective CSs in the 2 years prior to the survey. Women residing in affluent households with educated house-heads, who accessed antenatal care prior to delivery (AOR 4.12; 95% CI 3.06, 5.54) with regular access to media (AOR 1.31; 95% CI 1.10, 1.56) and who owned a mobile phone (AOR 1.25; 95% CI 1.04, 1.50) were more likely to opt for elective CSs, which suggests that health access and health literacy were crucial factors in women’s mode of delivery. Spatial analyses revealed that women living in larger cities had more elective CS deliveries, pointing towards the availability of better health and access to multiple safe delivery options in peripheral areas.
... Past research on indicators of labour induction has tended to focus on medical risk factors such as the woman's age, the presence of diabetes or hypertension, or the infant's birth weight and gestational age [8][9][10][11][12][13][14][15]. This paper aims to determine whether socioeconomic factors such as maternal education, income, or local neighbourhood deprivation have independent associations with induction in the United Kingdom once medical factors are controlled. ...
... Most of the research on the broader determinants of labour induction has been conducted in the United States. These studies indicate that women who are college-educated, white, and covered by commercial health insurance are the most likely to have their labours induced [8,12]. However, the US does not have the universal health care that is established in the United Kingdom and therefore it is not obvious whether the US findings are generalizable. ...
Background:
Labour induction is a childbirth intervention experienced by a growing number of women globally each year. While the maternal and socioeconomic indicators of labour induction are well documented in countries like the United States, considerably less research has been done into which women have a higher likelihood of labour induction in the United Kingdom. This paper explores the relationship between labour induction and maternal demographic, socioeconomic, and health indicators by parity in the United Kingdom.
Method:
Logistic regression analyses were conducted using the first sweep of the Millennium Cohort Study, including a wide range of socioeconomic factors such as maternal educational attainment, marital status, and electoral ward deprivation, in addition to maternal and infant health indicators.
Results:
In fully adjusted models, nulliparous and multiparous women with fewer educational qualifications and those living in disadvantaged places had a greater likelihood of labour induction than women with higher qualifications and women in advantaged electoral wards.
Conclusions:
This paper highlights which UK women are at higher risk of labour induction and how this risk varies by socioeconomic status, demonstrating that less advantaged women are more likely to experience labour induction. This evidence could help health care professionals identify which patients may be at higher risk of childbirth intervention.
... 19,20,36 Excessive fetal growth was a predictor in a prior model. 20 Cesarean deliveries also have been found to be more common among African Americans, 38,39 women with fibroids, 40 and those with herpes simplex virus. 38,41 The cesarean delivery rate in other studies of induced women ranged from 11%-13% 3,7 to 29%-30%. ...
Objective:
The goal of the study was to develop and validate a prediction model for cesarean delivery after labor induction that included factors known before the start of induction, unlike prior studies that focused on characteristics at the time of induction.
Materials and Methods:
Using 17,370 term labor inductions without documented medical indications occurring at 14 U.S. hospitals, 2007-2012, we created and evaluated a model predicting cesarean delivery. We assessed model calibration and discrimination, and we used bootstrapping for internal validation. We externally validated the model by using 2122 labor inductions from a hospital not included in the development cohort.
Results:
The model contained eight variables-gestational age, maternal race, parity, maternal age, obesity, fibroids, excessive fetal growth, and history of herpes-and was well calibrated with good risk stratification at the extremes of predicted probability. The model had an area under the curve (AUC) for the receiver operating characteristic curve of 0.82 (95% confidence interval 0.81-0.83), and it performed well on internal validation. The AUC in the external validation cohort was 0.82.
Conclusion:
This prediction model can help providers estimate a woman's risk of cesarean delivery when planning a labor induction.
... This could lead to increased use of epidural anesthesia, an intervention known to be associated with cesarean birth when administered in early labor (32). It is also possible that the low-Fowler's positioning commonly used to promote optimal EFM output may reduce pressure of the fetal head on the cervix, leading to an increased need for oxytocin augmentation, which also has a demonstrated association with increased rates of cesarean birth (33). ...
Background
In many United States hospitals, electronic fetal monitoring (EFM) is used continuously during labor for all patients regardless of risk status. Application of EFM, particularly at labor admission, may trigger a chain of interventions resulting in increased risk for cesarean birth among low-risk women. The goal of this review was to summarize evidence on use of EFM during low-risk labors and identify gaps in research. Methods
We conducted a scoping review of studies published in English since 1996 that addressed the relationship between EFM use and cesarean among low-risk women. We screened 57 full-text articles for appropriateness. Seven articles were included in the final review. ResultsThe largest study demonstrated an 81 percent increased risk of primary cesarean birth when EFM was used in labor, but did not differentiate between high- and low-risk pregnancies. Four randomized controlled trials examined the association of admission EFM with obstetric outcomes; only one considered cesarean birth as a primary outcome and found a 23 percent increase in operative birth when EFM lasted more than 1 hour. A study examining application of continuous EFM before and after 4 centimeters dilatation found no differences between groups. Conclusions
In general, the research on this topic suggests an association between the use of EFM and cesarean birth; however, more well-designed studies are needed to examine benefits of EFM versus auscultation, determine if EFM is associated with use of other technologies that could cumulatively increase risk of cesarean birth, and understand provider motivation to use EFM over auscultation.
