Inductions and C-section Risk

This was interesting — an article titled, “Inductions might reduce risk of C-section for some women.” There has been much talk over whether or not inductions increase the risk of C-section, but this is the first I’ve seen that might suggest that an induction might decrease the risk of a C-section. My “B.S.-o-meter” is going off full tilt, though, at the implications of this title.

First, inducing a woman with an unfavorable cervix is accepted as being more likely to fail (whether that means the induction will necessarily end in a C-section or not depends — many failed inductions are simply stopped and are started again later when the woman and her baby are more ready for birth), so I would assume that these would not be included in such a study. Perhaps they would be. Or the women in the study may have their cervices artificially “ripened” prior to the induction, which leads to greater success.

Second, the study only shows success for women induced at or after 41 weeks of gestation — a time when many women (if not most) would have already had their babies naturally, or certainly be more favorable to an induction, than when many doctors are now electively or quasi-medically inducing women at 37-40 weeks. So, reading just the headline may make women (and unfortunately perhaps doctors and nurses who might not read beyond the headlines, nor read the actual study) think that they ought to be induced at any ol’ time rather than wait for the baby to be ready, to reduce their risk of C-section.

Third, the article says that women who were not induced were more likely to have meconium-stained amniotic fluid. Not terribly surprising — as fetuses age, they tend to have their first bowel movement prior to birth instead of after birth. But while this may be “significant” from a statistical point of view, the thing I want to know is, does it alter the baby’s health or well being in any way? I’d have to do more research into meconium aspiration syndrome, but my memory of what I’ve read indicates that when a fetus passes meconium simply due to age as opposed some sort of stress or distress, that it is non-problematic. Some people say it may even be the aggressive suctioning of an infant who has passed meconium in utero that causes problems — pushing mec into the lungs, as an example, that would ordinarily have been coughed, sneezed, or otherwise removed from the infant naturally. Again, I haven’t done the research on it myself, but have been in conversations about this topic. But it’s been some time. Bottom line, though — were these babies harmed by being born later, rather than being induced?

Fourth, “More than 22% of pregnant women in the U.S. undergo inductions, more than double the rate in 1990, the Chronicle reports.” The C-section rate has also sharply increased since 1990, so if inductions were a “magic cure” for C-sections, it would seem that the C-section rate would be lower, or at least, not have risen so high.

I’m wondering how many women in these studies that did not have inductions ended up being sectioned for suspected big baby, as opposed to women who were induced “before their babies got too big.” Hmmmm… We know that when doctors suspect a big baby, they’re more likely to call for a C-section than when they believe the baby is of average size. Might this have had something to do with the increased rate of C-sections? Also, doctors may be more quick to call for a C-section in the presence of meconium-stained amniotic fluid, but what if the presence of meconium is simply due to the baby’s age, rather than distress? [The study indicated that there was little if any evidence of harm to the babies due to the meconium.]

Finally, the lead researcher said, “…we want people to realize that it’s not the induction itself, it’s how it’s managed.” Indeed! Unfortunately, there was no indication in either this article nor the study itself as to how better to manage the induction so as to reduce the C-section rate. Often there is a difference in outcomes in real-life situations than what happens in studies. This study mentioned that observational studies showed an increase in C-section rates with induction. So, even if a controlled experiment doesn’t show an increase, and even if it in fact shows a decrease, if that doesn’t translate into a practical decrease in C-section rates, that’s of little or no comfort to women who have unnecessareans.

h/t to Sidney Midwife for the link

One Response

  1. Hmmm, interesting. I can see how a headline like that could make people think. Oh, it is fine, it may help me avoid a cesarean. So rather then doing research to see it was inductions after 41 weeks. The OB group I recommend to my moms who want hospital births won’t induce until 41 weeks, unless there is a medical reason to. They will let moms go to 42 weeks with NST. But at least they won’t induce for no good reason.

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