Time for a Change? Induction of Labor Increases Odds of Cesarean Delivery
Time.com posted an article today titled “Are C-Sections Overused? Rethinking Induced Labor.”
The rate of C-sections has reached more than 31% in the U.S., a historical high, according to 2007 data from the American College of Obstetricians and Gynecologists (ACOG). The reasons for the increase are many and have been widely discussed: the rising rate of multiple births, more obesity in pregnant women, the older age of women giving birth. In fact, C-sections have become so common that many women may have an inflated sense of safety about them. “For the most part, moms and babies go through the process healthy and come out healthy, so maybe there’s this sense that we’re invincible,” says Dr. Caroline Signore of the Eunice Kennedy Shriver National Institute for Child Health and Human Development.
The article focuses extensively on the study, Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term, which appeared in the July 2010 Green Journal. From the discussion of this study:
We studied cesarean delivery for a cohort of nearly 8,000 nulliparous women presenting with a vertex singleton pregnancy at term using data derived from hospital obstetric records. Women in the cohort represented 85% of the births in the region and received obstetric care provided by a mix of both hospital staff and community providers. Consistent with earlier studies, the odds of a cesarean delivery was influenced by obstetric management, sociodemographic factors, maternal comorbidities, pregnancy complications, and neonatal factors.6,17–21 The risk factors with the greatest contribution to cesarean delivery in this population, based on the strength of their association and their prevalence, were the use of labor induction and the presence of maternal prepregnancy obesity. Neither of these factors is reliably reported in vital statistics data and neither has been included in explorations of temporal changes in cesarean delivery.7
Labor induction was associated with a twofold increase in the odds of a cesarean delivery after adjustment for confounders. The effect was somewhat larger among a low-risk group of women without major complications that might lead to the indication for labor induction or cesarean delivery. The population attributable fraction reflecting the contribution of labor induction to the rate of cesarean delivery in this population was estimated to be 20%. We also found that the obesity-related risk remained independently associated with odds of cesarean delivery after adjusting for maternal demographic factors as well as obesity-related complications including gestational diabetes, gestational hypertension, excess maternal weight gain, or neonatal birth weight of 4,000 g or more. The odds of cesarean delivery increased with increasing maternal BMI in the overweight range and continued to rise with each BMI category.
The article also discusses Magee Women’s Hospital, which was awarded in 2008 for lowering the number of induced births. The hospital’s 2008 cesarean rate was 27.2%.