Obstetric interventions levels during childbirth among singleton cephalic term births in France between 2010 and 2021: a novel classification method applied to repeated cross-sectional national surveys.

INTRODUCTION

The medicalization of childbirth is an ongoing concern in obstetric care. This study aims to propose a classification method for levels of obstetric intervention during childbirth, and evaluate evolution over time among term births in France from 2010 to 2021.

METHODS

This repeated cross-sectional population-based observational study was conducted using data from the French National Perinatal Surveys of 2010, 2016 and 2021. Women who gave birth to a live, term, singleton infant in cephalic presentation following an attempted vaginal birth were included in this study. Obstetric interventions were categorized into seven mutually exclusive levels: without intervention (level 0); epidural analgesia alone (level 1); labour augmentation (level 2); labour induction (level 3); episiotomy (level 4); operative vaginal delivery (level 5); and intrapartum caesarean delivery (level 6). Linear trends for each level and for two clinically meaningful cumulative categories were analysed: levels 0-1 (women exposed to analgesic support alone) and levels 0-3 [women who avoided all delivery interventions (i.e. episiotomy, operative vaginal delivery and caesarean section)].

RESULTS

Among 31,150 women, significant increases were observed for level 1 (from 12.4% to 29.4%), level 3 (from 12.9% to 18.5%), and the two cumulative categories: levels 0-1 (from 23.5% to 40.9%) and levels 0-3 (from 60.9% to 71.9%). Significant decreases were noted for level 2 (from 24.5% to 12.5%) and level 4 (from 15.3% to 3.5%). No significant trend was observed for level 0 (spontaneous vaginal birth without intervention), level 5 (operative vaginal delivery) or level 6 (intrapartum caesarean delivery).

CONCLUSION

These findings suggest an overall reduction in the level of obstetric medicalization during labour and delivery over the study period, driven by declining labour augmentation and episiotomy rates, despite a concomitant rise in labour induction.