Labour induction and ethnicity
George F Winter discusses issues surrounding providing midwifery care to women from ethnic minorities, who experience different obstetric outcomes as well as potential differences in quality of care
To what extent can a pregnant woman's socioeconomic status and/or ethnicity influence her birthing journey? Previous research on indicators of labour induction have concentrated on medical risk factors, such as a woman's age, the presence of diabetes or hypertension or an infant's birth weight and gestational age. Carter et al (2020) investigated whether socioeconomic factors such as maternal education, income or neighbourhood deprivation were independently associated with labour induction in the UK, controlling for medical factors. They found that the risk of labour induction differs by socioeconomic status, with nulliparous and multiparous women with fewer educational qualifications and those living in disadvantaged places having ‘a greater likelihood of labour induction than women with higher qualifications and women in advantaged electoral wards’ (Carter et al, 2020).
According to Walsh et al (2011), ethnicity can influence perinatal and obstetric outcomes; gestational time is shorter in black and Asian women compared with white European women and racial and ethnic disparities in caesarean section rates also exist. Walsh et al (2011) compared labour outcomes between women from Ireland and Eastern European countries, reporting that the latter were more likely to labour spontaneously, and during spontaneous labour, the duration was shorter and less epidural analgesia and oxytocin augmentation for dystocia were used, despite insignificant differences in birth weight. Walsh et al (2011) stated that this confirmed the ‘healthy migrant effect’, indicating a selection bias where ‘women who are able to migrate and be mobile are more likely to be healthier when compared with native-born counterparts’.
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