Aim: The aim of this study was to evaluate two regimens of administration of sustained-release dinoprostone on the need for oxytocin induction of labor.
Material and Methods: We carried out an open prospective study comparing labor, maternal and neonatal outcomes after 12 h of prostaglandin cervical ripening insert versus 24 h of prostaglandin cervical ripening insert in 284 patients (142 ripenings at 12 h [P12 group] and 142 ripenings at 24 h [P24 group]).
Results: The two groups were demographically similar. There was a significant difference in the need for artificial rupture of membranes/oxytocin induction of labor between the groups (49.3% for the P12 group vs 38% for the P24 group, P = 0.03). The delay between the beginning of ripening and delivery was significantly decreased in the P12 group, but the duration of active labor (6.6 h), the dose of oxytocics used (1326 UI), the rate of cesarean section, the rate of uterine hyperstimulation, the rates of hemorrhaging from delivery, the neonatal state and the experience of induction were similar in the two groups.
Conclusion: This study allows us to show for the first time that sustained-release of dinoprostone leads to spontaneous induction of labor without increasing the obstetrical risk in a majority of patients.
Denoual-Ziad C, Aicardi-Nicolas S, Creveuil C et al (2015). Impact of prolonged dinoprostone cervical ripening on the rate of artificial induction of labor: a prospective study of 330 patients. Journal of Obstetrics and Gynaecology Research 41(3): 370-76.
Now, in my Recipes for Normal Birth workshops, I talk a fair bit about the importance of not giving up on women who are having interventions such as induction of labour. I talk about the things that we can do to increase their chances of having a vaginal birth, and within that context I am always happy to see the publication of research which helps us better understand how we can do that. (Whether this is good-quality research is another question for another day).
I am also respectful of the fact that many of the authors of such studies are not writing in their mother tongue, and that their ability to speak and write in English is about a million times better than my ability to communicate by any means in their language.
But just as I have previously argued that we need to take care when using the term (or oxymoron) ‘natural induction’, I also want to argue that we need to take care not to use the word ‘spontaneous’ in conjunction with the word ‘induction’, or the action of using any drugs in an attempt to start labour. Saying that a pharmaceutical intervention leads to ‘spontaneous induction of labour’ is inaccurate, and we need to take care not to begin down such a slippery slope.
I do appreciate that, as a number of people have suggested, it may be of value to consider the use of cervical ripening agents separately from the use of synthetic oxytocin. But we shouldn’t be applying the term ‘spontaneous’ (or natural) in a context where we are using any drugs or interventions in an attempt to bring on labour.
I’m not saying there’s anything wrong with induction of labour if this is the result of a decision made by an informed woman who has decided it is right for her and her family within their individual and unique context. I’m not saying it’s a bad thing. I’m saying we should call it what it is. There’s enough confusion out there already.
If you’d like to learn more about post-term pregnancy and build your confidence with the evidence, I’d love to welcome you to my online course on this topic 😀 And you can keep up with my research postings via my free updates and monthly Birth Information Update.