... 5 Several studies have indicated that the elective application of induction without adequate or specific indications increases the rate of complications in pregnant women. 6,7 More cervical laceration, bleeding, uterine perforations and infection occur during or after the unnecessary practice of induction, which may result in problems for future pregnancies such as cervical failure, premature birth and infants with low birthweight. [5][6][7] Unnecessary inductions also cause increased caesarean births. ...
... 6,7 More cervical laceration, bleeding, uterine perforations and infection occur during or after the unnecessary practice of induction, which may result in problems for future pregnancies such as cervical failure, premature birth and infants with low birthweight. [5][6][7] Unnecessary inductions also cause increased caesarean births. 8,9 The World Health Organization (WHO) reports that the rate of caesarean birth should be 15% at the most, yet in the United States the rate of caesarean birth was 31.3% in 2011. ...
... Elective labour induction contributes to the development of many complications and an increase of caesarean birth rates. [5][6][7][8][9]35,36 It significantly increases the rates of caesarean births especially in women with immature cervix. [35][36][37] WHO reports that the rate of caesarean birth should be 15% at most. ...
... As stated by American College Obstetrician and Gynecologist (ACOG, 2008), induction of labor with synthetic oxytocin should not be performed on the basis of the personal preference of the doctor or the pregnant woman electively without being associated with a specific indication (e.g., postterm pregnancy, ablatio placenta). The studies performed in this context indicate that elective induction without any basis on a specific indication increases the rate of complications (e.g., hyperstimulation, C-section) in pregnant women (Reisner, Wallin, Zingheim, & Luthy, 2009;Wilson, Effken, & Butler, 2010). ...
... The literature reported the percentage of clinical failure in induction with oxytocin in the action of birth as 8%-50% (De Miranda et al., 2006;Kashanian, Akbarian, Baradaran, & Samiee, 2006). This failure leads to a higher risk of maternal and fetal morbidity and mortality and a higher risk of C-section (Wilson et al., 2010). Relevant studies report that the rate of spontaneous vaginal birth is 30%-53% (Kashanian et al., 2006) and the rate of C-section is 24%-56% (Boulvain et al., 2001;Kashanian et al., 2006) in synthetic oxytocin groups. ...
Aims:
The present research study was conducted with the objective of determining the effect of uterine and nipple stimulation on induction with oxytocin and the birth process.
Methods:
A randomized controlled experiment was conducted at the maternity ward of a state hospital located in the province of Sivas in Turkey. Three hundred ninety pregnant women who were giving birth via vaginal delivery were randomly assigned to three groups (nipple stimulation, uterine stimulation, control). After the birth, the groups were assessed in terms of the birth duration and synthetic induction with oxytocin. Statistical analyses were performed through the use of SPSS 14.0 software and included analysis of variance, Tukey's test, Dunnett's test, Tamhane's T2 test, and chi-square test.
Results:
The study established statistically significant differences (p < .05) among the groups in terms of the average durations of the first, second and third phases of the action of birth, the status concerning delivery by C-section and the application of labor induction. The phases of birth were shorter for the nipple stimulation group (first phase: 3.8 hours, second phase: 16 minutes, third phase: 5 minutes) and the uterine stimulation group (first phase: 4.0 hours, second phase: 21 minutes, third phase: 6 minutes) when compared to the control group (first phase: 6.8 hours, second phase: 27 minutes, third phase: 6 minutes). In the control group, 89.2% of the pregnant women were subject to labor induction and 8.5% to cesarean section. No women in the nipple stimulation group or uterine stimulation group had a cesarean section.
Linking evidence to action:
Nipple and uterine stimulation reduce the frequency of elective labor induction, the rate of relevant complications, and support normal vaginal birth by providing endogenous labor induction. Therefore, these interventions should be considered for pregnant women in labor.
... The QHOM has strength in the dynamic relationships it depicts between interventions, clients, and systems, addressing a major criticism of Donabedian's original model. Additionally, the model has been used as the conceptual basis for a large body of outcomes research examining the role of nursing care on patient outcomes (Aiken et al., 2003;Aiken, Clarke, Sloane, Sochalski, & Silber, 2002;Kelly, Kutney-Lee, McHugh, Sloane, & Aiken, 2014;Mark & Harless, 2010;Mitchell & Lang, 2004;Tubbs-Cooley, Cimiotti, Silber, Sloane, & Aiken, 2013;Wilson, Effken, & Butler, 2010). The QHOM modified for nursing skill mix is graphically represented in Figure 1, with the elements of the study outlined below each component. ...
