How often does an induction end in a caesarean?

[Miss E]

I'm probably way off track here, but from what I can tell talking to people and a lot of what I read here on BB, it seems that a large number of inductions end in a caesarean. Is this really the case?

[Trillian]

Unfortunately yes, some will end in a c/s. I wouldn't say a huge number, but more than should be happening. There is an actual figure somewhere in an article on here, but I can't remember what that is off the top of my head. I assume that you may be needing an induction?

Induction doesn't automatically mean you will end up with a c/s. But it is something that can happen due to a steamrolling effect of the interventions that usually follow one kwim? An induction is physically harder on your body so it is more likely that you will need further pain relief to help deal with the unrelenting contractions (and trust me - I have had 3 normal births and one induced one and induced contractions really are harder to cope with) and if that means an epidural then it can make it harder for the baby to descend and come out kwim? Plus an induction can lead to the baby getting distressed and if that gets serious enough a c/s is usually done. There are some great articles on the main BB site about induction if you want some further reading

[Glamourcide]

Well, I'm by no means an expert and I have no idea of the actual statistics on inductions leading to c-secs, but I'm one of the 'success stories', I suppose you would say. Most of my friends who have had c-secs have either been booked in *for* a c-sec, or have gone in booked for a c-sec but have tried an induction first - but mainly the intention there was just to give natural delivery a go because chances were it wasn't going to work out for them, kwim??

I was induced two days before my due date, had the gel applied twice (nothing both times, cervix stayed clammed up lol), then had my waters broken and hooked up to the drip to induce contractions. I delivered DD vaginally after a four-hour labour (going from the time my wtaers were broken, anyway) with no tears, no stitches, no episiotomy, no forceps/vacuum needed... I just needed that little push-start to get DD on her way and then it was a completely normal labour (apart from being hooked up to the drip, but ykwim).
I too wonder about the actual rates of inductions that lead to c-secs, I don't know whether my experience was unique or whether most women who are induced go on to deliver vaginally with little complication (I had a post-partum haemorrhage after delivering the placenta, and chances are that was because I was induced rather than going into labour spontaneously, but it didn't affect DD in any way so, although it was very traumatic at the time, DD was not in any danger or distress at any time so I don't think much about it).

[JellyBean]

Hi Miss excited,

I don't know the exact statistics, but it is a fact that the risk of caesarian section is increased with artificial induction compared with labour which starts spontaneously (naturally).
This is because, left to nature, a baby actually releases the hormones required to trigger labour, at a time when the baby feels ready to enter the world. The natural hormones that are released generally cause the labour contractions to come on slowly, gradually building in intensity and length so that the woman is better able to cope with the pain and the baby does not become distressed.
The hormones given intravenously to trigger labour contractions catch the baby 'offguard'. They also cause the uterus to start contracting harder and faster than they would naturally - which can cause the baby to become distressed, leading to irregular heartbeat and often a subsequent caesarian. The sudden onset of contractions also increase the likelihood of a woman opting for pain relief much sooner than she would naturally, and this can lead to a cascade of intervention (ie - epidural requires a catheta to be inserted into the urethra as the bladder becomes numb and the woman is then confined to the bed, pethidine slows down the labour and causes the heart rate & breathing of the baby to slow down significantly... etc etc).

The biggest problem here is the emphasis that is placed in obstetric care on the EDD (Estimated Due Date). It is a very old fashioned method for determining the date of birth and it is an estimate at best. For example, if you planted an apple tree would you expect all the apples of the first sprout to ripen and fall off the tree at the exact same time? Of course not. Babies are exactly the same. Some need 38 weeks in the womb, others 42 - and both are perfectly normal. If women only trusted the the innate knowledge of their babies and their bodies to do what they were meant to do- instead of being pressured by some 'expert' in a white coat saying 'your baby is overdue - we need to induce' then the rate of intervention at birth would be significantly lower.
Of course there are rare circumstances where induction may be necessary, but having a baby that is 3 days or 7 days overdue is not a valid reason at all and actually poses a far greater risk to the baby. This, in my opinion is the greatest tragedy of the birthing business today - and a business it is. Over the last century or so, women's power and knowledge of their bodies and the natural birthing process have been whitewashed by the system.
Ok - I'll stop rambling now. Let your babies come when they want to!!!! Know your rights and don't allow others to make decisions for you!!! The term 'overdue' is a fallacy - your baby is due when he or she decides to come and they know far better than we do!!!!

XXXX

[Miss E]

Thanks for the replies ladies... It is an interesting area. The reason I asked the question in the first place is because I'm jotting down notes for my birth plan at the moment and have been considering how I would feel about an induction. Personally, I want to wait two weeks after my due date before considering an induction (obviously if it is medically necessary for other reasons it's a different kettle of fish). But then I can't help but wonder if you are in the position where an induction is deemed absolutely necessary are you potentially better off electing to have a caesarean...

