Induced labor no more likely to go wrong: study

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Choosing induced labor is just as safe for first-time pregnant women as waiting for labor to start spontaneously, new research hints.

The number of women who have labor induction—either with drugs or mechanical devices to ripen the cervix—has been climbing steadily in recent years, reaching more than one in five in 2006.

At the same time, however, concerns have grown that induction for non-medical reasons could lead to more unplanned Cesarean sections and complications such as bleeding.

"For women who have a favorable cervix there was no difference in the C-section rate between those who were induced and those with expectant management,” said Dr. Sarah Osmundson, referring to the “wait-and-see” approach that usually leads to spontaneous labor.

Osmundson, of Northwestern University in Chicago, and her colleagues didn’t find any differences in complication rates for mother or baby either.

“This is not a call to induce everyone,” she said, noting that her study was relatively small. “We still need better data to really make recommendations.”

Osmundson examined results from close to 600 deliveries of women giving birth for the first time. Half had elective induction—that is, for a non-medical reason—while the rest waited to see if they would go into spontaneous labor.

Eventually, almost one in five ended up requiring induction, mostly because they reached 41 weeks of pregnancy. Normally, pregnancy lasts about 40 weeks.

In the “wait-and see” group, 20 percent of the women ended up with a C-section, compared to 21 percent of those who had elective induction. Bleeding after delivery occurred in about three and four percent, respectively.

Overall, mothers and babies did equally well in both groups. However, those women who had induced labor spent nearly 13 hours at the hospital, whereas the other group spent only nine hours on average.

“The bigger point is the women who were induced spent a lot more time in labor,” said Osmundson, adding that the extra time was likely to translate into higher healthcare costs.

Another study, published along with the first one in the journal Obstetrics and Gynecology, did find a higher C-section rate and more bleeding in first-time pregnant women with elective labor.

However, like many earlier studies with similar results, those women were compared to women who had already gone into spontaneous labor. That means some women who might have ended up with an unplanned induction or C-section weren’t part of the comparison group, biasing the result in favor of spontaneous labor.

“It doesn’t provide any real clinical guide for how to manage patients,” Osmundson told Reuters Health.

The American College of Obstetricians and Gynecologists discourages induction before 39 weeks unless there are medical reasons for starting labor early.

After that, induction is left at the discretion of the woman and her health provider, said Dr. Mary Rosser, an obstetrician and gynecologist at the Montefiore Medical Center in New York.

She added that the new findings were interesting, but that they didn’t convince her.

“I would discourage elective induction unless there is a reason we can put our hands on,” said Rosser, a fellow of the American College of Obstetricians and Gynecologists.

“What I tell my patients is, I will let you go until 10 days past your due date unless something comes up for mom or the baby.”

Osmundson concluded: “I think that the options are all available at this point.”

SOURCE: Obstetrics and Gynecology, September, 2010.

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