Wednesday, December 10, 2008

The evidence base against induction

Why do I discourage women I talk to from being induced?

Many reasons. But most importantly:

Induction greatly increases your risk for a cesarean.

"Elective induction of labor is associated with a significantly increased risk of cesarean delivery in nulliparous women. Avoiding labor induction in settings of unproved benefit may aid efforts to reduce the primary cesarean delivery rate." Abstract here.

Induction greatly increases your risk for a cesarean.

"Elective induction significantly increased the risk of cesarean delivery for nulliparas, and increased inhospital predelivery time and costs."
Abstract here.

If you body is not ready to give birth, induction greatly increases your risk for a cesarean.

"Compared with spontaneous onset of labor, medical and elective induction of labor in nulliparous women at term with a single fetus in cephalic presentation is associated with an increased risk of cesarean delivery, predominantly related to an unfavorable Bishop score at admission."
Abstract here.

Unless you have a very pressing medical indication, induction is not indicated, because induction greatly increases your risk for a cesarean.

"While these interventions often are medically indicated for the well-being of mothers and infants, the evidence supporting their benefits when used electively is controversial."
Abstract here.

There is no benefit to induction because "the baby looks big". Be skeptical of offers to induce because "the amniotic fluid looks a little low".

If a doctor says that there is no difference in risk between an induction and a naturally occurring labor, that person has not read their own professional literature, or is lying.

Because induction greatly increases your risk for a cesarean.


pinky said...

I am bummed out. I could not click on your abstracts. I would like to look them up in the medical library. I also want to know who did them. I have noticed advocates of NCB coming up with studys that low and behold prove their point. I don't have a dog in this race. I just want to find out what is and isn't a good idea. Unfortunately, that is anything but simple these days. Could you write up the names of the studies so I can take a look. Thanks

pinky said...

This is the study I want to make up. I want to look at how long someone is in the hospital and the rate of c-section. I would like to include the few healthy women who are in prodromal labor and should be sent home but are not.I would like to see what happens. I think their will be a corrolation/cause and effect of people who are in a labor room taking up space. Time in labor room would increase chance of C-section. Is there a study like that out yet. It makes perfect sense. If you are in a hospital, you will get some treatment. If you don't want treatment, perhaps go to the mall for a while. Go swimming. Take the kids to the park. But do it close to the hospital. Perhaps if there was a place to hang out near the hospital for the women who don't need intervention but don't want to venture too far in case they kick in to labor fast.

publichealthdoula said...

It's weird, I couldn't get to them either. I think there may be something wrong with the website right now because when I posted them, I remember checking to make sure they were accessible even without an academic log-in. If they're still not working in a day or two I'll have to fix the links. That's a bummer.

I think we all come up with studies that prove our point! The best I've done so far - and I guess anyone - is to understand how studies are conducted and read them carefully for design flaws. There is no perfect study, but you want to make sure you're taking the flaws into account in weighing the evidence.

That's an interesting iea for a study! If we could randomize healthy women in prodromal labor to stay or go home, that might work. Of course, they'd have to be willing to participate and thus possibly get randomized to stay. That might skew the sample (I know most people planning on a natural birth would probably not be willing to participate) but it would be interesting.

pinky said...

However, most folks are not interested in a NCB. Most want the epidural where I come from.

I guess one of my main points is that we have to be intellectually honest and cite the flaws instead of glossing over them.