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Primary Submission Category: Reproductive health
The Induction Cascade as a System Problem: Mixed-Methods Evidence from Low-Risk Births in Louisiana
Authors: Dovile Vilda, Regan A. Moss,
Presenting Author: Dovile Vilda*
Background: Rising intervention use in low-risk pregnancies has heightened concerns about medicalization of birth and unnecessary procedures. Induction has increased in the US while cesarean trends have fluctuated, within racialized differences in maternity care shaped in part by racism. We assessed whether trends among low-risk births reflect system pressures and differ across racialized groups.
Methods: Explanatory sequential mixed methods: Phase 1 analyzed Louisiana birth records (2012–2024) restricted to clinically low-risk births (first birth, term, singleton, head down; no preexisting conditions or major pregnancy complications). We estimated annual prevalence and trends in induction and cesarean delivery and tested differences by race/ethnicity. Phase 2 includes 16 interviews with obstetric clinicians, midwives, L&D nurses, and doulas; transcripts were analyzed using deductive and inductive thematic analysis. Integration used joint displays linking trends to provider-described mechanisms.
Results: Among low-risk births (n=148,962), cesarean declined from 30.2% in 2012 to 23.1% in 2024, while induction increased from 37.7% to 45.0% (p<0.05). Induction increased most for Asian patients (26.7% to 41.9%) and Black patients (33.1% to 44.9%); White patients remained highest overall (41.7% to 47.2%). Cesarean declined across groups but remained higher for Black patients (29.4% to 23.8%). Interviews highlighted protocol timelines, quality oversight, staffing/scheduling constraints, and liability-driven risk management that normalize default escalation and an induction pathway; limited counseling time and differential flexibility by patient race/payer were also noted.
Conclusions: Louisiana low-risk births show increasing induction alongside declining cesareans, with racialized differences. Provider accounts point to modifiable system targets, including revising low-risk protocols and strengthening staffing and counseling to support shared decision-making and physiologic labor.