title: Birth outcomes associated with interventions in labour amongst low risk women: a population-based study.
abstract: BACKGROUND
  Despite concern over high rates of operative birth in many countries, particularly amongst low risk healthy women, the obstetric antecedents of operative birth are poorly described. We aimed to determine the association between interventions introduced during labour with interventions in the birth process amongst women of low medical risk.
  
  
  METHODS
  We undertook a population-based descriptive study of all low risk women amongst the 753,895 women who gave birth in Australia during 2000-2002. Adjusted odds ratios (AOR) were calculated using multinomial logistic regression to describe the association between mode of birth and each of four labour intervention subgroups separately for primiparous and multiparous women.
  
  
  RESULTS
  We observed increased rates of operative birth in association with each of the interventions offered during the labour process. For first time mothers the association was particularly strong.
  
  
  CONCLUSIONS
  This study underlines the need for better clinical evidence of the effects of epidurals and pharmacological agents introduced in labour. At a population level it demonstrates the magnitude of the fall in rates of unassisted vaginal birth in association with a cascade of interventions in labour and interventions at birth particularly amongst women with no identified risk markers and having their first baby. This information may be useful for women wanting to explore other methods of influencing the course of labour and the management of pain in labour, especially in their endeavour to achieve a normal vaginal birth.
authors.affiliation: Australian Institute of Health and Welfare, National Perinatal Statistics Unit, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia. stracy@ozemail.com.au
authors.forename: Sally K
authors.initials: SK
authors.lastname: Tracy
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sullivan
authors.forename: Yueping Alex
authors.initials: YA
authors.lastname: Wang
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: Mark
authors.initials: M
authors.lastname: Tracy
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003657:Decision Making; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004841:Episiotomy / Q000706:statistics & numerical data; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D048949:Labor Pain / Q000453:epidemiology; D007751:Labor, Induced / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000458:organization & administration; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000517:prevention & control; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012307:Risk Factors