In 1985, the World Health Organization (WHO) stated that no country should have an induction rate higher than 10%. Inappropriate use of technology in childbirth has become an issue of international concern with reports of its negative impact on maternal and infant physical and psychological wellbeing. The aim of this paper is to describe the outcome data from a prospective cohort study and how these were used to test a model of the association between birth technology for inducing birth and maternal and infant morbidity, taking into account labour type, obstetric risk, method of monitoring, oxytocin, number of ultrasound scans and type of analgesia. Data from a prospective cohort study of a convenience sample of 200 primigravida women who gave birth at Bade’a Hospital in Northern Jordan was used for this statistical analysis. The data was obtained from a self-assessment questionnaire that was used to collect data on maternal and infant outcomes during the antenatal, intra-natal and postnatal period. Data extraction was confirmed by examining the case notes. A multivariate analysis using Structural Equation Modelling with goodness of fit assessed using chi-square. Ethical approval to conduct the study was given by the University of Ulster Research Ethics Committee and the Human Subject’s Committee at the Jordan University of Science and Technology. The data analyses demonstrated that Induction of labour (IOL) was associated with use of oxytocin, electronic fetal monitoring and analgesia. A number of chains of association was found: induced labour was associated with fetal distress (p
|Journal||International Journal of Basic and Clinical Pharmacology|
|Publication status||Published - 1 Nov 2013|
Bibliographical noteReference text: REFERENCES
Crowley P(1998). Interventions to prevent or improve outcomes from
delivery at or beyond term. (Cochrane review). In the Cochrane
library Issue (2), 2001 Oxford: Update Software.
Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett
TF(2007). Maternal Health Study Group of the Canadian Perinatal
Surveillance System. Investigation of an increase in postpartum
haemorrhage in Canada. British J. Obstet. Gynaecol. BJOG, Jun;
Grivell RM, Reilly AJ, Oakey HA, Chan A, Dodd JM(2011). Maternal
and neonatal outcomes following induction of labour: a cohort
study.ActaObstetricia et GynecologicaScandinavica. 91:198-203.
Rossen J, Økland I, BjarteNilsen O, Eggebø TM(2011). Is there an
increase of postpartum hemorrhage, and is severe hemorrhage
associated with more frequent use of obstetric interventions?
Obstetrical and Gynecological Survey. 66: 18–20.
Burgos J, Rodríguez L, Otero B, Cobos P, Osuna C, CentenoMdel M,
Melchor JC, Fernández-Llebrez L, Martínez-Astorquiza T(2012).
Induction at 41 weeks increases the risk of caesarean section in a
hospital with a low rate of caesarean sections, J. Maternal- Fetal
and Neonatal Med. 25(9):1716-1718. Epub 2012 Mar 9.
Investigation of an increase in postpartum haemorrhage in Canada.
Shetty A, Burt R, Rice P, Templeton A(2005). Women's perceptions,
expectations and satisfaction with induced labour—a questionnaire
based stud. Eur. J. Obstetrics and Gynaecology and Reproductive
Biol. 123: 56–61
Cooper, M; &Warland, J. (2011) Improving women’s knowledge of
prostaglandin induction of labour through the use of information
brochures: Aquasi-experimental study, women and birth, 24(4), 156-
Cheyne, H; Abhyankar, P; &Williams, B. (2012) Elective induction of
labour: The problem of interpretation and communication of risks
Midwifery. 28: 412-415.
World Health Organization Regional Office for Europe(1985). Joint
Interregional Conference on Appropriate Technology for Birth.
WHO: Fortaleza, Brazil.
Crowley P(1989). Effective care in pregnancy and childbirth. In
Chalmers, I. Enkin, M; &Keirse, M. (eds) Post term pregnancy.
Induction or surveillance?. Oxford University Press: Oxford.
World Health Organization(1998). Appropriate technology for birth: a
World Health Organization Perspectives. MIDRIS Midwifery Digest,
World Health Organization(2011). Recommendations for induction of
labour Geneva: World Health Organization. 2011 Available from
HRL the WHO reproductive library
National Institute for Health and Clinical Excellence(2008). Induction of
Labour. NICE Clinical Guidelines 70 National Collaborating Centre
for Women's and Children's Health, London.
Stock SJ, Ferguson E, Duffy A, Ford I, Chalmers J, Norman JE(2012). Outcomes of elective induction of labour compared with expectant
management: a population based study. British Med. J. 344: e2838.
