Researchers found that women with obesity who opted for labor induction at 39 weeks were primarily motivated by physical discomfort and desire for birth timing control rather than body mass index–related health concerns, according to a new study.
In the qualitative study, published in Acta Obstetricia et Gynecologica Scandinavica, the researchers interviewed 25 pregnant women with a body mass index (BMI) ≥ 30 kg/m² who were randomized to receive labor induction at 39 weeks as part of the larger WINDOW (When to INDuce for OverWeight) trial. The participants viewed inclusion in the study as a "great opportunity," hoping specifically for early induction assignment.
The study population included 12 nulliparous and 13 multiparous women, aged 24 to 39 years (14 aged 24 to 29 years, 11 aged 30 to 39 years). Educational levels varied, with 6 having low (1 to 10 years), 17 middle (11 to 14 years), and 2 high (> 15 years) levels of education.
The study, conducted between October 2022 and October 2023, collected data through 20 phone interviews, 3 video calls, and 2 in-person home visits at 4 to 6 weeks postpartum. The researchers conducted the study across four Danish hospitals: three regional maternity departments and one university hospital.
The research occurred within Denmark's health care system, where approximately 15% of pregnant women have a prepregnancy BMI ≥ 30 kg/m². The system provides free maternity care, with midwives leading low-risk care, including labor induction.
Study exclusion criteria included maternal age below 18 years, language barriers requiring interpreters, multiple pregnancy, previous cesarean section, uncertain gestational age, planned elective cesarean, noncephalic presentation, fetal conditions contraindicating vaginal delivery, placenta previa/accreta, vasa previa, and medical conditions such as insulin-treated diabetes, hypertensive disorders > 140/90, cardiac disease, and renal insufficiency.
The clinical protocol involved outpatient induction with daily hospital check-ups, including abdominal palpation, vaginal examination for Bishop score, and CTG monitoring. Women self-administered misoprostol tablets (25 μg) every 2 hours with a maximum daily dose of 200 μg for up to 3 days. If the tablets failed to initiate labor, procedures progressed to membrane rupture or balloon catheter insertion.
Among the 25 participants, 24 of them received misoprostol tablets, 7 required balloon catheter intervention, and 12 underwent artificial rupture of membranes. Fourteen of the participants received epidural analgesia. Regarding delivery outcomes, 21 of them achieved spontaneous vaginal delivery, 1 required instrumental intervention, and 3 underwent cesarean section. The average induction duration was 3 days, ranging from 1 to 8 days.
The researchers analyzed interview data using NVIVO 10.0 software, with three interviews independently test-coded by two researchers to resolve coding discrepancies. The study noted limitations, including the exclusion of non-Danish speaking residents and women randomized to expectant management.
The research was funded by the Novo Nordic Foundation and conducted through the Department of Gynecology and Obstetrics at Gødstrup Hospital and the Department of Clinical Medicine at Aarhus University.
The authors declared having no competing interests.
