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They Say: Induction Lowers Risk of C-Section. Really?

Posted by madeline holler on August 18th, 2009 at 12:00 pm

induced labor c section 300x180 They Say: Induction Lowers Risk of C Section. Really?In Tuesday’s issue of the Annals of Internal Medicine , a review of randomized trials concludes that elective induction at or after 41 weeks of pregnancy does not increase a woman’s risk for c-section.

In fact, inductions at or after 41 weeks lowered the risk of surgery by 22 percent (lowered!), according to the report.

Does this mean inductions have been unfairly fingered as one reason the c-section rate in Canada and, more so, the U.S., is so high? Aren’t inductions a part of the cascade of interventions that lead to c-section?

The upshot of this report, according to study author Dr. Douglas Owens, director of the Stanford-University of California, San Francisco Evidence-based Practice Center, is that a certain kind of induction — and one given time to work — doesn’t stack the odds in favor of a trip to the OR.

This study only looked at elective inductions, meaning there was no medical reason (diabetes, high blood pressure) for trying to induce labor. Elective inductions are done for scheduling reasons, mom’s discomfort or to prevent possible complications from continuing the pregnancy.

What the study doesn’t find is that medical inductions lead to fewer c-sections. Or that inductions prior to 41 weeks also decrease the risk of c-section.

Now, back to the study’s author saying that the inductions have to be given time to work. What exactly does he mean by that? Do medical boards need to establish induction guidelines to ensure enough time is given?

I was half-induced with my first pregnancy (at 42 weeks and a day … the midwife’s call). A cervix softening gel, inserted around dinnertime,  kicked things into gear for me and by the middle of the night I was in full-blown labor, no Pitocin required. I always think I got away with something in that birth — that I was this close to winding up with a c-section. But maybe not. Maybe my induction was given time to work.

I’d be interested in a study of elective inductions done earlier in pregnancies — there are plenty of them to plug into the database. Is 41 weeks an induction sweet-spot? Does an elective induction at 39 weeks or even just a day after your due date double your chances for a c-section? Or have inductions been unfairly blamed for super-high c-section rates?

Were you induced at 41 weeks by choice? Earlier? Later? Did you wind up with a c-section?

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 They Say: Induction Lowers Risk of C Section. Really?

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[...] They Say: Induction Lowers (Lowers!) Risk of C-Section [...]

Fatherhood in Six Words | Strollerderby commented on Aug 19 09 at 11:03 am

[...] Induction Actually LOWERS C-section Risk? [...]

Mom Fired For Breastfeeding | Strollerderby commented on Aug 26 09 at 12:32 pm

I was induced just shy of 41 weeks – “to prevent potential complications” was the reason. At 41 weeks, the SOP at my doctor/hospital was daily blood draws to monitor levels of various things…45 mile drive one way, no thank you. I had been having varying levels of contractions for two weeks prior, nothing “productive” but still having them. Membranes had been stripped, nothing spectacular happened. I was hooked up to pitocin as I was already beginning to thin out and dialate, Doc broke water, baby was born after 13.5 hours and 45 minutes of pushing with no real complications to either of us.

Can I just say I loathe this wandering Baby Bjorn ad and that any typos in this post are because I can only see about half of what I’m writing?

PlumbLucky commented on Aug 18 09 at 12:19 pm

My most recent pregnancy with my now-four month old ended in induction at 41 weeks. My cervix was tightly closed up until the day of induction. They placed misoprostol on my cervix in the morning and again in the early evening. By midnight I was in full blown labor. Pitocin was only given later on, to augment labor not induce it. My baby girl was born at 11 AM the next morning after three hours of pushing.

Blacksheep commented on Aug 18 09 at 1:04 pm

I was induced at 41 weeks with my first – Cervidil (cervix softening agent) the night before did very little, the Pitocin did very little until Doc broke my water several hours later, then baby girl delivered w/o problem a few hours later; Induced with second on my due date – Cervidil overnight started very mild contractions, Pit started about 10 minutes after water broken, baby born w/o problem less than 3 hours later. So, not bad experiences with induction at 41 and 40 weeks (especially considering the wonderful lil’ ones that resulted!)

