Both induction of labour and Caesarean section rates have increased significantly. A systematic review and meta-analysis of trials in women with intact membranes by Wood et al showed that induction of labour reduces Caesarean section in comparison with expectant treatment. Another meta-analysis by Kate Walker et al showed that induction of labour has no statistically significant effect on Caesarean section. Dr. O’Brien discusses the various indications for induction of labour, pros and cons for induction of labour in macrosomia and advantages of planned early birth vs expectant line of management for pre labour rupture of membranes at term. The methods for induction of labour and the timing (morning vs evening), the place (outpatient vs. inpatient) for improving outcomes are discussed in detail. NICE quality standards for induction of labour involve personalized information to patients regarding benefits and risks and alternatives to induction of labour. Pain relief, availability of safety and support procedures and audit are important considerations.
MB, BCh, MFFP, FRCOG
Mr Pat O’Brien has been a Consultant in Obstetrics and Gynaecology at University College London Hospitals NHS Foundation Trust and an Honorary Senior Lecturer at University College London ( UCL) since 1999. He qualified as a doctor in Ireland, but all his postgraduate training has been in London. He specialises in Maternal Medicine and high-risk obstetrics, with particular interest in complications of pregnancy and jointly runs a multi-disciplinary antenatal clinic involving consultants in Fetal Medicine, Cardiology, Haematology, Diabetes, Anaesthesia, and an Obstetric Physician.
Mr O'Brien is the Chair of the International Division of the Institute for Women’s Health in London, a spokesperson for the Royal College of Obstetricians & Gynaecologists, a member of the Obstetric Guideline Development Group of the National Institutue for Clinical Excellence (NICE) in the UK, and a reviewer for the Cochrane Collaboration and several medical journals. He lectures widely in the UK and abroad, examines for the DRCOG examination and works as an Obstetric Advisor for the BBC (British Broadcasting Corporation).