Wait for Labor to Start on its Own

Assumption: Spontaneous labor is better for mother and baby, if no complications are present during pregnancy.

TRUE
This study of women with low-risk pregnancies and no complications demonstrates that elective induction (inducing labor without medical cause) and elective cesarean surgery (cesarean without medical cause) can lead to more adverse outcomes than waiting for labor to begin on its own.  In the case of induction of women with no prior births, they were 2.7 times more likely to have an unplanned cesarean.  First time moms and those who had given birth before were both more likely to have postpartum complications.  Women who had prior births and chose to have cesarean surgery were more likely to have postpartum complications.  Rates of NICU (neonatal intensive care unit) admission and administration of oxygen for the baby were elevated in women who chose cesarean surgery.

http://www.ncbi.nlm.nih.gov/pubmed/20085677

My Views:
I am not surprised by these results.  The timing of labor is set by the baby’s readiness to be born and if the baby has not yet given the “signal” to the hormones that start labor, it makes sense that the baby would need more care and may not always be completely ready for birth.  It also stands to reason that the body would not be at its most efficient if it is not ready to go into labor.  A woman’s body starts preparing for labor some time before the labor actually starts and if it has not had time to go through the changes and preparations needed, labor could reasonably be more difficult and not progress as smoothly.

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Not Enough Amniotic Fluid

Assumption: If an ultrasound detects too little amniotic fluid (a condition called oligohydramnios) labor must be induced as quickly as possible.

FALSE
In this study, researchers found that isolated oligohydramnios did not lead to adverse outcomes.  However, when the condition was diagnosed, babies were delivered at earlier gestational ages.  So, women with this condition are at more risk of labor induction and cesarean section.

http://www.ncbi.nlm.nih.gov/pubmed/19813684

My Views:I first want to point out that this study was done on women in the THIRD trimester and who had no other symptoms of pregnancy problems, other than the oligohydramnios.  WIth this is mind, I would just want people to know that immediate induction does not seem to be necessary simply because low levels were discovered on ultrasound.  Women can be monitored using nonstress tests and kick counts to see how the baby is faring as they await labor.  This seems preferable to me since medical induction of labor carries so many risks of its own.

Pitocin: Friend or Foe?

Assumption: Pitocin is good for labor because it speeds things up, making birth more pleasant and less dangerous for everyone.

FALSE
While it may speed labor, birth is harder and more dangerous when synthetic oxytocin is used.  This study from New Zealand measures the use of synthetic oxytocin and the outcomes of births that use it versus births that do not use it.  The study shows a marked increase in the need for/use of pain killers, instrumental delivery like vacuum and forceps, and cesarean surgery.  There was also an increase in neonatal morbidity in cases where synthetic oxytocin was used.

http://www.ncbi.nlm.nih.gov/pubmed/22384940

My Views:
I understand that there are very good reasons to use Pitocin to induce or augment labor.  Situations like these are not the norm, however.  Unfortunately, many low-risk women with no medical problems are being induced for the sake of convenience.  There is a reason that studies of birth certificates show a huge discrepancy between births occurring Monday through Friday during “work hours” and those occurring on weekends and “after hours.”  If you have a weekend baby, you are in the minority!  I think the medical community is starting to see the problems these early scheduled inductions are causing and is slowly shifting inductions from 38-40 weeks to 41 weeks, which is a good start.  Still, I feel that women are not told of the risks they are taking by not waiting for labor to start (or continue) on its own.

Cesarean Rates

Assumption: It would be beneficial to lower cesarean rates in the US.

TRUE
This study, published in the Obstetrics & Gynecology journal this month enumerates the reasons cesarean delivery can have negative consequences in mothers: “increasing incidence of placenta accreta associated with multiple uterine scars requiring the need for emergency cesarean hysterectomy, blood transfusion, and maternal mortality due to obstetric hemorrhage” and babies: “elective repeat cesarean deliveries performed before 39 completed weeks of gestation have demonstrated increased respiratory and other adverse neonatal outcomes.”  Most importantly, with the rising cesarean rate, there has *not* been improvement in neonatal morbidity or maternal health.  Cesarean delivery does have its place, but physicians are encouraged to avoid surgery unless there are true medical indications.

http://journals.lww.com/greenjournal/Abstract/2011/09000/The_Rising_Cesarean_Delivery_Rate_in_America__What.28.aspx

My Views:
Much is made these days of decreasing the cesarean rate, but many women seem to prefer surgery to a vaginal delivery.  Many women feel that a vaginal delivery presents more of a risk than a cesarean and that cesarean deliveries are the safer route.  This study shows that this is not necessarily the case.  I am glad that we have the option of delivering our babies surgically and that the surgery is usually safe.  But I am afraid that we have overused surgery and have begun using it at times when the risk does not outweigh the benefits.  As with any surgical procedure, there are risks to a cesarean birth and I believe they should only be used when truly medically necessary.