Further evidence that inducing labour in healthy women increases the chance of caesarean

594554838_8a854e7c53“Induction of labour in medically uncomplicated nulliparous women at term carries a more than doubling of risk of emergency CS [caesarean section], compared with spontaneous labour, with no impact on perinatal mortality. All methods of induction and augmentation of labour were associated with an increase in the rate of CS. Women included in this study had no apparent medical indication for induction of labour or any complication of pregnancy, so the increase in CS was not due to identifiable underlying risk factors. These results suggest that, in the absence of direction from well-designed, contemporary RCTs, minimising unindicated inductions before 41 weeks’ gestation has the potential to reduce the rate of CS.”


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Davey M-A and King J (2016). Caesarean section following induction of labour in uncomplicated first births- a population-based cross-sectional analysis of 42,950 births. BMC Pregnancy and Childbirth 2016:16:92


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12 comments for “Further evidence that inducing labour in healthy women increases the chance of caesarean

  1. Mireia
    June 17, 2016 at 8:30 pm

    Thanks for you article. But what about all the research saying that pregnant woman > 40 yo have higher risk of stillbirth if pregnancy reaches over term gestation? I am a midwife in UCLH and we induce all healthy women 40yo or over with uncomplicated pregnancies before or when they reach 40w gestation for that reason. RCGO advises IOL on older women too.Thanks so much.

    • June 20, 2016 at 8:57 am

      I’ve written several articles and blog posts on this question because, while there does seem to be an increase in stillbirth for older women, we don’t know how much of this is down to co-morbidities and factors such as IVF, and we also don’t have good evidence that inducing these women’s labours will reduce the stillbirth rate. We do, however, know that induction of labour poses a number of risks and that not all women want to undergo this intervention, especially when they are told that ‘this is policy’. It’s a very complex question and we need to better understand the issues. I am concerned that the data on which the current claims that induction doesn’t lead to an increase in caesarean section are flawed, and I think we need to look beyond the guidelines and ask some important questions about what is going on here. Rosemary Mander has also written an excellent critique of the RCOG paper which you might find interesting 🙂

    • Rachel
      July 1, 2016 at 12:44 pm

      Yes but where are these still birth stats from? I believe them to be produced in the 50’s and totally out of date., of course no one can be a Guinea pig for more stats to be produced but we also cannot compare to neonatal care in the 50’s to now. I was induced at 42weeks with no reduction of fluid and placenta was in perfect condition…. I ended up having a very unnecessarily traumatic birth and I put this down to the induction process. There was no need to induce me as shown on the scan prior and placenta post birth – just an outdated stat.

    • Hypatia
      August 24, 2016 at 4:46 pm

      Crikey! Islington mother of two, here! 46 years old – second child born at home when I was 43, healthy natural birth! No pain relief required, no intervention, delayed clamping and partial
      Lotus birth. Family birth with all present and a great day we had!
      So glad I kept away from the likes of you!

  2. Anna
    June 23, 2016 at 2:17 am

    My understanding is that while the risk of stillbirth for women over 40 is higher than for younger women, it is still an extremely low probability for stillbirth-a fraction of a percent for healthy women over 40.

    • June 23, 2016 at 10:24 am

      That’s my understanding too, Anna. And it’s really important that we remember this, and look at the absolute chance (or risk) of something happening rather than just the relative chance/risk.

      • Mireia Coll
        June 26, 2016 at 6:35 pm

        Thanks so much Sarah. I’ll check that article.

  3. Lisa Ramsay
    July 1, 2016 at 5:30 pm

    I’m 29 years old and pregnant after IVF (with ICSI). There are no known issues with me, IVF was due to male factor. I’m 32 weeks and at our 28 week scan baby was measuring well and in 54 percentile so average. My consultant still wants to induce me at 39-40 weeks because of ‘low birth weight’ and ‘reduced movements after due date’ in IVF pregnancies. I’m really against this at the moment but she made me feel like I would be risking the babies health. What’s your opinion on inducing solely due to having an IVF pregnancy?

  4. July 2, 2016 at 6:08 pm

    Hi Sarah
    Thank you for bringing our attention to this research. I am unable to find the original paper would you be able to provide a link. Thanks Annabel

  5. August 24, 2016 at 11:46 am

    Thank you Sara! It would be so interesting if they had observed the same for 41 – 42 weeks interval…

  6. Katherine Kelly
    June 5, 2017 at 9:28 pm

    In May 2017 Southampton hospital offered me an induction at week 39 after I had asked for monitoring as I hadn’t felt baby move as usual overnight. There was nothing during monitoring to indicate anything was wrong so I asked why I had been offered induction. Apparently it is a new policy to offer anyone 39 weeks + an induction if they come in for monitoring even if there is no medical reason to. I politely declined. I wonder how many women will accept without really making a fully informed choice.

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