K's and R's Mommy commented on Aug 18 09 at 3:27 pm

Just jumping in to say the iPhone commenting is better than the actual page. It’s roomier and no ads!

Mistress_Scorpio commented on Aug 18 09 at 3:47 pm

So, they find that the more favourable a woman’s cervix is, the more likely medical intervention will be a tipping point for inducing labour. Which, really, it should be.

I’d bet a ridiculously large amount of money I don’t actually have that the fact of induction AFTER 41 weeks means the Bishop’s Score is much higher than it would be before, indicating the body is about to go into labour and maybe just needs a nudge, in which case a woman wouldn’t need many of the very invasive medical interventions which put babies at risk (amniotomy, misoprostal, high levels of pitocin for prolonged periods, mom’s bed bound and then numbed out) that raise the liklihood of c-sections.

Um, duh!

Hamilton Doula commented on Aug 18 09 at 4:23 pm

Bigger babies, overweight mothers and inactive moms are why we have more c-sections. Twenty five years ago the average baby was smaller than today. So was the average mom. Most moms gained 20 pounds max and started pretty slim. Being overweight causes lots of complications with the mother. Having bigger babies causes lots of complications, too. OLder moms are more common now than 25 years ago. They also have more complications such as high blood pressure taht warrant c-sections. Fatter, older moms and bigger babies cause more c-sections.

Ali commented on Aug 18 09 at 4:48 pm

I was induced at 39 weeks 5 days. They started with the cervix softening agents the night before, and started Pitocin in the morning. After 23 hours of labor and 2.5 of pushing, I had my son vaginally. I was induced because it was a week before Christmas, I was open and contracting, they thought he was 10.5 pounds, and because I refused to leave my doctor’s office until they scheduled me. I know it wasn’t a shining moment in my life, but I couldn’t take it anymore, and I was not going to be in labor on Christmas.

Kayt commented on Aug 18 09 at 7:10 pm

I was induced due to extreme swelling, and I ended up having a C-Section. I dilated very quickly, but when it came to pushing, I pushed her until she was almost crowning, and then she got stuck. Three hours of pushing later, they had to do a C-Section. I personally think that if I would have waited to go naturally, then my daughter’s head might have been in a better position to come out without getting stuck. So, eh, whatever.

Lindsay commented on Aug 18 09 at 8:49 pm

I was induced due to extreme swelling and an elevated blood pressure at 38 weeks, 2 days. I did not have a c-section, but it was strongly suggested toward the end, because I was not doing well pushing the baby out. However, I will say this: The hospital did keep cranking up the pitocin at regular intervals regardless of how labor was progressing (it was explained to me that it was “policy with inductions”), to the point where I was contracting every ninety seconds for over a minute each time…and this was EARLY labor! I had to argue with several different nurses about the baby getting a break between contractions, and had to (rudely) demand a doctor four times before the resident was consulted and agreed with me. I fully believe that if I had not won that battle, I would have had a c-section for fetal distress at some point.

puasamanda commented on Aug 18 09 at 9:15 pm

At 41 weeks my midwife tried prostin gel twice without success. She scheduled an induction at exactly 42 weeks. The day before my water broke but I did not progress at all. When I got to the hospital several hours later I was only 1 cm dilated. My midwife put me on pitocin although she did allow me to labor with our doula beside the bed and go off the monitor periodically so I could use the bathroom in a civilized manner. After several hours of labor with monster contractions 45 seconds apart I had not made any progress despite the efforts of my doula and midwife. I ended up having to have a c-section.

Ali…

I have to call bs on a lot of what you said. My mother had the same problem with both of pregnancies during the 70s that I had with mine. She didn’t gain a lot of weight with either, was very active and had 7 pounders. My older sister was 28 days late and ended up being taken by c-section as was I.

mbaker commented on Aug 18 09 at 9:40 pm

I don’t know, Ali. The question is, do fatter older moms need more c-sections. Or do fatter older moms get more c-sections. Is the need for a c-section real, or is there a medical bias? There’s considerable support for the latter.

