Induction can save lives, but birth study calls for balanced consent

Labour induction in Australia rose from 25 per cent of births in 2010 to 33 per cent in 2023, and from 30.6 to 39.7 per cent among first-time mothers. New survey research associates induction with more interventions and worse experiences for some women, while stressing that it can be life-saving when clinically indicated and that association does not prove causation.

Induction can use prostaglandin or oxytocin, a balloon catheter to open the cervix, or breaking the waters. It is often recommended after 41 weeks to lower stillbirth risk, for high blood pressure or diabetes, or another serious threat to the mother or baby. The World Health Organization advises induction after 41 weeks for healthy pregnancies because of stillbirth risk.

Using Australia's national Birth Experience Study, researchers compared 5,230 women whose labour started spontaneously with 2,561 whose labour was induced, adjusting for demographic, medical, obstetric and mental-health factors. Induction was associated with higher odds of forceps or vacuum delivery, emergency caesarean, episiotomy and reported fetal distress.

Those induced more often reported excessive postnatal pain, poorer physical health, reliving negative events, birth trauma, regret, diagnosed post-traumatic stress disorder, and disrespect or mistreatment by staff. They were less likely to have immediate skin-to-skin contact or a postnatal midwife home visit. Babies were more likely to have jaundice or receive formula despite an intention to breastfeed.

There was no statistically significant difference in major perineal injury, ongoing pelvic-floor problems, special-care or neonatal intensive-care admission, or additional medical care for the baby after birth. Midwifery continuity-of-care models had the lowest induction rates; earlier research found this difference persisted after accounting for differing risk factors.

The observational, self-selected survey cannot establish that induction caused the outcomes or represent every woman's experience. Unreported reasons for induction could contribute, and researchers relied on participants rather than clinical records. The study did not specifically examine stillbirth:28 participants reported a baby dying during labour, birth or afterwards, but bereaved women may be less likely to answer and induction can follow a stillbirth, so no further conclusions were drawn from that group.

Earlier NSW research found induction rates at 37 and 39 weeks tripled over 16 years to 2016, with 15 per cent of new mothers induced without a recorded medical reason. The authors say rates could have risen further since. Guidance emphasises that every week counts: without a significant clinical reason, planned birth should not occur before 39 weeks while the brain is still developing. In previous research, more than 90 per cent of women previously induced said they would try to improve their chance of spontaneous labour next time.

Informed consent needs balanced discussion of the treatment, why it is recommended, how, when and where it would happen, alternatives, and physical and psychological effects. Any increase in stillbirth risk should be explained in actual numbers rather than vague warnings. Birth-trauma inquiries in NSW and Tasmania, and an ongoing women's-health select committee, have highlighted harm when consent is ignored. Women should not simply be told induction is required; medically recommended induction's potential benefits and consequences both belong in the decision.

Illustrative cropped baby-shoe artwork from about 1937, not a patient, baby or medical procedure.