The cascade of intervention: labour induction and caesarean section in the United Kingdom

Abstract

Labour induction and caesarean section are childbirth interventions experienced by a growing number of women globally each year. These two medical procedures are often linked in maternal health literature through the cascade of interventions, an intervention pathway defined by labour induction at the start of birth and operative delivery at the end. While the maternal indicators of labour induction have been well documented in countries such as the United States, considerably less research has been done into which women have a higher likelihood of labour induction in the United Kingdom, and how the risk of labour induction is associated with operative delivery in the UK. This project examines the maternal risk factors of labour induction in the United Kingdom and how these indicators are related to the likelihood of operative delivery, using data from the Millennium Cohort Study.

The thesis first uses logistic regression to explore which maternal characteristics are associated with labour induction in the United Kingdom, and determines that maternal educational qualifications and the deprivation of a woman’s electoral ward have significant associations with likelihood of labour induction. In the second analysis chapter, this project examines health care context by utilizing multilevel logistic regression to analyse if risk of labour induction varies by NHS Trust. Results from these analyses determine that risk of labour induction does vary by NHS Trust, the influence of maternal educational qualifications on labour induction risk varies by NHS Trust, and country of NHS Trust is a significant predictor of labour induction. Finally, in order to better understand how the cascade of intervention operates in the United Kingdom, the third analysis investigates the link between labour induction and type of delivery using multinomial logistic regression and KHB mediation analysis. This analysis finds that women who are induced are more likely to experience operative delivery, and that this relationship is mediated by epidural anaesthesia. Additionally, maternal height moderates the associations between labour induction, epidural, and delivery type, such that women between 1.60 and 1.69 metres tall are more at risk of operative delivery after labour induction and epidural than women at shorter or taller heights.

This project finds that maternal demographic and socioeconomic indicators influence the risk of labour induction, and that the association between labour induction and operative delivery can be mediated by epidural anaesthesia and moderated by maternal height, within the health care context of the United Kingdom. Determining which women are more likely to experience labour induction and operative delivery in the UK can allow women to make more informed choices about their health care and can help support efforts to provide women with individualized, patient-centred care during their labours and births.

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ORCID for Andrew Channon: orcid.org/0000-0003-4855-0418

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