During the last few months, health officials have been paying close attention to the amount of babies born before they’re full-term and the associated risks for mothers and their newborns.
The March of Dimes gave America a “D” on its annual report card, finding more than half a million babies are born pre-term every year.
And researchers at Michigan State University recently found babies born even a few weeks early are at risk for any number of short-term medical problems and possible long-term behavioral and cognitive problems like lower IQs, higher levels of attention problems, and symptoms of anxious, withdrawn behavior.
This includes even healthy babies of mothers who elect to induce labor early.
Now, researchers at the University of Rochester Medical Center are hoping physicians and first-time mothers-to-be to understand the risks associated with elective induction, a procedure that continues to grow in popularity.
The study found inducing labor without a medical reason is associated with negative outcomes for the mother, including increased rates of cesarean delivery, greater blood loss and an extended length of stay in the hospital, and does not provide any benefit for the newborn.
Benefits vs. risk
“The benefits of a procedure should always outweigh the risks. If there aren’t any medical benefits to inducing labor, it is hard to justify doing it electively when we know it increases the risks for the mother and the baby,” said Christopher Glantz, M.D., M.P.H., study author and professor of Maternal Fetal Medicine at the University of Rochester Medical Center.
In the past decade, scheduled deliveries have become commonplace, with physicians making elective inductions part of their routine obstetric care. Study authors cite social reasons, such as convenience and patient requests to deliver with their physician, for the ongoing increase in purely elective inductions.
While physicians and patients alike may assume that inducing labor is harmless, it does not work as well as natural labor: inducing is essentially starting the birthing process from ground zero and because of that, more problems are likely to arise.
“As a working professional and a mother, I know how tempting it can be to schedule a delivery to try to get your life in order, but there is a reason that babies stay in the womb for the full term,” said Loralei Thornburg, M.D., an assistant professor who specializes in maternal fetal medicine. “Why put you and your newborn at risk if you don’t have to?”
The study included 485 women who delivered their first child between January and December of 2007 at the University of Rochester Medical Center. The major strength of this study is that, unlike most prior studies, researchers reviewed each mother’s and baby’s medical chart, as opposed to relying on medical coding.
Evaluating each chart allowed researchers to figure out exactly why women were induced and what the complications were, catching subtle details that may have otherwise been overlooked.
The researchers found approximately 34 percent of women who opted for elective induction of labor ultimately had a cesarean section, while only 20 percent of women who labored naturally underwent a cesarean delivery.
Like elective induction, cesarean delivery may be seen as routine and risk-free, when in fact it is a major surgery. And like all surgeries, cesarean delivery increases the risk of infection, respiratory complications, the need for additional surgeries, and results in longer recovery times.
Additionally, women who were induced had more bleeding, even after taking cesarean deliveries into account, and stayed in the hospital longer than women who delivered vaginally.
The study authors calculate for every 100 women who undergo elective induction, they spend an additional 88 days in the hospital compared to the same number of women who labor spontaneously. Although this may translate into only a matter of hours for some women, it represents increased costs for both the mother and the hospital when multiplied by large numbers of induced labors.
Eva Pressman, M.D., director of Maternal Fetal Medicine at the Medical Center said counseling women to steer clear of an elective induction can be challenging, but the bottom line is medical reasons trump social reasons.
“If physicians are armed with information about the risks associated with elective induction they have a better chance of convincing their patients to avoid this route,” said Pressman.
While scheduled deliveries present multiple risks for the mother, researchers also found that they did not improve the health of newborns either. When women were induced, their babies were more likely to need oxygen immediately following delivery. They were also more likely to require specialized attention from members of the neonatal intensive care unit (NICU).
The new findings only apply to women having their first child, and may not pertain to women having their second or third child. In fact, Glantz said women who have already had a child may respond more favorably to induction.
“If you’ve delivered once before, your body knows the drill and can do it again,” Glantz noted.
Though elective inductions are not outside the standard of care, physicians should be cognizant of the associated risks and communicate these risks to women considering the procedure.
In an effort to better address this issue at the University of Rochester Medical Center, the department of Maternal Fetal Medicine is applying for a grant to help put procedures in place that will prevent elective induction of labor before 39 weeks.
“Past research has shown that inducing labor early without a legitimate medical reason is risky, and this study further validates these findings” said Thornburg.
The study is published in the February issue of the Journal of Reproductive Medicine.
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