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A28 SCIENCE
Monday 13 august 2018

Helping nature: Inducing labor avoids cesarean for some moms

By MARILYNN MARCHIONE the labor and delivery unit
AP Chief Medical Writer but went home sooner af-
Move over, Mother Na- ter birth. Insurers often pay
ture. First-time moms at low a fixed rate for births, com-
risk of complications were plicating cost compari-
less likely to need a cesar- sons.
ean delivery if labor was in- The labor and delivery suite
duced at 39 weeks instead is one of the most expen-
of waiting for it to start on sive places in a hospital,
its own, a big study found. said Dr. Nanette Santoro,
Their babies fared better, OB-GYN chief at the Uni-
too. versity of Colorado School
The results overturn the of Medicine. If all eligible
longtime view that induc- moms decided to be in-
ing labor raises the risk for duced, “I do not believe
a C-section, and prompted we would have the re-
two leading OB-GYN doc- sources to accommodate
tor groups to say it’s now them,” but may have to
reasonable to offer women adapt based on this study,
like those in the study that she said.
option. WHAT OTHERS THINK
But only certain pregnant In this Aug. 7, 2018 photo, a doctor performs an ultrasound scan on a pregnant woman at a Christen Sadler, a certi-
women qualify, and the hospital in Chicago. fied nurse-midwife and
study did not track how Associated Press president-elect of Lamaze
inducing labor affected “Everyone has a different compared different types time in the hospital. International, said other
breastfeeding or other definition of what a natu- of women giving birth un- Nineteen percent of in- research suggests that “let-
mom-baby issues later. ral birth is,” said Dr. Cynthia der different types of cir- duced moms had a ce- ting labor start on its own
Some groups such as La- Gyamfi-Bannerman of New cumstances. This was the sarean versus 22 percent is almost always best for
maze International still ad- York-Presbyterian/Colum- first very big experiment to of the others. Doctors es- moms and babies” unless
vocate letting nature take bia University Medical Cen- time labor induction for 39 timate that one C-section there’s a problem that re-
its course rather than giv- ter, which participated in weeks — when a pregnan- would be avoided for ev- quires intervening.
ing medicines to make the the study. cy is considered full term ery 28 women induced. Nan Strauss, policy chief for
womb start contracting. “Some women feel that and complication rates are Nine percent of induced the advocacy group Every
“Many women don’t want natural just means deliver- lowest. women developed dan- Mother Counts, agreed:
all of the medical care that ing vaginally” and more More than 6,100 women at gerous high blood pressure “Inducing labor disrupts
goes with induction” such were able to do that when 41 hospitals were randomly at the end of pregnancy the complex hormonal
as an IV and fetal moni- labor was induced, she placed in two groups: one versus 14 percent of the processes that help labor
toring, said Lisa Kane Low, said. had labor induced at 39 others. Study participants progress, prepare the baby
past president of the Ameri- Results of the federally weeks; the other waited who were induced, such for birth, and promote suc-
can College of Nurse-Mid- funded study were pub- for labor to start on its own as Aleksa Owen, said they cessful breastfeeding and
wives and associate dean lished Wednesday by the and were induced only if had less pain and felt more bonding.”
of the University of Michi- New England Journal of a problem developed or in control. The American College of
gan School of Nursing. “It Medicine. they hadn’t delivered by “I was pretty open to any Obstetricians and Gyne-
can result in a very different ABOUT THE STUDY 42 weeks. kind of birth, whatever cologists and the Society
type of experience.” About 40 percent of U.S. HOW MOMS AND BABIES works to keep the baby for Maternal-Fetal Medi-
Being induced doesn’t women giving birth are first- FARED safe and myself safe as cine says it’s reasonable
mean moms can’t have time moms, and at least Deaths and severe compli- well,” said Owen, a 34-year- for doctors to offer labor
“natural childbirth” — they half are low risk — no prob- cations were fewer among old graduate student from induction “after discussing
can forgo pain medicine lems requiring early delivery babies of women who the Chicago suburb of Wo- the options thoroughly”
or use a hospital’s homelike or a cesarean. Many wom- were induced — about 4 odridge, Illinois. Her son was with first-time moms at low
birthing center rather than en ask to be induced now, percent versus 5 percent born in October 2016 and risk who had an ultrasound
delivering in “an operating to let them plan delivery in the other group — but “I felt like I had a sense of early in pregnancy to veri-
room in a sterile suite with a and ensure their doctor is the difference was so small control throughout the pro- fy when they will reach 39
big light over your head,” available, but the risks and it could have occurred by cess.” weeks.
said the study leader, Dr. benefits are unclear. chance alone. Significantly THE COST Dr. Michael Greene of Mas-
William Grobman, an OB- Previous studies suggesting fewer babies in the induced It’s not clear which option sachusetts General Hospi-
GYN specialist at North- that inducing labor rais- group needed breathing costs more; researchers tal noted that women in
western University in Chi- es the risk for a C-section tubes or extra oxygen after plan to study that. Induced the study were younger
cago. were observational and birth, and they spent less women spent more time in than U.S. mothers on aver-
age and fewer were over
35, calling into question
how generalizable the re-
sults are.
Still, the study “should re-
assure women that elec-
tive induction of labor at
39 weeks is a reasonable
choice” that’s unlikely to
harm moms or babies, he
wrote in a commentary in
the journal.q