First-time moms at low risk of complications were less likely to need a Caesarean delivery if labour 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 long-time view that inducing labour 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 labour 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 foetal 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 forego pain medicine or use a hospital’s home-like birthing centre 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 labour was induced,” she said.
Many women now ask to be induced to let them plan delivery and ensure their doctor is available, but the risks and benefits are unclear. Previous studies suggesting that inducing labour 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 labour induction for 39 weeks — when a pregnancy is considered full-term and complication rates are lowest.
Deaths and severe complications were fewer among babies of women who were induced — about 4% versus 5% in the other group — but the difference was so small it could have occurred by chance alone. Significantly fewer babies in the induced group needed breathing tubes or extra oxygen after birth, and they spent less time in the hospital. Nineteen percent of induced moms had a Caesarean versus 22% of the others. Doctors estimate that one C-section would be avoided for every 28 women induced.
Nine percent of induced women developed dangerous high blood pressure at the end of pregnancy versus 14% of the others. Study participants who were induced, such as Aleksa Owen, said they had less pain and felt more in control. “I was pretty open to any kind of birth, whatever works to keep the baby safe and myself safe as well,” said Owen, a 34-year-old graduate student from the Chicago suburb of Woodridge, Illinois. Her son was born in October 2016 and she said she felt a sense of control throughout the process.
Christen Sadler, a certified nurse-midwife and president-elect of Lamaze International, said other research suggests that letting labor start on its own is almost always best for moms and babies unless there’s a problem that requires intervening. Nan Strauss, policy chief for the advocacy group Every Mother Counts, agreed: “Inducing labour disrupts the complex hormonal processes that help labour progress, prepare the baby for birth, and promote successful breastfeeding and bonding.”
Results of the federally funded study were published by the New England Journal of Medicine.