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 group.
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.
It is important to understand that this study only looked at elective induction, as opposed to instances when induction is medically appropriate, according to experts in obstetrics.
"This study confirms what we seem to know about the increased likelihood of cesarean in first-timers being electively induced. In general, we try to avoid elective inductions, except in rare circumstances," says Edith Gurewitsch, MD. "When there is no medical reason for an induction, Nature is probably better than anything we could try." Gurewitsch, who is an assistant professor of obstetrics and gynecology at Johns Hopkins School of Medicine, was not involved in the study.
It is appropriate to induce labor when a woman -- or her baby -- has conditions that warrant a prompt delivery, says Martin November, MD, an attending obstetrician at Beth Israel Deaconess Medical Center in Boston and an instructor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. This is in an important distinction, though.
"All things being equal, allowing Nature to take its course is almost always the best route," he says. November is also the medical director for the Beth Israel Deaconess midwifery practice.
- Inducing labor in a pregnant woman increases the chance the woman will require cesarean section.
- Elective inductions that do not result in cesarean sections cost more money per patient and require more pre-delivery time in the hospital, compared to spontaneous labors.
- There are times when a woman or her baby has a medical condition that warrants inducing labor, but otherwise women should be allowed to go into labor naturally.