Monthly Archives: November 2018

To Induce or not to Induce? Let’s look at the evidence

Elective induction of labour (EIOL) is a hotly debated topic in the birthing community made even more controversial recently with the publication of the ARRIVE Trial (2018).  It’s not that often that a study will divide the community as much as this one has simply due to it’s large scale. The results can not be ignored, but can also not be misapplied.

The biggest thing to come out of the trial was that the results showed elective induction of labour at 39 weeks for first-time mothers had a decreased c-section rate. This took the birthing world by storm and begs the question: Should we induce ALL first time mothers at 39 weeks?

The answer is NO.

These results can not be generalized to the whole population because they are not representative of the whole population. Keep in mind that the study participants had to agree to be induced which means that it aligned with their values and beliefs. A large number of women qualified to participate in the study, but the majority of them declined because they did not want to be induced without a medical indication. It did not align with their values and beliefs.

Although the results of this study concluded that EIOL at 39 weeks for first time mothers decreased the cesarean rate, it did not acknowledge that there are many other effective and less-invasive approaches to lower the risk of c-section (1. continuous labour support (i.e Doula) 2. Intermittent auscultation (Hands on fetal monitoring) 3. Walking during labour and water births).

While the results of the ARRIVE Trial should not be applied to every birthing mother, the information can be used on an individualized basis and can be a viable option if: 1. It is inline with the mother’s values 2. the staff and facility are available to assist in longer labour (need to allow for a longer first phase of labour) 3. the protocol for “failed” inductions avoids a c-section. It is important to note that the outcomes for neonatal death or complications were the same for the induction group and the group that waited for spontaneous labour, so safety is not a concern. Also important to note is that not all women in the control group had a spontaneous vaginal delivery (some ended up being induced and some had c-sections, but this occurred after 39 weeks). This also skews the results.

PROS:

  • avoid potential complications associated with longer gestational periods (preeclampsia, hypertension, macrosomia)
  • Lower c-section rate with first time mothers under best-practice of ‘failed’ inductions
  • Theoretically may prevent future stillbirth
  • Convenience, ending an uncomfortable pregnancy

CONS

  • Failed inductions can lead to a preventable c-section
  • Longer time for labour
  • Medicalization of birth (more interventions such as electronic fetal monitoring)
  • medically induced contractions are much more painful and this leads to a higher epidural rate
  • Potential uterine tachysystole, infection
  • Unknown impact on labour and delivery costs/resources

I would like to specially thank Rebecca Dekker of Evidence Based Birth for dissecting the information and presenting it during her webinar. For more information on all things birth related visit: https://evidencebasedbirth.com/