22 Inez Rothman
Channel: Virtual Midwives
Date: 2023-05-17

Systematic literature review induction of labour: Exploring the sense or madness

Facilitator: Elisa Segoni

The population of low-risk pregnant women whose birth is induced has been increasing steadily in many countries. Considerable inter- and intraprofessional variation regarding the medical indications for induction, induction methods and induction term exists. 

The Flemish Association for Midwives did a systematic literature review on the effects of induction of labour at 41 and 39 gestational weeks, both compared to expectant management, on maternal and neonatal outcomes, and on maternal birth experience. This research included almost 40 studies across the 3 PICOs between 2017-2022 and 9 guidelines.

Clinical guidelines and current care policy are based on a limited number of research studies, with significant study limitations. The evidence from our systematic literature review shows that induction does not unambiguously lead to more favourable maternal and neonatal outcomes; new systematic reviews and the wealth of observational studies in recent years more often point to no or unfavourable iatrogenic effects of induction. Induction appears to have a higher chance of a negative birth experience and the shared informed decision-making process is flawed. Women receive insufficiently balanced information about the benefits and risks of induction, the different indications, the induction process, other interventions that may accompany an induction, the impact of induction on freedom of mobility, and the right to refuse an induction. Women often experience the induction recommendation as binding rather than as a choice, sometimes feeling pressured. An open, constructive, interdisciplinary dialogue is urgently needed to evaluate current induction policies. Our research points to several implications which can enrich this debate.