Inducing
labor without a medical reason is associated with negative outcomes for
the mother, including increased rates of cesarean delivery, greater
blood loss and an extended length of stay in the hospital, and does not
provide any benefit for the newborn. As the number of scheduled
deliveries continues to climb, it is important for physicians and
mothers-to-be to understand the risks associated with elective
induction.
The new findings, published in the February issue of the Journal
of Reproductive Medicine, only apply to women having their first
child, and may not pertain to women having their second or third child.
“The benefits of a procedure should always outweigh the risks. If
there aren’t any medical benefits to inducing labor, it is hard to
justify doing it electively when we know it increases the risks for the
mother and the baby,” said Christopher
Glantz, M.D., M.P.H., study author and professor of Maternal
Fetal Medicine at the University
of Rochester Medical Center.
In the past decade, scheduled deliveries have become commonplace,
with physicians making elective inductions part of their routine
obstetric care. Study authors cite social reasons, such as convenience
and patient requests to deliver with “their” physician, for the
ongoing increase in purely elective inductions.
While physicians and patients alike may assume that inducing labor is
harmless, it does not work as well as natural labor: Since you are
essentially starting the birthing process from ground zero, more
problems are likely to arise.
“As a working professional and a mother, I know how tempting it can
be to schedule a delivery to try to get your life in order, but there is
a reason that babies stay in the womb for the full term,” said Loralei
Thornburg, M.D., an assistant professor who specializes in
maternal fetal medicine. “Why put you and your newborn at risk if you
don’t have to?”
Researchers found that approximately 34 percent of women who opted
for elective induction of labor ultimately had a cesarean section, while
only 20 percent of women who labored naturally underwent a cesarean
delivery. Like elective induction, cesarean delivery naïvely may be
seen as routine and risk-free, when in fact it is a major surgery and
like all surgeries increases the risk of infection, respiratory
complications, the need for additional surgeries, and results in longer
recovery times.
Additionally, women who were induced had more bleeding – even after
taking cesarean deliveries into account – and stayed in the hospital
longer than women who delivered vaginally. Study authors calculate that
for every 100 women who undergo elective induction, they spend an
additional 88 days in the hospital compared to the same number of women
who labor spontaneously. Although this may translate into only a matter
of hours for some women, it represents increased costs for both the
mother and the hospital when multiplied by large numbers of induced
labors.
“Counseling women to steer clear of an elective induction can be
challenging, but the bottom line is that medical reasons trump social
reasons,” said Eva
Pressman, M.D., director of Maternal Fetal Medicine at the
Medical Center. “If physicians are armed with information about the
risks associated with elective induction they have a better chance of
convincing their patients to avoid this route.”
While scheduled deliveries present multiple risks for the mother,
researchers also found that they did not improve the health of newborns
either. When women were induced, their babies were more likely to need
oxygen immediately following delivery. They were also more likely to
require specialized attention from members of the neonatal intensive
care unit (NICU).
The study included 485 women who delivered their first child between
January and December of 2007 at the University of Rochester Medical
Center. The major strength of this study is that, unlike most prior
studies, researchers reviewed each mother’s and baby’s medical
chart, as opposed to relying on medical coding. Evaluating each chart
allowed researchers to figure out exactly why women were induced and
what the complications were, catching subtle details that may have
otherwise been overlooked.
As opposed to women having their first baby, women who have already
had a child may actually respond more favorably to induction. “If
you’ve delivered once before, your body knows the drill and can do it
again,” said Glantz.
Though elective inductions are not outside the standard of care,
physicians should be cognizant of the associated risks and communicate
these risks to women considering the procedure. In an effort to better
address this issue at the University of Rochester Medical Center, the
department of Maternal Fetal Medicine is applying for a grant to help
put procedures in place that will prevent elective induction of labor
before 39 weeks.
“Past research has shown that inducing labor early without a
legitimate medical reason is risky, and this study further validates
these findings” said Thornburg.