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By Jonathan Springston, Editor, Relias Media
The results of a new trial published last week indicate that inducing labor at 39 weeks instead of waiting for labor to begin naturally at full term could result in fewer cesarean deliveries for some first-time mothers.
In a multicenter trial, researchers assigned 3,062 women to labor induction and 3,044 to expectant management (waiting for labor to begin naturally). Trial participants were low-risk nulliparous women at 38 weeks zero days to 38 weeks six days of gestation. They were assigned either to labor induction at 39 weeks zero days to 39 weeks four days of gestation, or to expectant management. The frequency of cesarean delivery was significantly lower in the induction group than in the expectant-management group (18.6% vs. 22.2%).
After reviewing the trial results, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine released a joint statement declaring “that it is reasonable for obstetric care providers to offer an induction of labor to low-risk women after discussing the options thoroughly, as shared decision-making is a critical element.” The groups advised that eligible candidates for induction should be women who are healthy with no other medical complications and are presenting for their first delivery. Additionally, the groups said these candidates should be at 39 weeks and have undergone an ultrasound early in pregnancy to confirm accurate dating.
“It is important for all inductions of labor, as was done in this study, to adhere to clinical protocols that optimize the chances of a vaginal delivery. Elective induction of labor should not be offered to women under circumstances that are inconsistent with the study protocol unless performed as part of research or quality improvement,” the groups wrote. “As induction of labor involves coordination between the healthcare provider and the infrastructure in which induction and delivery will occur, it is critical that personnel and facilities coordinate polices related to the offering of elective induction of labor.”
The August issue of OB/GYN Clinical Alert contains a detailed exploration of recently published literature about cesarean deliveries. For further reading, Relias Media’s parent company offers an in-depth white paper titled Promoting Vaginal Birth: A Guide to Understand and Lower the Cesarean Birth Rate that helps clinicians understand when and why some cesarean deliveries are medically unnecessary.