Ask the Doctor: Inducing labor raises risk of Cesarean?

July 06, 2011 12:00 AM

Q: Does inducing labor increase the chance of a Cesarean Section at birth or in future births?

A: No. Inducing labor does not increase the risk of an emergency C-section for births occurring in Week 39 or later. However, if induction is required before a full 39 Weeks, the risk does increase. Having a C-Section does significantly increase the necessity of a C-Section in subsequent births.

Inducing labor has for many years been connected with a higher risk of emergency delivery by Cesarean Section and it has been the subject of heated discussions among midwifes and obstetricians. There is no doubt that a long delivery can be demanding for the pregnant mom (and dad!), and even with induction, may take several days from when the procedure starts until labor begins. Inducing labor may be more time consuming for the delivery ward.

At the same time, research indicates that induction does not raise the medical need for a C-Section for moms in their 39th week or later, compared with waiting for a later labor. This was true both for women having their first child and for moms who had previously delivered in a study of around 250,000 births from the National Birth Registry in Denmark.

The earlier in pregnancy, before 39 full weeks, induction takes place, the higher the risk for ending up with delivery by Cesarean Section. Of course, there may be medical reasons for accepting a higher risk.

I advise against inducing labor before a full 39 weeks, unless there is a medical reason. In weeks 39 and 40, I advise waiting for natural, spontaneous labor, unless there are complications that require faster delivery. This decision is always made in consultation with a midwife or obstetrician. By Week 41, however, my advice is to wait for spontaneous labor but schedule induction of labor in order to avoid extending pregnancy into week 42. Obviously, changes to the health of the mom and baby would speed up that decision.

If the woman delivers her first child vaginally, the risk of needing a Cesarean Section in future births is lowered considerably.

Ole Bredahl Rasmussen, MD.
Obstetrician in Herning Hospital, Denmark, with a delivery ward with 3000
deliveries per year. Dr. Rasmussen is the founder of a Danish organization for obstricians and midwifes discussing current dilemmas in obstetrics www.obst.dk.

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