Inducing Labor: Don't Force Mother Nature's Hand
June 22, 2000 -- The last few weeks of pregnancy can seem endless, and it's
tempting to ask your doctor to induce labor to get the whole thing over sooner
-- especially in the hot, uncomfortable summer months. Or perhaps your
obstetrician will be going out of town soon, and he suggests bringing on labor
when you get near your due date.
But maybe you shouldn't try to fool with Mother Nature. Investigators have
found that when women undergo elective induction, they are more than twice as
likely to have a cesarean delivery, according to the authors, who recently
published their findings in the journal Obstetrics Gynecology. When
women giving birth for the first time have an elective induction, they are
almost three times as likely to end up with a cesarean.
And cesarean deliveries are not without risk. Compared to women who have
regular vaginal deliveries, those who have cesareans are nearly twice as likely
to be back in the hospital within 60 days, according to a study in a May issue
of the Journal of the American Medical Association. Cesarean births
carry the risk of life-threatening blood clots, excessive bleeding, infection,
and tearing of the uterus or of the surgical incision, among others.
Physicians induce labor by administering medications like oxytocin, or break
the bag of waters before actual labor begins. It is considered
"elective" if there is no medical reason for it, and the established
medical community discourages widespread use of the practice.
"Women and physicians should not feel pressured to induce labor if the
pregnancy is at term but all is going well, even though the mother is tired of
being pregnant," according to lead author Arthur S. Maslow, DO, MSc.
"If you're not approaching the 42nd week of pregnancy, it's best to be
patient." He is a physician specializing in maternal-fetal medicine at St.
Joseph's Medical Center in Tacoma, Wash.
He and co-author Amy L. Sweeny, MPH, reviewed information from the medical
records of nearly 1,200 women. Of these, just over 870 went into spontaneous
labor, and nearly 285 had their labor induced. The women all had low-risk
pregnancies. They were each carrying only one baby, who was lying in the
standard "head-first" position, and they gave birth between the 38th
and 41st weeks of pregnancy.
Of the approximately 450 women giving birth for the first time, there were
about 40 cesareans, 18 in the induced group and 21 in the spontaneous labor
group. Among the approximately 680 women who had given birth previously, there
were 27 cesareans -- 11 in the induced group and 16 in the spontaneous labor
When the investigators compared the costs of labors that ended in vaginal
births, elective inductions averaged $273 more per patient. Those labors also
involved an average of four more hours pre-delivery in the hospital than did
the spontaneous labors.