A retrospective population-based study of induction of labour trends and associated factors among aboriginal and non-aboriginal mothers in the northern territory between 2001 and 2012

Abstract

BackgroundInduction of labour (IOL) has become more common among many populations, but the trends and drivers of IOL in the Northern Territory (NT) of Australia are not known. This study investigated trends in IOL and associated factors among NT Aboriginal and non-Aboriginal mothers between 2001 and 2012.MethodsA retrospective analysis of all NT resident women who birthed in the NT between 2001 and 2012 at ≥32 weeks gestation. Demographic, medical and obstetric data were obtained from the NT Midwives’ Collection. The prevalence of IOL was calculated by Aboriginal status and parity of the mother and year of birth. The prevalence of each main indication for induction among women was compared for 2001–2003 and 2010–2012. Linear and logistic regression was used to test for association between predictive factors and IOL in bivariate and multivariate analysis, separately for Aboriginal and non-Aboriginal mothers.ResultsA total of 42,765 eligible births between 2001 and 2012 were included. IOL was less common for Aboriginal than non-Aboriginal mothers in 2001 (18.0 % and 25.1 %, respectively), but increased to be similar to non-Aboriginal mothers in 2012 (22.6 % and 24.8 %, respectively). Aboriginal primiparous mothers demonstrated the greatest increase in IOL. The most common indication for IOL for both groups was post-dates, which changed little over time. Medical and obstetric complications were more common for Aboriginal mothers except late-term pregnancy. Prevalence of diabetes in pregnancy increased considerably among both Aboriginal and non-Aboriginal mothers, but was responsible for only a small proportion of IOLs. Increasing prevalence of risk factors did not explain the increased IOL prevalence for Aboriginal mothers.ConclusionsIOL is now as common for Aboriginal as non-Aboriginal mothers, though their demographic, medical and obstetric profiles are markedly different. Medical indications did not explain the recent increase in IOL among Aboriginal mothers; changes in maternal or clinical decision-making may have been involved.

Ethnic variation in causes of stillbirth in high‐income countries: A systematic review and meta‐analysis

“…This category includes stillbirth that has been attributed to malpresentation, forceps delivery, vacuum delivery, cesarean delivery or induction of labor. This is in agreement with a population‐based study from the Northern Territory, Australia which demonstrated higher rates of emergency caesarean and malpresentation in Indigenous mothers compared to non‐Indigenous, 60 but contrary to the study by Kildea and colleagues who found Indigenous Australian to have lower rates of instrumental delivery and induction of labor 61 . In our review, Asian and South Asian ethnicities showed a larger proportion of stillbirths attributed to complications of placenta, cord and membranes, in line with previous work showing higher rates of placental insufficiency 62 and placenta praevia 63 in women of Asian heritage.…”

Ethnic variation in causes of stillbirth in high income countries: A systematic review and meta-analysis

“…This category includes stillbirth that has been attributed to malpresentation, forceps delivery, vacuum delivery, caesarean delivery or induction of labour. This is in agreement with a population-based study from the Northern Territory, Australia which demonstrated higher rates of emergency caesarean and malpresentation in Indigenous mothers compared to non-Indigenous, 60 but contrary to the study by Kildea and colleagues who found Indigenous Australian to have lower rates of instrumental delivery and induction of labour. 61 In our review, Asian and South Asian ethnicities showed a larger proportion of stillbirths attributed to complications of placenta, cord and membranes, in line with previous work showing higher rates of placental insufficiency 62 and placenta praevia 63 in women of Asian heritage.…”