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They Say: Induction Lowers Risk of C-Section. Really?

induced-labor-c-sectionIn Tuesday’s issue of the Annals of Internal Medicine , a review of randomized trials concludes that elective induction at or after 41 weeks of pregnancy does not increase a woman’s risk for c-section.

In fact, inductions at or after 41 weeks lowered the risk of surgery by 22 percent (lowered!), according to the report.

Does this mean inductions have been unfairly fingered as one reason the c-section rate in Canada and, more so, the U.S., is so high? Aren’t inductions a part of the cascade of interventions that lead to c-section?

The upshot of this report, according to study author Dr. Douglas Owens, director of the Stanford-University of California, San Francisco Evidence-based Practice Center, is that a certain kind of induction — and one given time to work — doesn’t stack the odds in favor of a trip to the OR.

This study only looked at elective inductions, meaning there was no medical reason (diabetes, high blood pressure) for trying to induce labor. Elective inductions are done for scheduling reasons, mom’s discomfort or to prevent possible complications from continuing the pregnancy.

What the study doesn’t find is that medical inductions lead to fewer c-sections. Or that inductions prior to 41 weeks also decrease the risk of c-section.

Now, back to the study’s author saying that the inductions have to be given time to work. What exactly does he mean by that? Do medical boards need to establish induction guidelines to ensure enough time is given?

I was half-induced with my first pregnancy (at 42 weeks and a day … the midwife’s call). A cervix softening gel, inserted around dinnertime,  kicked things into gear for me and by the middle of the night I was in full-blown labor, no Pitocin required. I always think I got away with something in that birth — that I was this close to winding up with a c-section. But maybe not. Maybe my induction was given time to work.

I’d be interested in a study of elective inductions done earlier in pregnancies — there are plenty of them to plug into the database. Is 41 weeks an induction sweet-spot? Does an elective induction at 39 weeks or even just a day after your due date double your chances for a c-section? Or have inductions been unfairly blamed for super-high c-section rates?

Were you induced at 41 weeks by choice? Earlier? Later? Did you wind up with a c-section?

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Photo: guardian.co.uk

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