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A survey of obstetricians' attitudes to induction of labour at 39 weeks gestation with the intention of reducing caesarean section rates.

Authors
  • Davis, Georgina1
  • Waldman, Boris2
  • Phipps, Hala3
  • Hyett, Jon1, 3, 4
  • de Vries, Bradley1, 3, 5
  • 1 RPA Women's and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. , (Australia)
  • 2 NHMRC Clinical Trials Centre, Sydney Medical School, Sydney, New South Wales, Australia. , (Australia)
  • 3 Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia. , (Australia)
  • 4 Central Clinical School, Discipline of Obstetrics, Gynaecology and Neonataology, University of Sydney, Sydney, New South Wales, Australia. , (Australia)
  • 5 School of Public Health, University of Sydney, Sydney, New South Wales, Australia. , (Australia)
Type
Published Article
Journal
The Australian & New Zealand journal of obstetrics & gynaecology
Publication Date
Sep 28, 2020
Identifiers
DOI: 10.1111/ajo.13245
PMID: 32985691
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Induction of labour (IOL) and caesarean section (CS) rates continue to increase in Australia, New Zealand and globally. There is evidence that CS rates are decreased in the context of medically indicated and elective IOL; therefore, the emerging concept of using IOL as means of preventing CS warrants investigation. To assess obstetricians' opinions of elective IOL at 39 weeks gestation, its feasibility, generalisability and utility as a means of preventing CS in Australia and New Zealand. A de-identified cross-sectional survey was distributed electronically to all Fellows and trainees of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). The survey was voluntary and distributed with the approval of the RANZCOG Continuing Education Committee. The survey addressed opinions relating to rates of and indications for IOL, the perceived validity of those indications and explored the acceptability of using a screening tool to predict women at increased risk of intra-partum CS and tailoring obstetric management to include the option of IOL at 39 weeks gestation. The overall response rate was 34% (492/1423) (including trainees) and the response rate was 53% (394/750) for currently practising obstetricians. The majority (90%) of responders agreed on medical and clinical indications for IOL. There was no consensus on the validity of IOL if a woman were at apparent high risk of intra-partum CS; however, 81% (360/443) of clinicians would be interested in a tool that could predict those women at risk. There is heterogeneity of obstetrician's beliefs on using IOL at 39 weeks as a mechanism to reduce the CS rate. © 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

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