AJOG Study: Women Pushed Into C-Sections

Maybe you’ve seen the headlines. The New York Times, USA Today, LA Times, CNN and others are reporting on a study published this week in the American Journal of Obstetrics & Gynecology (AJOG) showing that c-sections now account for one third of all births, and that a big reason for this increase is the over-use of labor induction.

Researchers looked at data on 230,000 births and found:

  • Almost half of women wanting vaginal births were induced.
  • Women who were  induced were twice as likely to have a cesarean birth as moms whose labor starts spontaneously.
  • Of the c-sections done after induction, half were performed before the cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role.”
  • A third of first time mothers had c-sections.
  • C-sections upon maternal request (those done for non-medical reasons) account for only 9% of c-sections.
  • Attempts at VBAC are less likely to result in vaginal birth than previously thought. Few women are offered the option of VBAC.

I get very ornery about induction, or at least how people talk about it. So often debates about “natural childbirth” revolve around whether or not to get an epidural. But the truth is the epidural is a minor player in the brawl. The real instigator is pitocin. Jennifer Block’s investigation of America’s flawed maternity care system is called Pushed, not Doped, for a reason. The epidural at least gives mom relief. An unnecessary induction is offering no such perks.

Heather Turgeon over at Strollerderby wrote,” What seems off to me is that moms aren’t usually warned that induction raises the likelihood of a c-section. Is it the doctor’s responsibility to tell a mom who wants a vaginal birth that giving labor a jump start might make it less likely to turn out that way?”

Yes! The risks and benefits of all procedures should always be explained. (And we should get in the habit of asking about them.) But often all women hear is “we want to help push the labor along a little.” I know it is so appealing to be able to schedule labor but inductions come with risks. Among them, as this study confirms, a doubled risk of c-section.

The induction medication pitocin– an artificial form of the labor hormone oxytocin– can cause especially intense contractions Once you have pitocin you are confined to a bed, on your back, tethered to the IV and fetal monitor. When movement and positions are limited, labor can be less efficient– the supine position is not gravity-friendly–and more painful.

Often an epidural becomes necessary to help with the pain. An epidural is a great way to reduce/eliminate pain but if it’s given very early in labor– which it could be in an induction– chances of a c-section are further increased.

So what can you do about all this if you are pregnant and want a vaginal birth? Here are a few ideas:

- Talk to your care provider right now about his or her rates of induction, c-section and episiotomy. If you have a doctor who routinely uses pitocin and/or performs c-sections the chances of that happening in your birth are higher than they would be with a care-provider who performs fewer interventions.

Educate yourself about labor induction. According to ACOG the medical reasons for induction are: post date (42 weeks), pregnancy-induced hypertension, maternal health conditions, uterine infection, placental abruption (though this is more likely going to require immediate surgery), or premature rupture of membranes (PROM).

- Stay home in early labor. The authors of this study express serious concern over doctors’ and patients’ inability to let labor unfold at its own pace. Labors– especially for first time mothers– can be very long. One way to avoid pitocin is to show up at the hospital only when labor has really established itself. In the absence of any other concerns, a laboring women can wait to go to a birthing facility until contractions are four minutes apart, one minute long and have been so for one full hour.

I hope this large NIH study, and many others showing similar practices and results, will help lead to fewer unnecessary inductions. One can only hope. We need to turn our attention away from whether or not mom is tough enough to endure contractions, and focus our attention on practices that are making her labor so tough.

photo: inferis/Flickr

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