Induction of Labor: Newest Findings

  • By:  Emily Nobles, WHNP

Does being induced increase Caesarean rates? Not necessarily. Read the latest findings.

Induction of labor is an important tool that obstetricians use in the event of medical complications during pregnancy. Induction of labor is the use of medications to bring on labor in a woman who may not be going into labor on her own. If the mother or baby is at risk, labor can be induced to avoid or minimize complications.

The American College of Obstetricians and Gynecologists (ACOG) has guidelines established to help Ob-Gyns determine when induction of labor may be appropriate for a given condition. Ob-Gyns use these guidelines, along with their own expertise and knowledge of an individual patient situation, to determine when it is appropriate to induce labor.

Risks and benefits must be weighed, and potential complications must be considered alongside the development of the fetus. Some medical reasons for induction include poor fetal growth and preeclampsia (or high blood pressure in pregnancy), or if the baby still has not been born a week or more after the due date.

To determine the approximate development of the fetus, the Ob-Gyn will use the gestational age. Gestational age is counted in weeks, and a pregnant woman’s due date is the day on which she is 40 weeks pregnant. ACOG defines a baby as being “full term” if the baby is born between 39 weeks 0 days and 40 weeks 6 days.

Studies have shown that during this time frame, adverse outcomes for babies are the lowest. A baby is not considered premature unless he or she is born earlier than 37 weeks. Gestational age comes from the estimated due date, which is determined early in the pregnancy using the date of the woman’s last menstrual period, along with early ultrasounds.

Elective induction is any induction that is performed when a woman does not have a specific medical diagnosis that requires induction. ACOG, along with other organizations, has advised against any elective induction prior to 39 weeks because of studies demonstrating key fetal development occurring between 37 and 39 weeks.

Although there may be a medical reason to deliver a baby prior to 39 weeks, these organizations say that waiting until 39 weeks to induce offers the best chance of a healthy outcome for the baby.

Because of these guidelines set forth by ACOG, most hospitals and providers will not schedule any elective induction prior to 39 weeks. There is, however, discrepancy among providers whether the provider will perform any elective induction, even if it occurs between 39 and 41-42 weeks.

Some providers do not perform elective inductions because they do not think that the benefits outweigh the risks. For many years, the literature on elective induction seemed to show that one risk of induction was an increased risk of Caesarean delivery, or C-section.

However, a new study, published in the New England Journal of Medicine in August 2018 suggests that there was no increased risk of C-section with induction within the study.

The study followed over 6,000 healthy, first-time mothers. The women were randomly assigned to one of two groups. In one group, approximately half of the women had their labor induced at 39 weeks.

The other half of the women waited to go into labor on their own. The study then compared these two groups of women to examine the outcomes for the mothers and the babies.

In the group who underwent elective induction at 39 weeks, the rate of C-section was 3 percent lower than in the group who went into labor on their own. The women in the induction group were also found to have lower rates of blood pressure complications than the women who went into labor on their own.

There was no significant difference in adverse outcomes between the two groups. The study showed that the women in the trial who had an elective induction did not have an increase in bad outcomes, but it did result in lower rates of C-section and high blood pressure complications, such as preeclampsia.

According to a practice advisory statement released in response to this study, ACOG concluded that “based on the findings demonstrated in this trial, it is reasonable for obstetricians and health-care facilities to offer elective induction of labor to low-risk nulliparous women at 39 weeks gestation.”

Because the study only followed healthy women who were giving birth for the first time (nulliparous women), the ACOG practice recommendations are only applied to this patient type. The same outcomes may not occur for patients with other complications or for women who have had previous deliveries.

Based on the findings of this new study, elective induction can be a safe option for certain women. As this study is new, providers may or may not change their practice based on the findings. As with any aspect of prenatal care, it is vital for the patient to have a conversation with her healthcare provider to determine what is best for her and her pregnancy.

Having an elective induction is a shared decision between a woman and her provider, taking into account the patient’s values, as well as the provider’s experience and practices.

Emily Nobles, WHNP, is a nurse practitioner at Atlantic Ob/Gyn in Va. Beach and Chesapeake. Visit www.atlanticobgyn.com for more info.

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