Inducing labour one week before due date cuts childbirth complications, ‘game changing’ study finds

Trial hospitals routinely offering option to trigger birth at 39 weeks but UK experts say more evidence needed before NHS guidance changes

Alex Matthews-King
Health Correspondent
Thursday 09 August 2018 00:40
Women who opted for induced labour reported less pain and feeling more in control of the process of giving birth
Women who opted for induced labour reported less pain and feeling more in control of the process of giving birth

Women around the world could cut their risk of complications in childbirth after a “game changing” trial revealed that inducing labour ahead of the 40-week due date brings a host of benefits.

Despite concerns from doctors that inducing labour early could increase the chances of the baby needing to be born by caesarean section, a large study by US researchers found it actually lowered this risk by 14 per cent.

While caesarean sections are considered safe, they do bring an increased risk of infection and longer recovery time, which can lead to greater costs and pressures on the health system.

Early induction also saw cases of pre-eclampsia and gestational hypertension (high blood pressure) among mothers fall by more than a third and led to 25 per cent fewer babies needing breathing support.

“This study is a potential game changer and will have a significant impact on the practice of obstetrics,” said George Macones, head of obstetrics and gynaecology at Washington University School of Medicine, who led the study.

“Our department already is recommending induction at 39 weeks for healthy pregnant women.

“Some women prefer to schedule an induction because it allows them to plan ahead. Of course, women without pregnancy complications can choose how they want to experience labour and delivery, and we respect their wishes.”

The study, published in the prestigious New England Journal of Medicine, randomly allocated 6,100 healthy, first time mothers into two groups, one that waited for labour to start on its own, and one to have labour induced.

Of those who were induced at 39 weeks there were 569 caesarean sections (18.6 per cent of births) compared to 674 women (22.2 per cent) who required it while waiting for naturally occurring labour.

This amounts to one caesarean delivery being avoided for every 28 women who opted to have pregnancy induced at 39 weeks and women also reported less pain during labour and a greater sense of control over the process of giving birth.

“There’s a lot of controversy around the consequences of inducing labour,” said Dr William Grobman, another of the authors, from Northwestern University. “People were convinced that it increased the risk of caesarean delivery, but the reality was actually unknown."

While he said it should not be routine for every woman, Dr Grobman added: “This new knowledge gives women the autonomy and ability to make more informed choices regarding their pregnancy that better fit with their wishes and beliefs.”

In the NHS labour is only routinely induced after 41 weeks to avoid the risks of prolonged pregnancy, which can increase the risk of a baby being stillborn.

Obstetrics experts in the UK “welcomed the results” of the large new trial and said it would be valuable in discussions with mothers about early induction, particularly those at risk of stillbirth.

“However, other factors must be considered before changing recommendations in clinical practice about when to offer induction of labour,” said Professor Basky Thilaganathan, a consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists.

“While induction is safe and studies have shown no short term adverse impact on the mother of the baby, induction of labour is a medical intervention and can lead to a more prolonged and painful process than spontaneous labour, and with costs to the services.”

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