Why Inducing Labor Might Be the Wave of the Future

Mar 6, 2018 at 8:00 a.m. ET
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The end of a pregnancy can be an unpredictable time between false labor, real labor and the uncertainty that comes with not knowing exactly when the baby will arrive. That is, unless labor is induced. As it turns out, at a certain point, that may be the best option for both mother and baby.

A recent study performed by the Eunice Kennedy Shriver National Institutes of Health and Human Development from March 2014 to August 2017 has yielded interesting results: Inducing labor in healthy pregnancies at 39 weeks can be very beneficial to all those involved. The research, published in the American Journal of Obstetrics and Gynecology, was designed to test the theory that inducing labor at 39 weeks for low-risk pregnancies would reduce the number of stillbirths and lower infant mortality (infant death prior to 1 year of age). It was also used to test whether inducing labor at 39 weeks or expectant management, or natural labor in which you only intervene if complications arise, was more beneficial in the long run.

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Inducing labor, according to the Mayo Clinic, “is the stimulation of uterine contractions during pregnancy before labor begins on its own to achieve a vaginal birth.” Most of the time, labor is induced when someone is two weeks past their due date and natural labor hasn’t begun, which is called a post-term pregnancy. Other reasons can include an infection in the uterus, someone’s water breaking when they haven’t gone into labor, gestational diabetes, preeclampsia, gestational hypertension, the baby being 10 percent or more underweight of its expected gestational age, lack of amniotic fluid around the baby or any number of other medical reasons.

While inducing labor can be risky, like with anything else pregnancy-related, most of the time the benefits are greater. Doctors take into consideration the health of both parent and baby, gestational age, weight and size of the baby and position of the baby inside the uterus to make an informed decision. Elective labor induction is when labor is induced for nonmedical reasons — reasons of convenience — which may not be entirely accurate.

The American College of Obstetricians and Gynecologists guidelines currently recommend against inducing labor before 41 weeks, especially during first pregnancies, due to the “concern of increased need for cesarean delivery.”

However, the study performed by the NICHD finds the opposite to be the case. The study was conducted due to a recent rise in elective labor inductions — 6,100 people pregnant with their first children were selected from the NICHD’s maternal-fetal medicine units network and then randomly assigned into the group of people having elective labor induction or the expectant-management group.

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Upon evaluation of the study, only approximately 19 percent of those in the elective-labor group had to have a C-section compared to approximately 22 percent of those in expectant management. Other big findings include preeclampsia and gestational hypertension in just 9 percent of those induced compared to 14 percent of expectant management and 3 percent of induced newborns needing respiratory support to the 4 percent of newborns from expectant management that needed it.

Dr. Charles Lockwood, the dean of Morsani College of Medicine at the University of South Florida, formerly a proponent of expectant management but now for induced labor at 39 weeks, says that induced labor lowers the risk of stillbirth and reduces severe labor complications for both parent and child.

There is no benefit to the fetus waiting beyond 39 weeks in well-dated pregnancies,” according to Dr. Errol Norwitz, the chairman of obstetrics and gynecology at Tufts University of Medicine. In fact, multiple studies in both the United States and the United Kingdom have found that after 39 weeks, the risk of infant mortality significantly increases, while stillbirth rates “are at their lowest at 39 weeks.”

The cause of such a large increase in stillbirths after 39 weeks of pregnancy isn’t yet known. Norwitz believes stillbirths cause a “hugely underappreciated problem” given the fact that between 25,000 and 30,000 occur in the United States each year.

Norwitz also argues that “continuing a pregnancy beyond 39 weeks is riskier than previously believed for the fetus,” while he says the opposite is true for the risk of induction, that the risks to the parent are lower than they were previously believed to be.

Given the evidence, it seems like it may be a step in the right direction that more people are being induced at 39 weeks. The person pregnant has ultimate control over how they give birth, so it is important for them to be aware of labor induction as another viable option. According to the Centers for Disease Control, 32 percent of all babies born in 2015 were delivered via C-section. However, C-sections, while common, are still considered a major surgery. The Mayo Clinic says that, like all major surgeries, C-sections come with risks factors like breathing problems for the baby, surgical injuries, infection of the wound, blood clots and more.

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An opponent to the rise of induced labor at 39 weeks, Cristen Pascucci, vice president of the birth rights advocacy group Improving Birth, feels that induced labor takes choices away from the parent. The practice “reinforces a century-old, pre-feminist American obstetric view that birth is pathological and the doctor’s job is to extract the fetus from the incubator,” she says.

We are still a long way from routinely inducing labor at 39 weeks, though Norwitz says, “It’s a very healthy discussion to have.”

By Kelley O'Brien

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