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Learning Objective 1: The participant will be able to discuss the importance of supporting informed choices for women who are experiencing 'low-risk pregnancy'
Learning Objective 2: The participant will be able to better inform women about the possible outcomes associated with use of medical induction and epidural during labor
Methods: A retrospective study involved 10,676 women with a ‘low-risk’ pregnancy who gave birth between 1998-2003, within a regional area in NSW, Australia. A cascade tree was constructed to illustrate the likelihood of experiencing spontaneous vaginal birth according to hospital setting, use of induction of labor (IOL) and epidural for pain relief.
Results: When the cascade of intervention commences at IOL, the use of epidural in additional to IOL has a significant impact on increasing the chance of operative birth (instrumental and caesarean section). Women who experienced both interventions during labor were much less likely to experience normal vaginal birth even though their pregnancy was 'low-risk'. Multiple regression analysis revealed that use of epidural was an important determinant of mode of birth for the women studied.
Conclusion/Impact: Clinicians should share evidence about possible impact of the Cascade of Intervention on birth outcomes with women during pregnancy. Choices about IOL and epidural should be infomed by best available evidence about the possible outcomes of those choices.
Funding: University of Wollongong
Conflict of interest: Nil declared