Letter: Patient response to induction of labour

Induction of labor: an integrated review

Women's response to induction and augmentation of labor has received little attention in North America. A review of the literature revealed that these procedures epitomize the use of technology in childbirth. From a psycho-emotional perspective, women respond less positively to induction and augmentation than to spontaneous labor and report less satisfaction with the birth experience. In this review of the research and anecdotal literature, reasons for inattention to induction and augmentation are explored, and the nature of the procedures and women's response to them are examined.

Elective induction of labor: a prospective clinical study, II: Psychological effects

Several authors have stated that induction of labor may have deleterious psychological effects on women's experiences of labor and early mother-infant interaction. Research on this subject is scarce and in most cases no distinction is made between elective induction and induction for medical reasons. For that reason the observed effects may also have been caused by the medical complications that led to the induction. Differences in experience of labor may also be in part explained by differences in personal characteristics between women choosing or rejecting induction of labor. Influences of induction of labor can only be reliably assessed in prospective studies. In the present study of 271 women with an uncomplicated pregnancy, data regarding their experiences of pregnancy and their expectations of labor and motherhood were collected before labor. In 72 women labor was electively induced, and 199 women had a spontaneous onset of labor. Of 33 women, 19 with spontaneous labor and 14 with elective induction, the first contact with their newborn was observed. All women who could be contacted were interviewed about their experience of labor and the first contact with their infant. Six months after delivery the mothers were questioned about the state of health of mother and infant and about nursing the infant. Mothers with induced labor were rated as being generally less emotionally involved in the first contact with their newborn than mothers with spontaneous labor, but the differences were not significant (Fig. 1). The duration of spontaneous labor was longer, but the subjective time experience did not differ between groups. Women with spontaneous labor were more tired during labor.(ABSTRACT TRUNCATED AT 250 WORDS)

Maternal attitudes to their obstetric care

Advocates of 'natural childbirth' are many and vocal, but there appears also to be a group of women who are in favour of more active obstetric management. Preference for a subsequent confinement seems to be influenced by previous experience.

Mothers' experiences of induction

Mothers of a random sample of 2182 legitimate live births were interviewed about their experiences of pregnancy, labour, and delivery. Of these, 24% reported that their labours were induced, and data about this from a subsample of mothers tallied with information obtained through the doctors in charge in 88% of cases. All but 3% of the mothers who were induced perceived some medical reason for the induction. The proportion of inductions in the 24 study areas ranged from 6% to 39%. A relatively small proportion of labours in "teaching" hospitals, small hospitals with less than 100 beds, and GP maternity hospitals were induced, but a comparatively high proportion of private patients had an induction. There was no clear association between induction and the mother's age or parity. Despite being given more pain relief, those who were induced reported similar intensities of pain during the first and second stages of labour to those whose labour started spontaneously; they also reported that they had "bad pains" for a similar period. The period they had contractions was shorter for the induced than for those starting spontaneously, and the intensity of pain at delivery was rated somewhat less by those who were induced.There was no difference between induced babies and others in the proportion who were held by their mothers immediately after their birth. Two-fifths of the mothers who were induced would have liked more information about induction; and a similar proportion said they had not discussed induction with a doctor, midwife, or nurse during their pregnancy. Only 17% of the mothers who had an induction said they would prefer to be induced if they had another baby. This contrasts with 63% of those who had epidural analgesia who would opt for the same procedure next time, while 83% of those who had had a baby in hospital, and 91% of those having had a home birth, would want their next baby in the same type of place.