Inducing Labour Increases Risk for Healthy Pregnant Women - Research

1 September 2011 - This extensive study compared the outcomes of elective induction versus spontaneous onset of labour in almost 40 000 deliveries in Latin American women with low-risk pregnancies. The study found that women whose labour was artificially induced without medical justification were three times as likely to require anaesthesia during labour and/or to be admitted to intensive care. An increased risk of caesarean section and other medical interventions was also found.

WHO | World Health Organization


Website Link gives comprehensive details on the study on elective induced labour.



Elective Induction vs. Spontaneour Labour in Latin America


Gláucia Virgínia Guerra a, José Guilherme Cecatti a, João Paulo Souza b, Aníbal Faúndes a, Sirlei Siani Morais a, Ahmet Metin Gülmezoglu b, Renato Passini a, Mary Angela Parpinelli a, Guillermo Carroli c, for the WHO Global Survey on Maternal & Perinatal Health in Latin America Study Group

a. Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, PO Box 6030, 13083-881, Campinas, SP, Brazil.
b. Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
c. Centro Rosarino de Estudios Perinatales, Rosario, Argentina.

Correspondence to José Guilherme Cecatti (e-mail: cecatti@unicamp.br).

Published online: 05 July 2011.

Bulletin of the World Health Organization 2011;89:657-665. doi: 10.2471/BLT.08.061226


Elective labour induction without any medical or obstetric indication has been increasing in recent years. In some countries, 10% of all deliveries are electively induced.14 This increase has been attributed to greater demand by mothers and to logistic factors such as distance from the maternal dwelling to the hospital or a history of precipitate delivery.46 In addition, elective induction to suit the obstetrician’s schedule has been a contributing factor since the first half of the 20th century.7

In places where caesarean section rates are high, inducing labour in situations in which termination of pregnancy is advisable may help to reduce these rates.8,9 Nevertheless, the same is not necessarily true when labour is induced without any medical indication. Elective induction may in fact alter normal physiology when delivery begins and increase the rate of caesarean section, irrespective of parity, especially among women with an unfavourable cervix (e.g. women with the cervix in a posterior position, firm, poorly effaced and dilated, and with the fetus in a high station).1,1012 A caesarean section is usually performed after elective induction with an unripe cervix for the following indications: prolonged first stage of labour, fetal distress, failure to progress and intrapartum haemorrhage.1315

Some adverse maternal outcomes have been associated with elective induction of labour. These include an increase in instrumental vaginal deliveries; greater need for epidural analgesia; postpartum haemorrhage; increased need for blood transfusion; longer hospital stays and higher hospital costs.12,14,1619 In addition, the neonate requires immediate care and must sometimes be admitted to a neonatal intensive care unit (ICU), particularly when the cervix is unripe at delivery.15,17,19

Elective induction of labour is becoming increasingly common but is seldom directly reported in studies perhaps because of lack of consensus with respect to its definition. In some settings labour induction is reported as elective when it is performed without medical indication; in others, any pre-scheduled induction of labour, with or without medical indication, is considered elective. In the present analysis we use the term elective induction of labour when no medical indication for the procedure exists. Since this intervention may be associated with increased maternal and perinatal risks, knowing how frequently it is performed is important for taking steps towards preventing its associated problems and providing accurate information to both pregnant women and health-care professionals. The objectives of this study were to evaluate the frequency of elective induction of labour in Latin America; the procedure’s rate of success in achieving vaginal delivery; the factors determining its application and any associated unfavourable maternal and perinatal outcomes.