Trends in labour and birth interventions among low-risk women in New South Wales.

Roberts, CL; Algert, CS; Douglas, I; Tracy, SK; Peat, B

Trends in labour and birth interventions among low-risk women in New South Wales.

Roberts, CL Algert, CS Douglas, I Tracy, SK Peat, B

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Publication Type:: Journal Article
Citation:: Aust N Z J Obstet Gynaecol, 2002, 42 (2), pp. 176 - 181
Issue Date:: 2002-05

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Field	Value	Language
dc.contributor.author	Roberts, CL	en_US
dc.contributor.author	Algert, CS	en_US
dc.contributor.author	Douglas, I	en_US
dc.contributor.author	Tracy, SK	en_US
dc.contributor.author	Peat, B	en_US
dc.date.issued	2002-05	en_US
dc.identifier.citation	Aust N Z J Obstet Gynaecol, 2002, 42 (2), pp. 176 - 181	en_US
dc.identifier.issn	0004-8666	en_US
dc.identifier.uri	http://hdl.handle.net/10453/4489
dc.description.abstract	OBJECTIVE: To examine recent trends in obstetric intervention rates among women at low-risk of poor pregnancy outcome. DESIGN: Cross-sectional analytic study SETTING AND POPULATION: A population of 336,189 women categorised as low-risk of a poor pregnancy outcome who gave birth to a live singleton in NSW from 1 January 1990 to 31 December 1997. MAIN OUTCOME MEASURES: Obstetric intervention rates including oxytocin induction and augmentation of labour, epidural analgesia, instrumental births, caesarean section and episiotomy METHODS: Trends over time were assessed by fitting trend-lines to numbers of births or by trends in proportions. Unconditional logistic regression was used to assess the impact of epidural analgesia on instrumental birth over time. RESULTS: Rates of operative births did not rise despite increases in maternal age and use of epidural analgesia. Instrumental births declined over time from 26% to 22% among primiparas and 5% to 4% among multiparas. There was also a shift to vacuum extraction rather than forceps. Although instrumental birth was strongly associated with epidural analgesia, the strength of the association declined over the study period, for primiparas from an adjusted odds ratio of 7.2 to 5.2 and for multiparas from 13.2 to 10.3. CONCLUSIONS: Increased use of epidural analgesia for labour has been a feature of the management of birth at term during the 1990s. The decline in the strength of association between epidural analgesia and instrumental birth may reflect improved epidural techniques and management of epidural labour, and recognition of the adverse maternal outcomes associated with forceps and vacuum births.	en_US
dc.language	eng	en_US
dc.relation	http://purl.org/au-research/grants/arc/C79920018
dc.relation.ispartof	Aust N Z J Obstet Gynaecol	en_US
dc.relation.isbasedon	10.1111/j.0004-8666.2002.00176.x	en_US
dc.subject.classification	Obstetrics & Reproductive Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Pregnancy Outcome	en_US
dc.subject.mesh	Anesthesia, Obstetrical	en_US
dc.subject.mesh	Delivery, Obstetric	en_US
dc.subject.mesh	Cesarean Section	en_US
dc.subject.mesh	Episiotomy	en_US
dc.subject.mesh	Extraction, Obstetrical	en_US
dc.subject.mesh	Labor, Induced	en_US
dc.subject.mesh	Population Surveillance	en_US
dc.subject.mesh	Logistic Models	en_US
dc.subject.mesh	Probability	en_US
dc.subject.mesh	Odds Ratio	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Cross-Sectional Studies	en_US
dc.subject.mesh	Maternal Age	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Labor, Obstetric	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Obstetric Labor Complications	en_US
dc.title	Trends in labour and birth interventions among low-risk women in New South Wales.	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	42	en_US
utslib.location.activity	Australia	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1114 Paediatrics and Reproductive Medicine	en_US
utslib.for	1117 Public Health and Health Services	en_US
dc.location.activity	Boston, USA
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	42	en_US

Abstract:

OBJECTIVE: To examine recent trends in obstetric intervention rates among women at low-risk of poor pregnancy outcome. DESIGN: Cross-sectional analytic study SETTING AND POPULATION: A population of 336,189 women categorised as low-risk of a poor pregnancy outcome who gave birth to a live singleton in NSW from 1 January 1990 to 31 December 1997. MAIN OUTCOME MEASURES: Obstetric intervention rates including oxytocin induction and augmentation of labour, epidural analgesia, instrumental births, caesarean section and episiotomy METHODS: Trends over time were assessed by fitting trend-lines to numbers of births or by trends in proportions. Unconditional logistic regression was used to assess the impact of epidural analgesia on instrumental birth over time. RESULTS: Rates of operative births did not rise despite increases in maternal age and use of epidural analgesia. Instrumental births declined over time from 26% to 22% among primiparas and 5% to 4% among multiparas. There was also a shift to vacuum extraction rather than forceps. Although instrumental birth was strongly associated with epidural analgesia, the strength of the association declined over the study period, for primiparas from an adjusted odds ratio of 7.2 to 5.2 and for multiparas from 13.2 to 10.3. CONCLUSIONS: Increased use of epidural analgesia for labour has been a feature of the management of birth at term during the 1990s. The decline in the strength of association between epidural analgesia and instrumental birth may reflect improved epidural techniques and management of epidural labour, and recognition of the adverse maternal outcomes associated with forceps and vacuum births.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/4489