Rates of harm to surgical patients remain largely unchanged despite decades of initiatives to address safety concerns, while wide variations in mortality and failure to rescue (FTR) persist between hospitals. Despite the critical role that registered nurses (RNs) play in providing care to hospitalized patients, there has been limited exploration of the relationship between nursing skill mix and surgical patient outcomes. The purpose of this study was to examine the association between nursing skill mix and adult surgical patient 30-day mortality and FTR. This retrospective, cross-sectional, secondary data analysis utilized three datasets to study surgical patient outcomes in four states (California, Florida, New Jersey, Pennsylvania): the 2006-2007 Multi-State Nursing Care and Patient Safety Survey, the 2006-2007 American Hospital Association Annual Survey, and hospital discharge abstracts for patients age 18-85 years who underwent general, orthopedic, or vascular surgical procedures in non-federal acute care hospitals in 2006-2007. A total of 1,267, 516 surgical patients, 29,391 nurses, and 665 hospitals comprised the final sample. Logistic regression models were used to assess the association of nursing skill mix, defined as the proportion of RNs to all nursing staff (RNs, licensed practical and vocational nurses (LPN/LVNs), and unlicensed assistive personnel (UAPs)) on 30-day mortality and FTR. After analysis, each 10% increase in RN skill mix was associated with a 7% decrease in the odds of 30-day mortality (P
... Early trials completed in the 1980s reported that intrapartum oxytocin used early in labor reduced the risk of CB [14,15] but more recently studies have shown a strong association with uterine hyperstimulation and an increased risk of emergency cesarean [11,16] . Main and colleagues [17] found that early use of oxytocin reduced the use of CB, although other studies have shown a significant association with increased surgical birth [11,18] . ...
The purpose of this study was to examine the relationship between the type and timing of commonly used intrapartum clinical factors and their relationship to birth outcomes. The factors included in the analysis were type of provider (midwife or obstetrician), place of birth (home or hospital) cervical dilation on admission, and commonly used labor interventions, namely use of continuous electronic fetal monitoring, epidural anesthesia and oxytocin on the type of birth (cesarean or vaginal birth). The research question guiding the analysis was: what factors increase the likelihood of cesarean birth (CB)? The findings reported here are part of a larger mixed methods study that used three data collection methods: a projective test, a focus group, and a semi-structured postpartum interview. The study took place in an urban area in the mid-Atlantic United States and the sample was comprised of 49 low-risk primigravid women recruited between 28-36 weeks gestation. The analysis reported here only used data from the postpartum interview. During the interview, each woman reported the events of their labor and birth that were then mapped along a timeline. The findings show that admission to hospital early in labor played a key role in increasing the number of interventions used and was associated with increased risk of CB. The small, homogenous sample limited the ability to conduct more comprehensive statistical analysis and to generalize to more diverse groups however the proportional differences are highly suggestive and warrant further investigation.
... Despite being the least likely to be electively induced in comparison to White or Hispanic women, Black women were most likely to experience a primary Cesarean section . Medically-indicated induction in Black women irrespective of parity leads to higher rates of Cesarean birth (Wilson, Effken, & Butler, 2010). All of the reasons for these disparate outcomes are not clear, and the reality of these experiences may create different ideas about birth in the Black community, leading to differing constructions about birth. ...
A focused ethnography was conducted to determine the cognitive constructions about birth described by nulliparous Black women in an urban area of the Southwestern US; also, during postpartum, how do these women reconcile expectations with the actual birth? Semi-structured interviews were conducted before birth and after birth.
Women, 16 or older, 17 - 33 weeks carrying a singleton fetus and without anomalies or problems like pre-gestational diabetes, NYHA Cardiac Class III/IV, cancer, renal failure, or sickle cell anemia that eliminated vaginal birth were sequentially recruited and sampled in an affiliated ultrasound clinic. Women scheduled for an anatomy scan were approached.
Eleven women enrolled. Participants were 17 to 30 years old, with 11 to 22 years of schooling. Gestational age at enrollment was 17+5 to 31+5 weeks. Two women were college graduates. Four women were employed, and all used Medicaid to pay for care. Seven women received SNAP and/or WIC benefits. Three of the 4 employed women received this assistance. Three women did not have their mother in their lives. The sample was purposefully analyzed for age, education and maternal presence, and a natural spread of ages and situations was found, making purposeful sampling unnecessary.
Initial interviews lasted 12.5 to 41 minutes. Post-delivery interviews lasted 24 to 54 minutes, and occurred 13 to 25 days postpartum. The researcher transcribed all interviews, and used Atlas.ti to assist in analysis and organization.
Women described views of birth that grew from ideas shared with them by their own mothers. Themes included “birth is painful” which was the predominant view, followed by “birth damages you and/or the baby” Two women identified, “birth changes you.” Ideas obtained from friends, other family members, the media and the popular culture, as well as their care providers were evaluated in light of these maternal ideas. Women also evaluated their own births using these maternal ideas. Beyond describing birth as their mothers did, women concluded that birth was essentially unknown to them, and they had limited expectations about what would happen during the birth.
