7

It seems that there is conflicting evidence on whether inducing labour causes an increase in the likelihood that a caesarian section becomes medically necessary.

Let me quote two authorities:

British Medical Journal

Outcomes of elective induction of labour compared with expectant management: population based study”, BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2838 (Published 10 May 2012)

Conclusions and policy implications

Our finding that elective induction of labour is not strongly associated with an increased odds of caesarean section and is associated with a reduction in maternal complications, goes against obstetric dogma but supports evidence from a recent systematic review comparing elective induction of labour with expectant management, where induction of labour was associated with about a 20% reduction in caesarean section.

Mayo Clinic

Website: Labor induction: Risks

The need for a C-section. Labor induction is more likely to result in the need for a C-section — particularly if you've never given birth before and your cervix hasn't already begun to thin, soften and dilate (unfavorable cervix).

I would like to know which is correct - or perhaps why the two authorities differ. Does inducing labour increase the risk that a C-section will be necessary?

  • It may vary by country. In the US, a drug that's not FDA approved for induction (I think it's like the morning after pill) is used to stimulate powerful contractions. It's possible this practice varies and may affect induction outcomes. I hope this is a useful starting place for some research. – William Grobman Oct 11 '12 at 13:56
  • @WilliamGrobman: It's a good point you make about the distinction between the commonly prescribed induction methods and fake methods. My intention was to address only the methods prescribed by physicians (pitocin). – Brian M. Hunt Oct 11 '12 at 19:37
  • Many physicians prescribe cytotec in addition to pitocin. While it's not FDA approved for induction, one of the side effects can be premature delivery and it's even used for chemical abortion. In the USA, at least, physicians can prescribe drugs for non-approved use. Since this method may be less well understood, it's possible that different practices regarding its use could affect the data on C-sections. – William Grobman Oct 12 '12 at 16:02
  • 1
    wouldn't inducing labor be primarily used when the natural process isn't working correctly to begin with so a C-section would be a likely outcome whether labor was induced or not? – Ryathal Oct 12 '12 at 17:24
4
  1. Induction of labour in women with intact membranes reduces the risk of caesarean section.

Per a systematic review and meta-analysis of trials in women with intact membranes in 2014 by Wood S et.al. for the question 'Does induction of labour increase the risk of caesarean section?', the authors conclude that in clinical trials of induction of labour versus expectant management in women with intact nonruptured membranes, induction reduced the risk of caesarean section.

AUTHOR'S CONCLUSIONS: Induction of labour in women with intact membranes reduces the risk of caesarean section. Review of the trials suggests that this effect may arise from non-treatment effects, and that additional trials are needed.

  1. The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term.

Per a systematic review and meta-analysis of trials in women by Ekaterina Mishanina et.al. in 2014 to investigate whether the risk of cesarean delivery is higher or lower following labour induction compared with expectant management, the interpretations were

Interpretation: The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term and post-term gestations. There were benefits for the fetus and no increased risk of maternal death.

  1. Elective induction of labor is associated with decreased odds of cesarean delivery when compared with expectant management.

Per Blair G. Darney et.al. in 2013, the results were "Elective induction was not associated with increased odds of severe lacerations, operative vaginal delivery, perinatal death, neonatal intensive care unit admission, respiratory distress, shoulder dystocia, or macrosomia at any term gestational age."

CONCLUSION: Elective induction of labor is associated with decreased odds of cesarean delivery when compared with expectant management.

Per AB Caughey in 2014, "there are a few cautionary items to review before we start inducing all patients at 39 weeks of gestation".

  1. First, the prospective studies of induction of labour included in the meta-analyses are generally from academic medical centres. It may be that the practice patterns in academic centres are different from those in the private-practice setting.

  2. Additionally, there has been no large modern trial of induction versus expectant management at 39 or 40 weeks of gestation, i.e. the equivalent of the Hannah trial of induction versus expectant management that was conducted at 41 and 42 weeks of gestation. Until such a large modern trial is conducted, I would not routinely recommend induction of labour prior to 41 weeks of gestation.

  3. Finally, although induction of labour at 41 weeks of gestation has been found to be cost-effective, it appears that as one moves to earlier gestations, such as 40 weeks of gestation, the intervention is only marginally cost-effective, and could lead to incremental increases of billions of dollars of healthcare costs.

  • 1
    I am really confused how this was ethically allowed to be studied in "clinical trials". Were women chosen at random and had their labor induced? – Jonathon Sep 7 '15 at 15:15
-2

I am also confused about this, but it seems like more recent studies suggest that induction may not be associated with an increased risk of caesarian section. http://www.medicalnewstoday.com/articles/263311.php

  • 2
    Welcome to Skeptics! We don't consider link-only answers to be great content. Could you please summarize the main points from that article in your answer? – user5582 Nov 3 '13 at 17:51

You must log in to answer this question.

Not the answer you're looking for? Browse other questions tagged .