I had a look at that article you mentioned Trillian and it interestingly quoted some different figures:

'A midwife from a large Melbourne hospital recently confided that they see many women come in for inductions where both mother and baby are well, but sadly somewhere between 50-75% of first time mothers being induced are ending up with caesareans'

and

?The Doula Book?, written by Klaus, Kennell & Kennell, contains a study on Doulas and induced labour in Cleveland, USA. The overall epidural rate for those who were induced was 81% and caesarean rate 43%. This includes women who had professional support people with them and others without.'

Of the four women I know who have been induced, all have ended up having a caesarean (mostly after a very long and very painful labor). In fact Goth Mum you're the only one I know who hasn't had what they would describe as a traumatic labor. But I didn't know that there was an increased risk of post-partum haemorrhage either.

Like Jelly Bean said, if you're having an induction bubs usually isn't ready (or wanting might be a better word) to be born. To me it seems that the odds of the birthing experience being traumatic for mum and bub are pretty high, and if after all that trauma you are likely to end up having a caesear, then maybe you and bubs are better off skipping the induction and the risks associated with it, and going straight for the caesarean... It kind of all depends on what the real rate of inductions that lead to a caesearing are.

Don't get me wrong, I'm really hoping to be able to have a natural active labor. But if that isn't possible because bubs needs to come out before they're ready for that and the odds of an induction ending in a caesar are 75% then I can't help but think we might both be better off going down that route...

[Bun]

FWIW, I am another case who was induced and ended up with an 'easy' vaginal birth after an 11 hour labour, and I was induced 2 weeks early due to high BP. It was VERY painful with no lead up at all, just instantaneous 2 min apart contractions, so I ended up having an epi, but all went well.

[TwinsMummy]

Same over here i was induced and was lucky enough to deliver naturally with the twins.... Was induced due to twin to twin transfusion ( one smaller twin) had a fabulous 5 hour labor delivery was perfect no tearing no stitches....

[mrsmac]

I was induced with my 1st due to high BP, on my due date, I had a very traumatic birth which ended up with epesiotomy (Sp?) and forceps but no c/s. With my 3rd i was induced 12 days early again high BP and I had an easy vaginal delivery.

[Tinks]

I was induced all 3 times and none of them resulted in a c-section.

[Sterla]

I was induced and ended up having an emergency c/s. I think in my case it would have ended in an emergency c/s anyway, as bub's heart rate was dropping before I was even induced. They induced me to give me a chance at a vaginal birth, but told me that it was possible that it could distress bub even more - which it did. Because there was already something wrong before I was induced, my chances of ending up having a c/s were already higher.

[Miss E]

Glad to hear there are lots of positive induction experiences... Clearly the odds aren't nearly as bad as I thought they may be. Thanks for sharing

[Snacks]

You've made some interesting points, Miss Excited. I haven't been induced before (and don't want to be if I can help it) but I think I'd rather give induction and VB a go over going straight to c/s.
There's still every chance that you can have your baby vaginally if you're induced, and to me, that's preferable to surgery and it's potential problems. JMO. All the best for your birth!

[DiannaQ]

2 inductions due to failure to progress - both time my water broke on its own.

1st time resulted in Epi and Vaccum extraction = 14 hours labour
2nd time no drugs = 50minutes labour

2 completely different births but definitely give the thumbs up for birth no.2 - very full on but over in a very short time - although baby had issues with the lungs due to too fast labour

[Glamourcide]

I think every birth, and every woman, is such a different experience from the next that it all really falls to fate in most cases, kwim?? Others have said that induction increases the likelihood of the mother wanting pain relief too early, or asking for more pain relief than they would otherwise have considered... I used gas and was very open to the idea of it well before being admitted to hospital (I have a great pain tolerance but I knew birthing was going to be very hard on me and I was happy to use pain relief if I felt it was needed), but although it was extremely intense and very hard on my body, I refused an epidural purely because I'm terrified of catheters lol... After going through what I did, and reading about the experiences of other mums (who weren't induced), I do realise that my experience *was* actually quite traumatic, but as it was my first baby I really had no idea what to expect so I assumed at the time it was all completely normal to feel what I felt, and I thought everybody had the same experience, kwim? If anything, the knowledge that an induction is so much harder on a mother's body has made me feel much stronger and more confident, as I know now that I got through it okay, and a perfectly healthy daughter at the end of it, so if I have my next one spontaneously I think I will handle it better than if I had gone into labour spontaneously, purely because by all accounts it will be a bit easier on my body, and I'm actually looking forward to labouring this time so I can get a taste of what it 'really' feels like.

I suppose the key here is educating yourself - I knew quite little about the risks associated with inductions until well after DD was born - I'd never even HEARD of PPH until I lost over 3L of blood within minutes and, to tell the truth, I thought *that* was normal as well until I saw my husband's face after speaking to a midwife and I knew something was going wrong. I didn't know that inductions weren't all, 'We'll just pop your waters and bub will be here soon', I didn't know that inductions had such a high rate of ending in c-sec, I didn't know exactly how they worked or what effects they had on mums and babies... I just knew that the pain in my back and hips in the weeks before having DD were so bad that I just wanted her OUT, I didn't really care how!!
I think if you're aware of the risks, the statistics, and the facts, you can make a much better-informed decision - as you've seen, some of us have had quite positive experiences with induction, some haven't, but if you know the 'tricks' to help you through it it may be an option that leads to a good outcome for you (eg, I avoided an epi for totally different reasons, by the time I started yelling for one DD was crowning lol, maybe if you know an epi ups the risk of a c-sec you could say 'no' to it, kwim?).

I'd best be sitting down to complete my birth plan too lol, all I've written so far is, 'No epidural, no episiotomy/forceps', good luck with yours, great to see you're arming yourself with as much knowledge as possible and that us BB members are able to help you in some small way

[Trillian]

Naturally the figures are going to be different when you're looking at two different 'studies' and you also have to take into account the type of hospital the women are having inductions in and the reasons. Some tertiary hospitals take on many 'high risk' cases which would include inductions for medical reasons etc so it will probably be something that you would never get a truly reflective figure on. It's also slightly higher for first time mums who get induced to have a c/s in the end too.

You will hear of many inductions that go perfectly fine, but the stats make it something to be wary of and you do need to be prepared that once you succumb to it, then there could be further intervention etc.

GothMum, FYI, syncto induction can cause PPH as a side effect of the drug. I had a PPH requiring a transfusion after my one and only induction. This is an updated 'adverse reaction' list on the synctocinon from the main site JIC you haven't seen it;

This is taken from the packaging of Syntocinon which has been recently updated:
?ADVERSE REACTIONS
The following adverse reactions have been reported in the mother: Anaphylactic reaction, Postpartum hemorrhage, Cardiac arrhythmia, Fatal afibrinogenemia, Nausea, Vomiting, Premature ventricular contractions, and Pelvic hematoma.
Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.
The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.
Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.
The following adverse reactions have been reported in the fetus or infant:
Due to induced uterine motility: Bradycardia, Premature ventricular contractions and other arrhythmias, Permanent CNS or brain damage, and Fetal death.
Due to use of oxytocin in the mother: Low Apgar scores at 5 minutes. Neonatal jaundice, and Neonatal retinal hemorrhage.?

So it's not something to be taken lightly as they are quite serious complications that can arrise. So it is best to avoid an induction at all costs and only used as a last resort before a c/s

[~Gee_Whizzy~]

I too wonder about the actual rates of inductions that lead to c-secs, I don't know whether my experience was unique or whether most women who are induced go on to deliver vaginally with little complication (I had a post-partum haemorrhage after delivering the placenta, and chances are that was because I was induced rather than going into labour spontaneously, but it didn't affect DD in any way so, although it was very traumatic at the time, DD was not in any danger or distress at any time so I don't think much about it).

Goth i agree with you on the actual rates of inductions that lead to a CS?

I too was induced due to insulin dependent GD (I had two lots of gel inserted with waters breaking on their own 2 hrs after the last lot of gels was put in. My labour then progressed normally - 7hrs in total but really only 5hrs of "active" labour as i pushed for 2 hours ) I had no further intervention (ie no drugs, no drip, no vac etc) and DD was born vaginally, no tears, no epi etc. - I delivered in a private hospital with my DH, OB and Doula all present and encouraging me. - So really i think it depends on 3 things:-
1. Your medical team and how willing they are to support YOUR wishes - my OB was FANTASTIC
2. How your Baby copes with the induction

And last, but probably the most important
3. How YOUR body copes with it.

Now my induction may have been one of the "lucky" ones, but i really do think that there are a lot of scare tactics for women who have to be induced and although yes some inductions do end up in a CS and other complications not ALL do and there are positive inductions.....

[LucaJack'sMum]

Not sure of the stats but DS1 was induced at 37+5 (due to pre-eclampsia) and I ended up with an emergency CS due to foetal distress. He wasnt coping with B/Hicks contractions, heartrate was up and down, the decision was made pretty quickly.

[Mak]

I too was induced (syntocin) after my waters broke and I had not gone into labour 15hours later. I had a 6 hour labour, 3rd degree tears, episiotomy and PPH. DD1 also had quite severe jaundice (significant weight loss) and issues with range of movement in her neck. Whilst extremely glad I had a VB I was quite traumatised from the whole process (sorry - not intended to scare you) and was anaemic for months afterwards. I found recovery quite slow and wished I had armed myself with more information prior to her arrival. Good on you for seeking information to prepare for such an important event.