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Induced labor 'does not increase risk of

cesarean delivery'

Tuesday 29 April 2014 - 12am PST
Past research has indicated that women who have induced labor are more likely to need
a cesarean section. But a new study published in the Canadian Medical Association
Journal suggests that evidence to support this is "weak" and women who undergo
expectant management of labor - close clinical monitoring of the process - may be at
increased risk of cesarean.

According to the research team, including Prof. Khalid Khan of Queen Mary University of
London in the UK, around 20% of births are induced - a process used to artificially
encourage uterine contractions.

There are many reasons why labor induction is administered, including overdue
pregnancy, fetal distress, preterm rupture of the membranes, or the mother may have
preeclampsia or diabetes.

The investigators say that labor induction has been criticized for increasing the risk of
cesarean section - an operation that involves making a cut in the front wall of a woman's
abdomen and womb to deliver the baby.

Labor induction 'reduces risk of cesarean delivery by 12%'Pregnant woman in hospital
New research suggests that labor induction may actually reduce the risk of cesarean
delivery rather than increase it.
To investigate further, the researchers analyzed 157 randomized controlled trials
throughout April 2012 involving 31,085 births.

The team found that for pregnancies that were induced at full-term or post-term, there
was a 12% lower risk of cesarean delivery, compared with pregnancies that were
managed expectantly.

The researchers found that this reduced risk persisted for both high- and low-risk
pregnancies, and women who were induced had lower risk of fetal death and other
complications, compared with those who underwent expectant management.

In addition, the researchers found that women whose labors were induced using
Prostaglandin E2 - a drug commonly used in the US and Canada - had a significantly lower
risk of cesarean delivery. But use of oxytocin and amniotomy for induced labor was not
associated with reduced risk of cesarean.

Commenting on the findings, Prof. Khan says:

"The risk of cesarean delivery following labour induction was significantly lower than the risk
associated with expectant management.

This finding supports evidence from systematic reviews but is contrary to prevalent beliefs
and information from consumer organizations, guidelines and textbooks."

The researchers say their findings provide a "robust answer to the disputed question of risk
of cesarean delivery associated with induction of labour."

They note that their study results also have implications for clinical guidelines as well as the
clinical practice of obstetrics. "Our findings are important when selecting candidates for
labour induction and when advising women on the risks of induction," they add.

The process can pose many risks to both mother and baby, including infection, maternal
death and postnatal depression. But the research team notes that recent studies have
shown there are fewer cesarean deliveries with labor induction than without it.
C-section is not only the potential negative outcome to induction, but those are not
mentioned. I am sure epigenetics has a lot to say. Also they are not stating strongly
enough that the c-section rate does not decrease when synthetic oxycontin is used which
is probably most of the cases, and I am not clear if in induction cases they are also
including augmentation with pitocin. How many births take place by induction in which
only prostaglandins are used? You take away oxytocin and it doesn't surprise me that
there are less c-sections. When you compare prostaglandin inductions to inductions with
synthetic oxytocin and to natural births I wonder then which one of these truly lowers c-
section rates and by how much???! And what are their "managed expectantly"
criteria...and those who are "managed expectantly" how many ended up on pitocin or
other drugs or interventions of risk? For me it raises more questions then it answers...