title: Trends in labour and birth interventions among low-risk women in New South Wales.
abstract: OBJECTIVE
  To examine recent trends in obstetric intervention rates among women at low-risk of poor pregnancy outcome.
  
  
  METHODS
  Cross-sectional analytic study
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Centre for Perinatal Health Services Research, University of Sydney, New South Wales, Australia.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Roberts
authors.forename: Charles S
authors.initials: CS
authors.lastname: Algert
authors.forename: Ian
authors.initials: I
authors.lastname: Douglas
authors.forename: Sally K
authors.initials: SK
authors.lastname: Tracy
authors.forename: Brian
authors.initials: B
authors.lastname: Peat
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000639:trends*; D002585:Cesarean Section / Q000639:trends; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000639:trends*; D004841:Episiotomy / Q000639:trends; D005113:Extraction, Obstetrical / Q000639:trends; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000639:trends; D007743:Labor, Obstetric / Q000502:physiology; D016015:Logistic Models; D008423:Maternal Age; D009517:New South Wales; D007744:Obstetric Labor Complications; D016017:Odds Ratio; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors