C-Section Rates Decrease with Induction

Induction at 39 weeks is as safe as spontaneous labor for mothers and infants, finds a new study.

For years, there has a been a push to avoid inducing labor among women with uncomplicated pregnancies as a way to prevent cesarean sections.

The Association of Women's Health, Obstetric and Neonatal Nurses' grassroots public health campaign Go the Full 40 encourages women to complete 40 weeks of pregnancy and has goals of:

• Increasing the percentage of women who complete at least 40 weeks of pregnancy
   
• Decreasing the percentage of women who choose elective inductions or elective C-sections
   
• Increasing nurses' and other pregnancy-care providers' effectiveness in reducing the number of elective inductions and C-sections

But a new study has made a surprising find—inducing labor in healthy women at 39 weeks into their pregnancy reduces the need for a C-section and is at least as safe for mothers and infants as waiting for spontaneous labor.

Induced Labor—A Safe Option
 

The study, published online in the New England Journal of Medicine, looked at 6,106 first-time mothers enrolled in the ARRIVE clinical trial. Carried out at 41 hospitals participating in the National Institutes of Health-supported Maternal Fetal Medicine Units Network, ARRIVE examined outcomes from two groups of healthy, first-time mothers. One group elected to induce labor at 39 weeks. The other group took part in expectant management—waiting for spontaneous labor but utilizing intervention if a medical need occurs.

The study found:

• On average, women electing to induce at 39 weeks delivered nearly one week earlier than women who waited for spontaneous labor.
   
• C-section delivery was less likely after elective induction (18.6%) than after expectant management (22.2%).
   
• Women who chose to induce at 39 weeks had lower rates of preeclampsia (9%) than those who waited for spontaneous labor (14%).
   
• A composite score measuring several health indicators in newborns including death, seizures, hemorrhage, and trauma did not differ significantly between the two groups.
   
• Infants born after elected induction at 39 weeks needed less respiratory support after delivery.

"This doesn't mean that everyone should be induced at 39 weeks," says the study's co-author Robert Silver, MD, chair of obstetrics & gynecology at University of Utah Health and a maternal-fetal medicine physician at Intermountain Healthcare in Salt Lake City. "Electing to induce labor is a reasonable option that may give the best chance for vaginal delivery and improve outcomes."

Decreasing Unnecessary C-Sections
 

Based on the study's findings, the researchers estimate that inducing labor at 39 weeks could eliminate the need for one C-section for every 28 deliveries.

Since 2016, about 32% of infants have been delivered by C-section in the U.S., and medically unnecessary C-sections among healthy first-time mothers account for 80% of those deliveries.

 "We're always trying to find the safest way to deliver babies and take care of our patients," says M. Sean Esplin, MD, an associate professor of obstetrics and gynecology at University of Utah Health and chief of maternal-fetal medicine at Intermountain Healthcare. "If the primary goal is to keep rates of C-sections down, then elective induction is an option."

Researchers are evaluating whether induction at 39 weeks is cost effective.

A 2017 article on the website MONEY, reports the cost of a C-section delivery can range from $14,528 to $7,439 depending upon the state. Vaginal births range from $10, 413 to $5,017.