Inducing can lower C-section risk
Study that involved first-time parents refutes long-standing view
Move over, Mother Nature. First-time parents at low risk of complications were less likely to need a caesarean delivery if labour was induced at 39 weeks instead of waiting for it to start on its own, a big study found. Their babies fared better, too.
The results overturn the view that inducing labour raises the risk for a C-section and led two leading ob-gyn doctor groups to say it’s now reasonable to offer people like those in the study that option.
But only certain pregnant people qualify, and the study did not track how inducing labour affected breastfeeding or other parent-baby issues later. Some groups, such as Lamaze International, advocate letting nature take its course rather than giving medicines to make the womb start contracting.
“Many women don’t want all of the medical care that goes with induction,” such as an IV and fetal monitoring, said Lisa Kane Low, past president of the American College of NurseMidwives and associate dean of the University of Michigan School of Nursing. “It can result in a very different type of experience.”
Being induced doesn’t mean parents can’t have “natural childbirth” — they can forgo pain medicine or use a hospital’s homelike birthing centre rather than delivering in “an operating room in a sterile suite with a big light over your head,” said the study leader, Dr. William Grobman, an ob-gyn specialist at Northwestern University.
“Everyone has a different definition of what a natural birth is,” said Dr. Cynthia GyamfiBannerman of New York-Presbyterian/Columbia University Medical Center, which participated in the study.
Results of the federally funded study were published recently by the New England Journal of Medicine.
About the study
About 40 per cent of U.S. women giving birth are first-time parents, and at least half are low risk — no problems requiring early delivery or a caesarean. Many ask to be induced now, to let them plan delivery and ensure their doctor is available, but the risks and benefits are unclear.
Previous studies suggesting that inducing labour raises the risk for a C-section were observational and compared different types of women giving birth under different types of circumstances. This was the first very big experiment to time labour induction for 39 weeks — when a pregnancy is considered full term and complication rates are lowest.
More than 6,100 pregnant people at 41 hospitals were ran- domly placed in two groups: one had labour induced at 39 weeks; the other waited for labour to start on its own and were induced only if a problem developed or they hadn’t delivered by 42 weeks.
How moms and babies fared
Deaths and severe complications were fewer among babies of those who were induced — about 4 per cent versus 5 per cent in the other group — but the difference was so small, it could have occurred by chance alone. Significantly fewer babies in the induced group needed breathing tubes or extra oxygen after birth, and they spent less time in the hospital.
Nineteen per cent of those induced had a caesarean versus 22 per cent of the others. Doctors estimate that one C-section would be avoided for every 28 women induced.
Nine per cent of those induced developed dangerous high blood pressure at the end of pregnancy versus 14 per cent of the others. Study participants who were induced, such as Aleksa Owen, said they had less pain and felt more in control.
“I was pretty open to any kind of birth, whatever works to keep the baby safe and myself safe as well,” said Owen, a 34year-old graduate student from the Chicago suburb of Woodridge, Ill. Her son was born in October 2016 and “I felt like I had a sense of control throughout the process.”
What others think
Christen Sadler, a certified nurse-midwife and presidentelect of Lamaze International, said other research suggests that “letting labour start on its own is almost always best for moms and babies” unless there’s a problem that requires intervening.
Nan Strauss, policy chief for the advocacy group Every Mother Counts, agreed: “Inducing labour disrupts the complex hormonal processes that help labour progress, prepare the baby for birth, and promote successful breastfeeding and bonding.”
The American College of Obstetricians and Gynecologists and the Society for MaternalFetal Medicine say it’s reasonable for doctors to offer labour induction “after discussing the options thoroughly” with firsttime pregnant moms at low risk who had an ultrasound early in pregnancy to verify when they will reach 39 weeks.
Dr. Michael Greene of Massachusetts General Hospital noted that women in the study were younger than U.S. mothers on average and fewer were over 35, calling into question how universal the results are.
Still, the study “should reassure women that elective induction of labour at 39 weeks is a reasonable choice” that’s unlikely to harm moms or babies, he wrote in a commentary in the journal.