About Birth

Induced Labors Twice As Likely To End In C-Section

(Reuters Health) - First-time mothers who have their labor induced may face a greater risk of needing a cesarean section than those who go into labor naturally, a new study finds.

A new study involving nearly 8,000 first time mothers suggests a strong link between inductions and c-sections.  Researchers found that women who had their labors induced were twice as likely to have a c-section.

Published in the July issue journal Obstetrics & Gynecology, these results are in keeping with much of what we already know.  Inducing labor increases the chance of a c-section and is therefore not recommended by the the American Collage of Obstetricians and Gynecologists (ACOG) as a routine procedure.  It’s questionable whether these recommendations are being adhered to in most hospitals.

In this study, 44% of the women were induced.  Of those inductions 40% were “elective inductions” (inductions done for non-medical reasons).  That number seems very high and not in synch with current medical recommendations.

The findings, reported in the journal Obstetrics & Gynecology, firm up the link seen in past studies between labor induction and an increased risk of C-section. By definition, labor induction is performed before a woman's body is ready for spontaneous labor, and in some cases there will be problems with labor progression that necessitate a C-section.

The connection is important because while cesarean section is a generally safe procedure, it requires a longer recovery time than vaginal birth, and does present certain risks, such as blood clots, infection at the incision site or in the lining of the uterus, and breathing problems in the baby.

Moreover, the rates of both labor induction and C-section have been on an upward trend in the U.S. since the 1990s. Labor inductions have risen from just under 10 percent of births in 1990 to 22 percent in 2006; and in 2007, C-sections were done in almost one-third of all births.

The current findings suggest that putting more limits on so-called "elective" inductions would help lower the number of C-sections performed nationally, according to lead researcher Dr. Deborah B. Ehrenthal of the Christiana Care Health System in Newark, Delaware.

There are good reasons to medically induce a labor including maternal or fetal medical conditions (such as pre-ecclampsia); a post-date pregnancy (42 weeks onwards); or a situation where the waters have broken and labor does not start spontaneously within 24 hours. The latter is not very common. Of the 10% of women whose water does break before labor starts 85% of them will go into labor all by themselves within 24 hours.

Medical induction replaces the body’s labor hormones with artificial ones. It often works but sometimes doesn’t. (In this study, researchers pointed to “failed induction” as the reason for 20 % of the c-sections performed.) Also pitocin– the drug used to stimulate contractions– isn’t as gentle as the naturally occurring hormone oxytocin. Women often find contractions from pitocin harder and/or more intense than non-induced contractions. This makes an epidural more likely. An epidural is not necessarily going to lead to surgery. In fact, epidurals given late in a very long labor can reduce the chance of a c-section. But an early epidural is associated with c-section. It’s all a very delicate balance; starting a labor from scratch involves revving pretty hard without the body’s support.

The findings in this study suggest that we look again and more closely at why these inductions are taking place. A c-section is a very commonly performed and generally safe surgery. But it is surgery and brings with it an increased risk of infection or blood clots for the mother and increased chance of respiratory issues and infection for the baby. The c-section rate has risen dramatically over the last several decades. And though obesity and other issues are doubtlessly playing into this trend, inductions are clearly another factor.

“Even among the 4,600 women in the study considered ‘low risk’ for needing a labor induction — because they were not post-term, were free of diabetes, high blood pressure and obesity, and the fetus was not overly large — 29 percent had their labor induced…” writes Amy Norton for Reuters, “Among these low-risk women, one-quarter of those who had a labor induction ended up needing a C-section, versus 14 percent of those who had a natural labor.”

Dr. Caroline Signore, a scientist with the U.S. National Institute of Child Health and Human Development wrote an editorial published with the study, in which she argues that women considering elective induction should be given better information: “Labor induction performed for no medical reason is an area for us to target.”

What’s the take-away for pregnant women wanting to avoid an unnecessary induction or c-section? Talk to your care-provider about his or her induction policy and rates. Care-providers with high induction rates are more likely to give inductions and visa versa. Always ask what your options are. What are the risks? What are the benefits? What are the alternatives? What if we wait? What if we do nothing? It’s good to get in the habit of being actively involved in your medical care; there’s certainly no harm in asking. In fact, studies have also shown that doctors and midwives respond positively to engaged and curious patients.

Reuters "Induced labor may double the odds of C-section"

"Being Pregnant"  Induced Labors Twice As Likely To End In C-Section

 'Behold, I will bring them from the north country, And gather them from the ends of the earth,
 Among  them the blind and the lame, The woman with child and The one who labors with child,  together,
 A great throng shall return there...And My people shall be satisfied with My goodness, says the LORD.'
 Jeremiah 31:8, 14
~~~
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February 2011