Friday, August 20, 2010

Labor Induction: The Back Door to Reducing Cesarean Rates?

by Melissa Garvey, ACNM Writer and Editor

A study in the July 2010 issue of Obstetrics & Gynecology underscores why the midwifery model of care—a model which minimizes interventions—should be the standard of care for women. Researchers set out to investigate the link between labor induction and cesarean birth, and discovered some telling findings.

This retrospective study examined the electronic hospital clinical records of nearly 8,000 women who had never given birth, were pregnant with only one baby, experienced head-first (specifically, vertex) presentation of the baby at birth, and were between 37 and 42 weeks of pregnancy. Of the group, 43.6% underwent induction of labor—39.9% of which were elective. That means that instead of being medically necessary, the labor induction happened because the woman and/or her health care provider chose to induce labor.

Many women and health care providers opt for elective labor induction. In fact, it may be a factor in why the latest CDC statistics show a 140% increase in the rate of labor induction between 1990 and 2007. Elective labor induction may seem like an attractive option when a woman is uncomfortable near the end of her pregnancy or is trying to plan for a vacation or important event. One study showed that most women don’t perceive labor induction as a safety hazard even at just 37 weeks of pregnancy.

But here’s the rub: researchers estimate that 20% of cesarean births among the women studied could be attributed to labor induction. After adjusting for confounders, for example, obesity and high blood pressure, labor induction was associated with a two-fold increase in the risk of cesarean birth.

Researchers also found a significant association between obesity and risk of cesarean birth. What do you think? Could the answer to reducing our 31.8% cesarean birth rate be reduced by a healthy lifestyle and avoiding unnecessary induction of labor?

For more information on when to allow labor to start on its own and when labor induction is medically necessary, check out the Journal of Midwifery & Women’s Health “Share With Women” handout on induction of labor.

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