The Truth About Induction

The case for (carefully timed) labor induction

By Jeanne Faulkner, R.N.

The American College of Obstetricians and Gynecologists reports that 20 percent to 40 percent of labors are induced—a number that, along with Cesarean-section rates, has doubled in the last decade. In fact, failed inductions play a large role in not only the ever-increasing Cesarean-section rate, they're also linked to delivery of newborns who have to be admitted to the neonatal intensive care unit (NICU) because of respiratory or other problems.

James Nicholson, M.D., an assistant professor at the University of Pennsylvania Department of Family and Medicine and Community Health, is spearheading a four-year study called Active Management of Risk in Pregnancy at Term. His goal is to safely reduce Cesarean-section births and NICU admissions by delivering before the baby is too big and the placenta is too old.

"If 41 weeks is the optimal upper limit for delivering low-risk moms, then for those with risk factors the upper limit would be earlier," Nicholson explains. "We translate odds ratios for risk factors into days and subtract from 41 weeks. For example, we'd want a patient with Type-1 diabetes delivered 10 days before 41 weeks. If she's very short, we'd subtract another six days, and if she gained more than 30 pounds, we'd subtract another six days, for an optimal delivery date of 37 weeks, six days." Nicholson rarely induces before 38 weeks, however, and his approach has yielded very low C-section rates; rates of other adverse birth outcomes have been either lower or unchanged.

From June/July 2008