Does induction lead to more C-sections? This RCT says “no”.

From the NEJM, “Randomized Trial of Labor Induction in Women 35 Years of Age or Older“:

The risk of antepartum stillbirth at term is higher among women 35 years of age or older than among younger women. Labor induction may reduce the risk of stillbirth, but it also may increase the risk of cesarean delivery, which already is common in this older age group.

We conducted a randomized, controlled trial involving primigravid women who were 35 years of age or older. Women were randomly assigned to labor induction between 39 weeks 0 days and 39 weeks 6 days of gestation or to expectant management (i.e., waiting until the spontaneous onset of labor or until the development of a medical problem that mandated induction). The primary outcome was cesarean delivery. The trial was not designed or powered to assess the effects of labor induction on stillbirth.

I’ve written about how giving birth in the hospital is associated with higher rates of induction and c-sections. But does the induction cause the c-section? To the RCT!

This was a randomized controlled trial of first-time pregnant women who were at least 35 years old. They were randomly assigned to labor induction in the 39th week of pregnancy, or to expectant management – which means watch and only induce if there’s a medical problem. The main outcome of interest was c-section.

More than 600 women were randomized, and there were no significant differences between the groups. Overall, 32% of those in the induction group had a c-section, versus 33% in the expectant-management froup. There was, therefore, no difference. If you’re interested, there was also no difference in the percentage of women who had a vaginal delivery using forceps (38% of induction and 33% of expectant-management).

The study wasn’t powered for other outcomes, but there were still no differences in maternal or infant deaths, adverse outcomes, or womens’ experiences.

The rates of c-section were high overall compared to other countries (about a third of women). But there’s no evidence to be found there that it’s induction that’s causing that to happen.


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