Article: Caesarean risk higher when labour induced

Interesting article from The Age:

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FIRST-time mothers have a higher risk of needing a caesarean if their baby is induced, new Melbourne research shows.

Experts are looking closely at the potential link between induction and caesareans as one way of reducing the increasing caesarean rate.

In a study of more than 37,700 women, Mary-Ann Davey, an epidemiologist at La Trobe University's Mother and Child Health Research, looked at all uncomplicated first births in Victoria between 2000 and 2005. The mothers were aged 20-to-34 when they were between 37 and 41 weeks' pregnant.

Of those, 9.4 per cent had their labour induced — 6.1 per cent of public patients and 14.1 per cent of private patients.

"These women had no medical indication recorded for induction of labour," Ms Davey said. "Common reasons given were 'social' or 'post dates' (but less than 41 weeks' gestation)."

She also found that more women who were induced had epidurals then those who weren't induced. Although her findings are still preliminary, Ms Davey said there was "a substantial and significant increase in the number of caesareans" following an induced labour.

Earlier randomised trials had not found that induction led to caesars, Ms Davey said, "but most of those trials are quite old and don't really reflect the way people are induced today".

Department of Human Services figures show that in 2005, 15.9 per cent of low-risk first time mothers in public hospitals were induced, compared to 23.9 per cent in the private sector.

Of all the first-time mothers giving birth, 28.5 per cent had a caesarean after being induced compared to 13.3 per cent who had a caesarean birth but were not induced. For private patients the caesarean figure rose to 31.2 per cent for those who were induced compared to 16 per cent for those who were not.

But until further evidence such as Ms Davey's is made public, obstetricians say they have to go by the latest randomised trials that say induction does not increase the risk of caesarean.

The chairman of the State Government's quality and safety subcommittee of the Maternity Services Advisory Committee, Euan Wallace, says finding a relationship between inductions and caesareans was a complex issue.

Recent Department of Human Services figures showed that the proportion of women under 35 who had a low-risk first pregnancy then went on to have a caesarean in a private hospital rose from 23.4 per cent in 2001 to 27.5 in 2005.

In public hospitals, the figure was about 19 per cent since 2003, from 17 per cent in 2001.

"In a trial format one couldn't say induction of labour leads to caesarean section," Professor Wallace said. "That does beg the question 'how come we have this data suggesting there is an association?'. What is underlying that needs to be looked at is — what is the reason women had the induction of labour?"

The college's communications manager, Shannon Morris, said women, doctors and midwives needed to be educated about the risks of induction if there was no medical reason to warrant one.

"Midwives are of the opinion that if you're induced, you're not ready to have a baby yet … you're inducing a baby that's not ready to be born in a body that's not ready to give birth to it."

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Maybe doctors will be less keen to do inductions too early once this gets published.

It's actually well known that this is the case and in earlier studies (but not specifically about induction but reflects the results, e.g. induction for suspected macrosomia ends in more c/s than improving outcomes) ;) Great that its in the media though, with all the other maternity stuff hopefully its cranking things up another notch.

I liked this bit the best:

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"Midwives are of the opinion that if you're induced, you're not ready to have a baby yet … you're inducing a baby that's not ready to be born in a body that's not ready to give birth to it."

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It's about time something like this was actually put out there for the "everyday woman" to read. So many women go in thinking there was something wrong with their bodies and it just didn't know how to birth or labour properly or efficently when that is so not the case. Bringing on a labour before your body or your baby is the real reason behind a failed induction that leads to a c section.

Hopefully this article can inform some women out there, who aren't lucky enough to have BB, that intervention is not always best.

I read this and thought "Don't they already know this?". The mid (as ancient and outdated as she was) who gave my birthing classes hinted that if you were induced you were more likely to have an epi and c-sect... I'm glad they are getting this out into the media though...

I'm so glad to see this in the media. Whenever I told anyone that I didn't want to be induced, and explained my reasons why (not wanting an epi, caesar etc) they all thought I was crazy and 'making it up'!

Like MG I would have thought that it was fairly obvious, but I guess not!

Thanks for posting this Yael... I agree: pretty obvious... but it seems that most people are missing the obvious these days in regards to their own bodies... I think the main issue is that most of us are forgetting we are animals and that our bodies follow natural paths. We are not machines to be fixed. I see us as a society distancing ourselves more and more from nature... like that it's a dirty word... like we are "above all that". Have we ever heard of other animals being induced? Do we induce our pets? I can imagine some people might be offended by what I've just suggested because we are "better" than mere animals... but there's no denying that we are biological creatures... we are not "man made".

I think there is a place for inductions (i had one at 10 days overdue due to very low fluid levels), i also think there is a place for c/sections, and pain relief.

But i think the above things (maybe not pain relief, that is a personal call that should be decided by the woman), should be dictated by medical necessity, not convience, and like all medical procedures, people should be aware of the risks involved and the likely outcomes henceforth.

I agree with what you are saying Bath, that let nature take its course before you try and fix it.. and i'm sure everyone here agrees that they would ultilize a western medical approach where it is a genuine medical necessity, just like they would take their pets to the vet...

What concerns me is the lack of education people have about the outcomes and risks of intervention.. and at the end of the day if they weigh it up and say they are prepared to have a intervention (even for convience), than that is their choice, and we all take our own risks (i.e. not exercising, smoking etc)... But that people aren't aware of the risks is what bothers me more.

This also seemed obvious to me, the whole pattern of increasing intervention, but i guess the larger picture only becomes clear when you research into the broader scope of birth and interventions in general.

I forgot to add that I've had 2 inductions: for my 2nd and 3rd babies.

1st induction was because I was 42 weeks and my private OB really put the pressure on and I wasn't as educated and agreed. Baby emerged without any signs of being 'over cooked' and the placenta was still in a very good condition so *shrug* I felt a bit annoyed about that... but it was no "biggie".

2nd induction was due to cholestasis: potentially life threatening condition for the baby... my liver wasn't processing fats... something like that... bile salts were building up which was the problem. Anyhow I researched as much as I could and as Kelly was my Doula I decided to run it by her and we went with it... so you're right Yael, you do what you gotta do... but taking ALL the risks into account... and I would certainly not recommend doing it for mere convenience... it just doesn't make sense.

I was induced at 10 days overdue with my first and had to have an emergency c - section.

I forgot to add, i would have my induction again in a second, as i felt i did it for the right reasons, just like you Bath.

But i was lucky, just had ARM, and refused the drip as i was contracting anyway, so i think that helped avoid the epi and the c/s.

I don't believe in induction for convience, but i also don't believe in smoking or doing drugs either... I was just saying that everyone adds up the risks and proceeds differently, but you can't make an informed choice to proceed or not unless you do know what you are more likely to be facing.