New Research Questions the "Epidemic" of Early Inductions

Is peer pressure influencing your OB?


Doctors' increasingly frequent decisions to induce labor instead of waiting for nature to take its course have played a significant role in the rise of preterm births over the past two decades, according to new research.

The practice of induction for any number of reasons even appears to be "socially contagious," says Michael Kramer, M.D., professor of pediatrics, epidemiology and biostatistics at McGill University in Montreal and the author of the study, published recently in BJOG: An International Journal of Obstetrics & Gynaecology.

While doctors might believe they're erring on the side of caution, it's possible that they're being swept into a social phenomenon. In other words, if a doctor's colleagues are quick to induce labor, the practice seems more acceptable and reasonable.

"People tend to copy and emulate the leaders in their field," Kramer explains. "But there isn't very good evidence that doctors who are more likely to induce labor have better outcomes in terms of the health of the mother and child."

Drawing parallels

Preterm birth rates in the United States rose by 30 percent between 1992 and 2006. Much of that increase was in preterm births that occur between 34 weeks and 36 weeks. Meanwhile, the rate of medically induced labors nearly doubled during this period.

Even though many inductions are being done only two to three weeks before women's due dates, they're not as harmless as previously thought: Research now shows that birth even one or two weeks early can increase the risk of complications and developmental delays. Preterm babies' organs are not fully developed, so respiratory and digestive tract complications can arise early in life.

Preterm births between 34 weeks and 36 weeks raise the risk of jaundice, hypoglycemia, respiratory distress and even death among newborns, as well as an increased risk of needing intravenous feeding and a longer hospital stay than normal. Later in life, according to numerous studies, these babies have been shown to have lower academic test scores and more behavioral problems compared with children born at full term.

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"The vast majority of inductions are done because the fetus is not growing well in utero, the mother has difficulty controlling diabetes or high blood pressure or the mother is sensing that the fetal movements are reduced and there is fear of a stillbirth," Kramer says. "But there isn't clear evidence that inducing labor early resolves problems or improves anything."

Reducing haste

The American College of Obstetricians and Gynecologists has identified specific conditions in which labor should be induced before 39 weeks, including preeclampsia, eclampsia and premature rupture of membranes. But as recognition of the risks associated with preterm births sinks in, some hospitals are implementing new detailed guidelines for doctors to assess medical need before inducing.

In Ohio, for example, the Central Ohio Hospital Council has reduced preterm rates by identifying women at higher risk, such as older or low-income women, and pairing them with a nurse who makes weekly home visits during the latter half of the pregnancy to check on them and address their concerns. And, Kramer notes, "They have been successful without any obvious adverse effects."