Induced labor may double the odds of C-section

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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 ...

... those who had their labor induced were twice as likely to ultimately need a C-section.

... 44 percent had their labor induced -- and the researchers estimate that failed induction accounted for 20 percent of the C-sections performed.

The findings ... 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.

... There are circumstances in which labor induction may be advisable. There is good evidence, for example, that inducing labor benefits mom and baby when pregnancy goes beyond 41 weeks ...

... when a mother has pregnancy-related high blood pressure or diabetes, or when the mother's "water breaks" but labor does not spontaneously begin.

I'd like to add that none of these are absolute reasons for inducing labour. High blood pressure that is stable and has no other complicating factors, does not necessarily require an induction. The research supports induction sometime after 41 weeks and before 42 weeks, not not strictly at 41 weeks. Furthermore, ruptured membranes does not necessarily require induction although the risk of infection does increase the longer the waters are broken.

In general, elective labor induction refers to those done with no clear medical reason. It may be done for convenience, for example, or in cases where late pregnancy is causing significant physical discomfort or when a woman wants to ensure that her own doctor delivers the baby.

Of the labor inductions performed in this study, 40 percent were elective ...

... the bottom line for pregnant women is that they should understand the reasons for and potential risks of all forms of delivery. "It's really important to have a frank discussion with your doctor about all of your options for delivery," she said.

And, it would seem it is also important for care providers to understand the reasons and potential risks of induction. Many articles blame women for the outcome, however in reality women often do what their trusted care provider suggests.

... women contemplating an elective labor induction should be aware of the relatively higher risk of C-section.

Shouldn't all women be aware of the higher risk of c/s with a planned induction? This would help them to determine whether they wish to proceed down the induction route, or explore other alternatives such as expectant management and monitoring.

In an interview, she also pointed out that when first-time moms have a C- section, they often have repeat cesareans with any future pregnancies. So limiting the need for C-section in first-time pregnancies is particularly important.

... the rate of labor induction in this study -- at 44 percent -- was striking.

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 ...

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.

... the current findings ... underscore a widespread need ... to try to cut rates of "inappropriate" labor induction. "Labor induction performed for no medical reason is an area for us to target," ...

... according to ACOG guidelines, elective inductions and elective C-sections should not be scheduled before the 39th week of pregnancy, in order to reduce the odds of complications associated with relatively earlier birth.

However ... this guideline is "not followed rigorously."

A study published last month, for example, found that as the U.S. national rate of labor induction rose between 1992 and 2003, so did the proportion of births occurring at the earlier end of full-term ...

In 2003, the study found 30 percent of all full-term singleton births occurred during the 37th or 38th week, versus 19 percent in 1992. The researchers concluded that labor inductions performed before the 39th week were a "likely cause" of that trend.

Melissa Maimann, Essential Birth Consulting 0400 418 448