Despite popular misconceptions about the risks of induced labor, medical researchers say the delivery technique actually lowers rates of emergency cesareans by 12 percent — with no additional risk of the mother’s death.
Some one in five live births in the United States come after labor induction, which is mistakenly thought by many to increase the risk of cesarean delivery. Doctors today induce labor for many reasons including preeclampsia, diabetes, preterm membrane ruptures, and fetal distress. Many pregnancies are also induced in the case of overdue pregnancies and, sometimes, for the sake of convenience.
In a study published Monday in the Canadian Medical Association Journal, researcher Khalid Khan of Queens Mary University of London says the record has been cleared.
"The risk of cesarean delivery following labour induction was significantly lower than the risk associated with expectant management," he said in a university press release. "This finding supports evidence from systematic reviews but is contrary to prevalent beliefs and information from consumer organizations, guidelines and textbooks."
In the study, Khan and his colleagues reviewed 157 high-quality clinical trials — randomized and controlled — that covered more than 31,000 deliveries. They compared the rates of cesarean deliveries for induced deliveries with “expectant management,” the term describing a “wait-and-see” approach to making the decision. Even among late pregnancies, the rate of cesarean deliveries fell for deliveries induced by the doctor.
Interestingly, the risk for cesarean delivery also fell for women with high-risk pregnancies. And compared to women who delivered without induction, birth complications and fetal death risk were both lower, too. "These findings show that induction is a way to increase the likelihood of a vaginal birth," Khan said.
Yet lowered risks for cesarean delivery and other complications, including fetal death, were realized only with pregnancies induced by Prostaglandin E2, which is commonly used in the U.S., Canada, and the United Kingdom. By contrast, deliveries induced with oxytocin and amniotomy did not carry the same lowered risk for cesarean delivery.
"Our meta-analysis has provided a robust answer to the disputed question of risk of cesarean delivery associated with induction of labour,” Khan said. “Women whose labour was induced were less likely than those managed expectantly to have a cesarean delivery. In addition, the risk of fetal death and admission to neonatal intensive care unit were decreased in the induction group.”
The new information should help doctors to make more informed decisions about labor induction, with improved risk-management for patients.
Source: Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis. Canadian Medical Association Journal. 2014.