{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T18:17:18Z","timestamp":1792261038756,"version":"4.4.0"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,3,21]],"date-time":"2017-03-21T00:00:00Z","timestamp":1490054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01\u2010HD052990"],"award-info":[{"award-number":["R01\u2010HD052990"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Mode of delivery at first childbirth largely determines mode of delivery at subsequent births, so it is particularly important to understand risk factors for cesarean delivery at first childbirth. In this study, we investigated risk factors for cesarean delivery among nulliparous women, with focus on the association between labor induction and cesarean delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective cohort study of 2851 nulliparous women with singleton pregnancies who attempted vaginal delivery at hospitals in Pennsylvania, 2009\u20102011, was conducted. We used nested logistic regression models and multiple mediational analyses to investigate the role of three groups of variables in explaining the association between labor induction and unplanned cesarean delivery\u2014the confounders of maternal characteristics and indications for induction, and the mediating (intrapartum) factors\u2014including cervical dilatation, labor augmentation, epidural analgesia, dysfunctional labor, dystocia, fetal intolerance of labor, and maternal request of cesarean during labor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>More than a third of the women were induced (34.3%) and 24.8% underwent cesarean delivery. Induced women were more likely to deliver by cesarean (35.9%) than women in spontaneous labor (18.9%), unadjusted OR 2.35 (95% CI 1.97\u20102.79). The intrapartum factors significantly mediated the association between labor induction and cesarean delivery (explaining 76.7% of this association), particularly cervical dilatation &lt;3\u00a0cm at hospital admission, fetal intolerance of labor, and dystocia. The indications for labor induction only explained 6.2%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increased risk of cesarean delivery after labor induction among nulliparous women is attributable mainly to lower cervical dilatation at hospital admission and higher rates of labor complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12286","type":"journal-article","created":{"date-parts":[[2017,3,21]],"date-time":"2017-03-21T08:01:38Z","timestamp":1490083298000},"page":"252-261","source":"Crossref","is-referenced-by-count":36,"title":["Labor induction and cesarean delivery: A prospective cohort study of first births in Pennsylvania, <scp>USA<\/scp>"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5376-2581","authenticated-orcid":false,"given":"Kristen H.","family":"Kjerulff","sequence":"first","affiliation":[{"name":"Departments of Public Health Sciences and Obstetrics and Gynecology Penn State University College of Medicine  Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B.","family":"Attanasio","sequence":"additional","affiliation":[{"name":"Sewanee: The University of the South  Sewanee TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0465-9043","authenticated-orcid":false,"given":"Joyce K.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Connell School of Nursing Boston College  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy B.","family":"Kozhimannil","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health  Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Repke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Penn State University College of Medicine  Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,3,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182704880"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.060870"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aoa.0000452167.10247.d7"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.06.035"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000219750.79480.84"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14896-9"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2011.553695"},{"key":"e_1_2_6_9_1","volume-title":"Recent Declines in Induction of Labor by Gestational Age","author":"Osterman MJK","year":"2014"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(99)00377-4"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.119643"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200308000-00014"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000152338.76759.38"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181e10c5c"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200006000-00026"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12220"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-012-2582-1"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182a6a4d0"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyt127"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182a44cb9"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1101100306"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12328"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13301"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12014"},{"key":"e_1_2_6_25_1","unstructured":"DeclercqER SakalaC CorryMP et\u00a0al.Listening to Mothers: Report of the First National U.S. Survey of Women\u2019s Childbearing Experiences. 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