By Sterling Petersen
According to the National Perinatal Information Center, labor induction is defined as the use of pharmacological and/or mechanical methods to initiate labor (Examples of methods include, but are not limited to: artificial rupture of membranes, balloons, oxytocin, prostaglandin, Laminaria, or other cervical ripening agents).
To examine Utah trends in induced deliveries, we queried the Utah Healthcare Facility Database for inpatient stays and applied a subset of the criteria used by the Joint Commission on National Quality Measures to identify induced deliveries. Induction rates were then calculated by dividing the number of inductions by the total number of deliveries.
The total number of deliveries excluded deliveries where comorbid conditions might have justified an induced delivery. In other words, this analysis focuses on induced deliveries where patient and provider preferences were a possible factor. The denominator and numerator for the induced delivery rates were calculated on inpatient stays from Utah hospitals from January 2016–June 2020 using the following definitions.
Denominator: Inpatient stays with at least one ICD procedure code from Table Number 11.01.1: Delivery or at least one ICD diagnosis code from Table Number 11.06.1: Planned Cesarean Birth in Labor and without any ICD diagnosis codes from Table Number 11.07: Conditions Possibly Justifying Elective Delivery.
Numerator: Inpatient stays from the denominator with at least one ICD procedure code from Table Number 11.05: Medical Induction of Labor.
The results show an upward trend in the percentage of induced deliveries over the period of analysis (January 2016–June 2020). During the first quarter of 2016, about 32.6% of deliveries were induced. By the end of the second quarter of 2020, approximately 44.6% of deliveries were induced.
Figure 1. Induced deliveries as a percentage of total deliveries
January 2016–June 2020, displayed in quarters
Monthly totals between 2019 and 2020 show an increase in the number of induced deliveries occurring in February, March, and April 2020. This coincides with an increasing number of COVID-19 cases in Utah and around the nation, as illustrated below.
Figure 2. Induced deliveries as a percentage of total deliveries
January 2019–June 2020, displayed in months
While induced deliveries have notably increased over time, the overall percentages varied by race and ethnicity. Mothers indicating “Asian” as their race had the lowest rate over the period of analysis (30%), while those indicating “Other Race” had the highest (45.9%). The identified racial group with the highest percentage of induced deliveries was that of American Indian/Alaskan Natives (40.5%). Mothers identifying as “Hispanic or Latino” had a lower rate than those indicating they were “Not Hispanic or Latino.”
Figure 3. Induced deliveries as a percentage of total deliveries
By Race, aggregated January 2016–June 2020
Figure 4. Induced deliveries as a percentage of total deliveries
By Ethnicity, aggregated January 2016–June 2020
To further explore and identify consistencies or differences in induced deliveries, the team investigated maternal age groups. Women of the 35-39 age group had the highest rate (approximately 40.4%); those in the 15-19 age bracket had the lowest (35%) between January 2016 and June 2020.
Figure 5. Induced deliveries as a percentage of total deliveries
By Maternal Age, aggregated January 2016–June 2020
The team at the Utah Department of Health (UDOH) Office of Health Care Statistics further explored the degree to which medically-induced deliveries differ across Utah’s geographic regions. The analysis by county demonstrates that notable differences exist in the proportion of induced deliveries. For example, from January 2016 through June 2020, Carbon County had approximately 16.4% of deliveries involving inductions, while Duchesne and Daggett counties both had approximately 60% of deliveries involving induction. Notably, Daggett County has a relatively wide confidence interval, likely due to small numbers, so it may be best to monitor induced deliveries for a longer period to draw better conclusions for this county. These notable variations across Utah’s counties could shed light on varying practices across the state with regard to induced deliveries.
Figure 6. Induced deliveries as a percentage of total deliveries
By County, aggregated January 2016–June 2020
Laurie Baksh manager of the UDOH Maternal and Infant Health Program says, “This data is an important contributor to examining induction trends in Utah. The decision to induce labor can be complex and should be made with a comprehensive discussion between patient and provider. The American College of Obstetricians and Gynecologists recommends nonmedically indicated inductions of labor should not occur before 39 weeks of pregnancy. Some inductions may be done with consideration to the mother’s residential distance to a hospital, which in rural/frontier Utah may be a great distance.”
The underlying reasons for the differences observed aren’t fully understood. However, there is a possibility at least some of the differences are due to patient and provider preferences. The UDOH Office of Health Care Statistics is committed to learning more about induced deliveries in Utah using our Healthcare Facility Database, and will further explore inductions by cesarean vs. vaginal delivery and the role gestational age may play in patterns surrounding inductions across the state. The office will continue to monitor these trends over time and hopes this DataByte will foster conversations among stakeholders in the field, who can help to better understand the notable variations in induced deliveries across Utah.