Helping nature: Inducing labor avoids cesarean for some moms

August 8, 2018

Helping nature: Inducing labor avoids cesarean for some moms

Associated Press

Move over, Mother Nature. First-time moms at low risk of complications were less likely to need a cesarean delivery if labor was induced at 39 weeks instead of waiting for it to start on its own, a big study found. Their babies fared better, too.

The results overturn the longtime view that inducing labor raises the risk for a C-section, and prompted two leading OB-GYN doctor groups to say it’s now reasonable to offer women like those in the study that option.

But only certain pregnant women qualify, and the study did not track how inducing labor affected breastfeeding or other mom-baby issues later. Some groups such as Lamaze International still advocate letting nature take its course rather than giving medicines to make the womb start contracting.

“Many women don’t want all of the medical care that goes with induction” such as an IV and fetal monitoring, said Lisa Kane Low, past president of the American College of Nurse-Midwives and associate dean of the University of Michigan School of Nursing. “It can result in a very different type of experience.”

Being induced doesn’t mean moms can’t have “natural childbirth” — they can forgo pain medicine or use a hospital’s homelike birthing center rather than delivering in “an operating room in a sterile suite with a big light over your head,” said the study leader, Dr. William Grobman, an OB-GYN specialist at Northwestern University in Chicago.

“Everyone has a different definition of what a natural birth is,” said Dr. Cynthia Gyamfi-Bannerman of New York-Presbyterian/Columbia University Medical Center, which participated in the study.

“Some women feel that natural just means delivering vaginally” and more were able to do that when labor was induced, she said.

Results of the federally funded study were published Wednesday by the New England Journal of Medicine.

About 40 percent of U.S. women giving birth are first-time moms, and at least half are low risk — no problems requiring early delivery or a cesarean. Many women ask to be induced now, to let them plan delivery and ensure their doctor is available, but the risks and benefits are unclear.

Previous studies suggesting that inducing labor raises the risk for a C-section were observational and compared different types of women giving birth under different types of circumstances. This was the first very big experiment to time labor induction for 39 weeks — when a pregnancy is considered full term and complication rates are lowest.

More than 6,100 women at 41 hospitals were randomly placed in two groups: one had labor induced at 39 weeks; the other waited for labor to start on its own and were induced only if a problem developed or they hadn’t delivered by 42 weeks.