Patients’ acceptance toward elective induction of labor at 39th week of gestation among low-risk pregnancies in a tertiary hospital in Vietnam: the PALI study

Abstract

Background

The term “elective induction of labor (eIOL)” refers to the practice of inducing labor before the due date in the absence of medical indication. In 2022, the American College of Obstetricians and Gynecologists (ACOG) recommended that eIOL be considered for healthy women at 39 weeks of gestation. However, the acceptance of eIOL among pregnant women is crucial. Understanding pregnant women's perspectives on this issue is essential for developing strategies to shift public perceptions of eIOL.

Objective

To evaluate the opinion and acceptance of low-risk pregnant women regarding elective induction of labor at 39^th week of gestation.

Materials and Methods

From January 2022 to January 2023, we conducted a survey of low-risk pregnant women attending routine obstetrics at Hanoi Obstetrics and Gynecological Hospital, Hanoi, Vietnam, at 2 intervals: 36 weeks and 39 weeks of gestation. The first survey included questions regarding basic demographics, obstetric history, and participants' opinions and acceptance of labor induction, with a particular focus on eIOL at 39 weeks of gestation in the absence of medical indications. The women's acceptance was asked for a second time at 39 weeks, and in-depth interviews were conducted with those who changed their minds between the 2 surveys.

Results

For 200 pregnant women who participated in the study at 36 weeks, the 3 most common reasons for IOL prior to the due date were maternal indications, fetal indications, and a convenient day for pregnant women, about 88%, 87%, and 80%, respectively. Women not opting for eIOL were concerned about the risk of harm to the fetus (53%) and increasing infection complications (33%). Among 177 pregnant women who completed the second survey, the rate of eIOL acceptance was decreased compared to the first time (40.1% vs 54.5%, respectively). Twenty-eight women altered their decision from acceptance to rejection of eIOL due to apprehension about the risk associated with labor induction (43%) or impacts from others, including medical staff (25%) and relatives (21%). Four out of 8 women conversed to accept eIOL at the 39th week of gestation to choose a date of birth.

Conclusion

Awareness of the induction of labor among pregnant women in Vietnam remains limited. More than half of women who do not support eIOL believe it could be harmful to the fetus. The acceptance rate for eIOL declines as the pregnancy approaches the due date because of adverse impacts from relatives and medical staff. These findings underscore the importance of comprehensive medical counseling for pregnant women and their families, as well as improving the healthcare providers’ awareness regarding the advantages and disadvantages of induction of labor.