Euro- Peristat Project(2008). European Perinatal Health report by the
Euro -Peristat Project, Data from 2004 available at
Information Services division (ISD) Scotland(2010). Birth in Scottish
hospitals. Available from http://www.isdscotland.org/HealthTopics/Maternity-and-Births/Publications/2012-08-28/2012-08-28-
Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP,
Taneepanichskul S, Ruyan P, Attygalle DE, Shrestha N, Mori R,
Nguyen DH, Hoang TB, Rathavy T, Chuyun K, Cheang K, Festin M,
Udomprasertgul V, Germar MJ, Yanqiu G, Roy M, Carroli G, BaThike
K, Filatova E, Villar J (2008). World Health Organization
Global Survey on Maternal and Perinatal Health Research Group.
Method of delivery and pregnancy outcomes in Asia: the WHO
global survey on maternal and perinatal health. Lancet 2010,
Hamilton BE, Martin JA, Ventura SJ(2011). Births: preliminary data for
2010. National Vital Statistics Reports, 60(2):1-25. Available from
Ministry of health(2011). Annual statistics report, Amman: Jordan.
Available from http://www.moh.gov.jo/MOH/En/publications.php
Accessed on 27 of Sept.
Sinclair M(1999). Midwives’ readiness to use high technology in the
labour ward. Implications for Education and Training. Queen’s
University Belfast (unpublished PhD thesis).
Sinclair M, Crozier K(2004). Medical device raining in maternity care:
part 2. British J Midwifery 12(8): 509-513.
Duff C, Sinclair MK(2000). Exploring the risks associated with induction
of labour: a retrospective study using the NIMATS database. J. Adv.
Nursing. 31(2): 410-417.
Bricker L, Luckas M(2012). Amniotomy alone for induction of labour
Boulvain M, Stan CM, Irion O(2010). Membrane sweeping for induction
of labour available from
Alfirevic Z, Kelly AJ, Dowswell T(2009). Oxytocin for induction of labour.
Alfirevic Z, Devane D, Gyte GML(2008). Comparing continuous
electronic monitoring of the baby's heartbeat in labour using
cardiotocography (CTG, sometimes known as EFM) with
intermittent monitoring (intermittent auscultation, IA) available from
summaries: Independent high-quality evidence for health care decision
Devane D, Lalor JG, Daly S, McGuire W, Smith V(2012). Comparing
electronic monitoring of the baby's heartbeat on a woman's
admission in labour using cardiotocography (CTG) with intermittent
monitoring available from
Parkes J, Dolk H, Hill N, Pattenden S(2001), Cerebral palsy in Northern
Ireland: 1981--1993. PaediatrPerinatEpidemiol, 15(3):278-86.
Jordan Population and Family Health Survey(2009). Department of
Statistics. Amman Jordan. Available from
Central Intelligence Agency(2011). The world factbook – Jordan.
Central Intelligence Agency: Washington.
Amarin Z, Jaddou H, Khader Y, Okour A(2009). Maternal Mortality in
Jordan, unpublished study, Jordan University of Science and
Higher Population Council (2007-2008). Maternal Morbidity In Jordan.
Retrieved. From http://www.hpc.org.jo/.
Hatamleh R, Sinclair M, Kernohan WG, Bunting B(2008). Technological
childbirth in northern Jordan: descriptive findings from a prospective
cohort study. Evidence Based Midwifery 6(4): 130-135.
World Health Organization(2004). Making pregnancy safer statistics in
EMR part one. WHO: Geneva.
Khresheh R. Homer C. Barclay L(2007). A comparison of labour and
birth outcomes in Jordan with WHO guidelines: a descriptive study
using a new birth record. Midwifery.
Caughey AB, Sundaram V, Kaimal AJ, Gienger A, Cheng YW,
McDonald KM, Shaffer BL, Owens DK, Bravata DM(2009).
Systematic Review: Elective Induction of Labor Versus Expectant
Management of Pregnancy. American College of Physicians
Gülmezoglu AM, Crowther CA, Middleton P, Heatley E(2012). Induction of
labour in women with normal pregnancies at or beyond term available
.Jun13;6:CD004945. doi: 0.1002/14651858.CD004945.pub3.
- Induction of Labour
- Infant morbidity
- maternal morbidity
- Middle East
- birth technology
- prospective study