Madeline commented on Aug 18 09 at 11:48 pm

I only went to a doctor when I was 41 weeks, had been seen by a midwife up to that point and was determined to go into labour naturally. We tried everything to bring it on naturally, walking, sex, blue and black cohosh, acupuncture, reflexology, castor oil, you name it. At 42 weeks 6 days I had made it to 4 cm dilated but had run out of time and was induced. I was put on a pitocin drip but was able to deliver vaginally after a 12 hr labour and 4 pushes (yes there was a silver lining) . I truly believe that had I not used the natural methods to get as far dilated as possible I would had have a c-section. My mother had a c-section with my sister and I in the early 80s and she was a 100lbs former athlete who put on 15 lbs with each of her pregnancies. None of her babies were over 6lbs. So I’m not sure where Ali is getting her figures from.

Andrea commented on Aug 19 09 at 2:24 am

I find it interesting that induction to prevent complications is considered “elective” rather than “medical.”
I was induced at 41 weeks, one day because they worried that leaving her in there would cause problems (the day before the induction, when I was officially a week late, her heart rate did start to slip, proving their point). I was most worried about the C-section issue, but the doc said it had to be done because there were increased risks. I was able to deliver naturally (yay!), which would back up this study. But I still wonder how a doctor’s concerns for risk to a baby don’t count as “medically necessary.”

jeannesager commented on Aug 19 09 at 10:45 am

I was induced at 37 weeks due to preeclampsia and extremely high blood pressure. I was 30 and not fat. They put the gel on my cervix over night, gave me an epidural and pitocin the next morning and the baby was born at 5:00pm after 90 minutes of pushing. I am pregnant again and really wondering how this next one is going to turn out.

hoosthatgirl commented on Aug 19 09 at 2:05 pm

I was induced at 41.5 weeks to prevent complications. I was admitted in the evening so that the induction had time to work overnight and then we started the pitocin in the morning although I had begun to contract on my own by that point. 12 hours later I was stuck at 7 cm and there was no hope of any further progression so C-section it was.

Heather commented on Aug 19 09 at 4:04 pm

i was induced by a homebirthing midwife at nearly 42 weeks – using homeopathy
stayed and waited overnight at the clinic and had some prelabour contractions that night every hour or so – sleeping inbetween..
by the next day at 1pm the real contractions started and by 9.30pm (with only homepathic medicine) my daughter of 10 pounds was born naturally. now am waiting for my next big baby to be born any day now – but this time hopefully in the comfort of my own home.

elvira commented on Aug 19 09 at 6:26 pm

I was induced at 39 weeks because they thought the baby would be large and had a relatively easy vaginal birth (other than a 3rd degree tear) . I was 35, slightly overweight before getting pregnant, gained almost 40 lbs with the pregnancy and the baby was 9 lbs. I’m glad I did not wait and risk a 10 lb. or more baby.

jeni commented on Aug 19 09 at 7:18 pm

by the way – no tear or cut – not one stitch – big babies dont mean you have to tear or be cut – even the 10 pounders! perenium massage is a fantastic thing!

elvira commented on Aug 19 09 at 7:54 pm

Ali, it is just obvious that you are not a doctor. Fatter, innactive and older mothers are at a higher risk of getting complications at delivery and at a higher risk of getting a c-section, not the cause of high rate c-sections in the US. Maybe you should read a little more before stating non-facts.

Rosana commented on Aug 20 09 at 10:28 am

Anyway, I almost got a C-section if it wasn’t for my delivery nurse telling my doctor that I was able to have the baby on my own. Thank you very much. That nurse watched the progress of my labor from the beginning while the doctor was showing up every 30 to 45 minutes, yeah I think she was more prepared to state an opinion. If my labor experience is very common in the US, I will say that maybe doctors making the wrong call is the cause of the high number of c-sections in the US. I was 5 cm dilated when I got to the doctor’s office ON MY DUE DATE, but when I was in the delivery room, I was inmediately given pitocin and later told me that I had to get an epidural (of course, because the contractions I was having where far from natural and the epidural only made me tired, I felt every single contraction and procedure afterwards) which later caused my son to suffer distress and then is when the doctor was ready to do a c-section. I firmly believed that if the doctor would have left my labor progressed on its own, I would have had a shorter labor and an easier one. Needless to say, I have a new doctor for this second pregnancy :)

