NPR新闻:Pregnancy Debate Revisited: To Induce Labor, Or Not?



For years, obstetricians have cautioned women that if they chose to induce labor, they would increase the risk of needing a cesarean section. A large study out today in the New England Journal of Medicine upends that advice, as NPR's Richard Harris reports.

RICHARD HARRIS, BYLINE: Doctors induce labor when a delivery has failed to progress or if a woman is far overdue, but Dr. Uma Reddy says obstetricians have tended to steer women with uncomplicated pregnancies away from the procedure.

UMA REDDY: When they've asked about induction and they don't have a reason, we've been saying, well, you know, one thing you need to know is it does increase the c-section rate.

HARRIS: That advice was based on some older medical research, but Reddy, at the National Institutes of Health, had doubts about that conclusion. So she helped head up a study involving more than 6,000 first-time mothers with uncomplicated pregnancies to put the idea to the test. Half let nature take its course. The other half had labor induced when the baby was full-term at 39 weeks. And it turns out that, all in all, moms and babies did fine when labor was induced with a drug.

UMA: I think the most surprising finding was a decrease in the c-section rate.

HARRIS: Yes, it actually dropped from 22 percent, among the group who weren't automatically induced, to 19 percent for women whose labor was induced. Dr. William Grobman, the study's lead author and a professor of obstetrics at Northwestern University, says an individual woman might or might not consider that 3 percentage points drop a big deal.

WILLIAM GROBMAN: I think that's not really for me to decide (laughter). I think that's for patients to decide.

HARRIS: As expected, women who opted to have labor induced spent more time in the labor and delivery suite.

GROBMAN: That being said, I also think it's important to recognize women who planned to be induced had fewer days in the hospital and their children had fewer days in the hospital after delivery.

HARRIS: Women whose labor was induced were less likely to have high blood pressure - pre-eclampsia - and their babies were less likely to need help breathing. So, all in all, it seemed medical intervention was a net plus. That was certainly the story for 33-year-old Kelli Rojek, a Chicago woman who opted into the study and whose labor was induced. She thought about the risk of having a longer labor.

KELLI ROJEK: That was the concern that I was most aware of - was that it can slow down labor, and it can cause some headaches or nausea afterwards.

HARRIS: But she also saw benefits.

ROJEK: But it actually was rather convenient for us because we have a dog at home. And we were able to call our families and say, hey, we're going to go in at 11:00 p.m. on this day. And can you guys come up and take care of the dog and then, you know, come up to the hospital afterwards?

HARRIS: Quick labor runs in her family, she says. And by 6:30 the next morning, her son Harrison came into the world. Commenting on the study, Lisa Kane Low at the American College of Nurse Midwives says it was done well and provides useful information. But she's concerned that doctors and women will be nudged toward this more medical approach to childbirth.

LISA KANE LOW: How we message this can really confuse people. If you say to somebody, we could really reduce your risk of a cesarean by inducing your labor, people who are very fearful of a cesarean may say, OK, I'm willing to trade off and take the medical induction even though that's not what I might want because it's going to reduce my risk. But yet, the absolute reduction is very small overall.

HARRIS: This study was done under optimal conditions, she notes. And even there, it took 28 induced labors to prevent one cesarean section. Richard Harris, NPR News.


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