Problems and Hazards of Induction of Labor

A CIMS FACT SHEET

The Coalition for Improving Maternity Services (CIMS) is concerned about the dramatic increase and ongoing overuse of induction of labor. The U.S. induction rate has more than doubled since 1989, rising from one woman in ten to one woman in five in 2001. (Ref. 22) This may, however, grossly undercount the true incidence of labor induction. Nearly half of women in a 2002 survey reported that some effort had been made to start labor artificially. (Ref. 5) The World Health Organization recommends no more than a 10 percent induction rate. (Ref. 31)

Despite modern techniques, induction of labor still introduces considerable risk compared with natural onset of labor, and many, if not most, inductions are done for reasons that are not supportedby sound medical research.

HAZARDS OF LABOR INDUCTION

First-time mothers have approximately twice the likelihood of cesarean section with induction compared with natural onset of labor. This risk is due to the procedure itself, not any reason that might have led to inducing labor. (Ref. 9) Inducing labor at 41 weeks in a hypothetical population of 100,000 first-time mothers will result in somewhere between 3,700 and 8,200 excess cesareans and cost an extra $29 to $39 million. (Ref. 17)

Women who have had prior vaginal births may increase their chances of cesarean section five-fold if the cervix is not ready for labor, and they are given cervical ripening agents. (Ref. 26) Inducing 100,000 hypothetical women with prior births at 41 weeks will result in between 100 and 2,300 excess cesareans and cost an extra $25 to $26 million. (Ref. 17)

All induction agents can cause uterine hyperstimulation (contractions too long, too strong, and too close together and higher baseline muscle tension). (Ref. 10) Uterine hyperstimulation can cause fetal distress. (Ref.10) This means that, paradoxically, inducing labor because of concern over the baby’s condition may cause the very problem the induction was intended to forestall while the baby might have tolerated natural labor.

Induction of labor involves the need for other interventions — IV drip, continuous electronic fetal monitoring, usually confinement to bed — that also can have adverse effects.

Rupturing fetal membranes, a routine component of labor induction, can cause fetal distress and increases the likelihood of cesarean section. (Ref. 2, 8, 11) It may also precipitate umbilical cord prolapse (a life-threatening emergency for the baby in which the umbilical cord slips down into the vagina). (Ref. 7, 19) Forty percent of all full term births involving cord prolapse were induced labors, rising to nearly 50% of births involving prolapse at 42 weeks or more. (Ref. 21)

Induced labors are usually more painful, which can increase the need for epidural analgesia. (Ref. 3) Epidurals introduce a higher probability of a host of adverse effects on the labor, the baby, and the mother.

Women with prior cesarean sections have a slightly increased probability of the scar giving way with Pitocin (oxytocin) induction (8 per 1,000 vs 5 per 1,000 with spontaneous labor onset) and greatly increased risk when prostaglandins (24 per 1,000) are used for cervical ripening or induction. (Ref. 20) Prostaglandins include Cytotec (misoprostol), Prepidil (prostaglandin E2), and Cervidil (prostaglandin E2).

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