Rosana commented on Aug 20 09 at 10:40 am

I was induced at 41 weeks 5 days due to low levels of amniotic fluid. It was pitocin for about 20 hours and three hours of pushing. My daughter was slightly posterior and stuck in my pelvis and if not for an internal version using forceps done by a very old OB, I most likely would have ended up with a C-section. I still think that had I been able to push in a hands and knees position, she might not have stayed posterior. If I have another baby, I’m doing whatever I can to bring on labor on my own – pitocin inductions, and all the interventions that come with, are dreadful. I don’t know why they would push someone to have it if they didn’t need it.

Heather M commented on Aug 20 09 at 11:50 am

I was induced at 40 weeks 3 days with my second baby. I had a high Bishop score and was so ready to have the baby but hadn’t had consistent contractions. When the doctor offered induction, I jumped at the chance. He began pitocin at 7:15 and things started progressing. He broke my water at 8:15. By 9:25 I was at 5 and got an intrathecal. I was at 10 cm by 9:50, pushed for 8 minutes, and my 8lb 1oz daughter was born at 10:00. The whole thing was 2 hours 45 minutes. I had some tearing, but not a single complication. I was 24 at the time and overweight. I’m pregnant again and if I go late and I have a high Bishop score again, I’d have another induction.

I think it’s very important that the mother’s body is ready for it. Most of the horror stories I’ve heard are because the inductions were done before the mother was 40 weeks and had a low Bishop score.

paularenae27 commented on Aug 29 09 at 9:58 am

I was half-induced at 39 weeks. I was already in labor, but they gave me Pitocin to speed my progress. It actually stalled it. My monitor was never properly placed, so they thought I was not contracting strongly. With the Pitocin, I was contracting so hard that I was in pain, even with an epidural. My body went into shock against the pain and I quit progressing. When they removed the Pitocin to prep me for a section, I jumped from 7 to 10 cm and had my baby in 4 pushes.

I suspect that part of the reason the research begins at 41 weeks is that many doctors will induce before that point and those often lead to surgery.

ashley commented on Sep 07 09 at 9:05 am

I was induced with babies #2 and #3. I was at 40 weeks and 4 cm. Once the pitocin kicked in, she was born in 5 hours with little pushing. Baby #3 was induced due to my inability to walk due to sciatica @40 weeks. Labor lasted 4 hours, and she pretty much fell out. The first labor was augmented with pitocin and lasted 6 hours.

Michelle commented on Oct 09 09 at 1:18 pm

Comments
I am currently 38 weeks and 3 days… I am fighting with my dr about him practically forcing me to have a c section with this baby. My last pregnancy was a 11lb 4 oz vaginal delivery, he was a shoulder distocia baby. The delivery was the scariest thing in the world.. He is ok now!!! Because of this history I have now.. my dr does not want to take the chance of this happening again, and wants to plan a c section. I am against it!!! My first was 8lb 14 oz, then 11 lbs 4oz. and this one.. we dont know. The ultrasound last Tuesday said it was 8lb 4 oz, and the ultrasound this Tuesday said 8 lb 2 oz. Why did it go down? The scary thing is when I had my son, his last ultrasound showed him at 8lb 1oz and then 11 days later he was 11lb 4 oz. so we all know the ultrasounds are inaccurate.
I just cannot see having a c section after two vaginal births… It is my dr that is scared and afraid to take the chance. I want to believe that this baby is not as big… I am heavy, 256lb, 5’8″ I look good though. I started at 214lb so a total gain so far of 42lb.. with my son, I gained about 55 lbs. I have tried to stimulator my own labor, by pumping my breasts, sex, and a long walk.. nothing seems to be working… What should I do?

Janet commented on Dec 02 09 at 2:21 pm

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