Use of induction of labour and emergency caesarean section and perinatal outcomes in English maternity services: A national hospital-level study

Abstract

Objective: To assess the association between hospital-level rates of induction of labour and emergency caesarean section, as measures of ‘practice style’, and rates of adverse perinatal outcomes. Design: National study using electronic maternity records. Setting: English National Health Service. Sample: Hospitals providing maternity care to women between April 2015 and March 2017. Main outcome measures: Stillbirth, admission to a neonatal intensive care unit and babies receiving mechanical ventilation. Results: Among singleton term births, the risk of stillbirth was 0.15%, the risk of admission to a neonatal intensive care unit was 5.4% and the risk of mechanical ventilation 0.54%. There was considerable between-hospital variation in the rate of induction of labour (minimum 17.5%, maximum 40.7%) and in the rate of emergency caesarean section (minimum 5.6%, maximum 17.1%). Women who gave birth in hospitals with a higher rate of induction of labour had better perinatal outcomes. For each 5%-point increase in induction, there was a decrease in the risk of term stillbirth of 9% (OR 0.91, 95% CI 0.85–0.97) and a decrease in the risk of mechanical ventilation of 14% (OR 0.86, 95% CI 0.79–0.94). There was no significant association between hospital-level induction of labour rates and neonatal unit admission at term (p > 0.05). There was no significant association between hospital-level rates of emergency caesarean section and adverse perinatal outcomes (all with p > 0.05). Conclusions: There is considerable between-hospital variation in the use of induction of labour and emergency caesarean section. Hospitals with a higher rate of induction had a lower risk of adverse birth outcomes. A similar association was not found for caesarean section.