Use of induction of labour and emergency caesarean section and perinatal outcomes in English maternity services: A national hospital-level study

Objective To assess the association between hospital-level rates of induction of labour and emergency caesarean section, as measures of 'practice style', and rates of adverse perinatal outcomes. Design National study using electronic maternity records. Setting English National Health Service. Sample Hospitals providing maternity care to women between April 2015 and March 2017. Main outcome measures Stillbirth, admission to a neonatal intensive care unit and babies receiving mechanical ventilation. Results Among singleton term births, the risk of stillbirth was 0.15%, the risk of admission to a neonatal intensive care unit was 5.4% and the risk of mechanical ventilation 0.54%. There was considerable between-hospital variation in the rate of induction of labour (minimum 17.5%, maximum 40.7%) and in the rate of emergency caesarean section (minimum 5.6%, maximum 17.1%). Women who gave birth in hospitals with a higher rate of induction of labour had better perinatal outcomes. For each 5%-point increase in induction, there was a decrease in the risk of term stillbirth of 9% (OR 0.91, 95% CI 0.85-0.97) and a decrease in the risk of mechanical ventilation of 14% (OR 0.86, 95% CI 0.79-0.94). There was no significant association between hospital-level induction of labour rates and neonatal unit admission at term (p > 0.05). There was no significant association between hospital-level rates of emergency caesarean section and adverse perinatal outcomes (all with p > 0.05). Conclusions There is considerable between-hospital variation in the use of induction of labour and emergency caesarean section. Hospitals with a higher rate of induction had a lower risk of adverse birth outcomes. A similar association was not found for caesarean section.