As noted earlier, the decrease in Caesarean rates seen in these meta-analyses was almost exclusively due to a study conducted by Hannah et al.40 Therefore, it is important to take a closer look at this study. Between 1985 and 1990, Hannah et al. randomly assigned 3407 low-risk women from six different hospitals in Canada to either expectant management or elective induction at 41 weeks. Women could be included if they had a live, single foetus, and were excluded if they were _44 weeks, three or more centimetres dilated, or had a previous Caesarean, pre-labour rupture of membranes, or medical indication for induction. At around 41 weeks, women were randomly assigned to either induction of labour or expectant management. In the induction group, labour was induced within four days, and women received cervical ripening (if the cervix was less than 3 cm dilated), followed by intravenous oxytocin and/or artificial rupture of membranes. In the expectant management group, women were taught how to do kick count monitoring, had three non-stress tests per week, and underwent amniotic fluid measurement two to three times per week. Labour was induced if the non-stress test was nonreactive or showed decelerations, if there was low amniotic fluid (deepest pocket less than 3 cm), if complications developed, if the mother requested an induction, or if the mother did not go into labour on her own by 44 weeks. If an induction occurred in the expectant management group, mothers did not receive cervical ripening— instead, they either had their water broken and/or oxytocin, or had a Caesarean without labour.