Inducing Labor May Reduce C-Sections

July 31, 2007 — -- Doctors may be able to reduce the need for Caesarean section surgery by inducing labor, a new study suggests.

The conclusion contradicts conventional obstetric wisdom, as inducing labor -- artificially causing birth to occur at a specific time -- has commonly been thought to actually increase the chances that a C-section would be necessary.

The research has big implications, as C-sections have been on the rise for years. Today, nearly one in three babies is born through a C-section, which has become the most common surgical procedure.

But while the surgery is necessary for some (and simply convenient for others -- a trend that has also contributed to the rising numbers), it can sometimes lead to problems that include long recovery times, risk of infection and even death for mother and child.

The research, published Monday in the Annals of Family Medicine, studied 1,869 women in a rural New England hospital.

One group of women were treated according to a specific protocol, which induced labor more aggressively (31 percent of the time), while a control group had labor induced only 20 percent of the time.

Following induction, only 5.3 percent of the women in the study group had Caesareans, while 12 percent of the control group had the surgical procedure.

"I am not claiming a causality here," said study author Dr. James Nicholson, assistant professor of family medicine and community health at the University of Pennsylvania Health System.

"I'm saying there's a pretty strong association, and the association is clear enough and supported enough by other studies that it should be considered for a randomized control trial."

The doctor's first step in the protocol, called the Active Management of Risk in Pregnancy at Term (AMOR-IPAT), was to accurately define a due date for each woman. Nicholson said that this is a preventive approach, developed by a rural hospital in the 1990s.

"We use a scoring system, using each woman's constellation of risk factors, which gives weight to each factor," said Nicholson. "You can figure out the optimal time of delivery, which is between 38 and 41 weeks. The lower the risk, the higher the upper limit to that timeframe."