Elective induction of labor: a prospective clinical study, II: Psychological effects

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Abstract
Several authors have stated that induction of labor may have deleterious psychological effects on women''s experiences of labor and early mother-infant interaction. Research on this subject is scarce and in most cases no distinction is made between elective induction and induction for medical reasons. For that reason the observed effects may also have been caused by the medical complications that led to the induction. Differences in experience of labor may also be in part explained by differences in personal characteristics between women choosing or rejecting induction of labor. Influences of induction of labor can only be reliably assessed in prospective studies. In the present study of 271 women with an uncomplicated pregnancy, data regarding their experiences of pregnancy and their expectations of labor and motherhood were collected before labor. In 72 women labor was electively induced, and 199 women had a spontaneous onset of labor. Of 33 women, 19 with spontaneous labor and 14 with elective induction, the first contact with their newborn was observed. All women who could be contacted were interviewed about their experience of labor and the first contact with their infant. Six months after delivery the mothers were questioned about the state of health of mother and infant and about nursing the infant. Mothers with induced labor were rated as being generally less emotionally involved in the first contact with their newborn than mothers with spontaneous labor, but the differences were not significant. The duration of spontaneous labor was longer, but the subjective time experience did not differ between groups. Women with spontaneous labor were more tired during labor. Analgesic drugs were given more often to women with induced labor. No differences were apparent in reported experience of pain and anxiety, drowsiness and in the evaluation of labor as a whole. Six months after delivery no differences between the two groups were apparent with regard to the evaluation of labor, health of mother and infant, and nursing problems. Mothers with induced labor were more self-confident in taking care of their infant, but they less frequently breast-fed. Consistency with respect to the choice of the mode of labor in the next pregnancy was greater in women with spontaneous labor as compared with women with induced labor. Differences in outcome between the two groups could only partly by explained by differences in personal characteristics. It is concluded that in weighing advantages and disadvantages of elective induction of labor, possible changes in the feelings of the women have to be taken into account: it seems likely that she will be less anxious and more self-confident when her labor is induced, but also emotionally less involved with her newborn, as compared with a woman with spontaneous labor.

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