Labor induction is the use of medication to induce labor. Labor is induced by stimulating uterine contractions to result in a vaginal birth.
Is 39 Week Elective Induction of Labor (EIOL) Mandatory?
Pregnancy is a joyous time, but as pregnant women, we are left to wonder – when will this baby come? We often tease that it is the first lesson in parenthood – that we are not in control of much related to our children. The uncertainty of when labor will begin can cause significant anxiety. Almost always – our bodies will begin to labor on their own prior to 42 weeks. In a healthy normal pregnancy, forcing labor to start with medication is not medically required until 42 weeks when the risk of stillbirth increases significantly. For some, the idea of waiting until 42 weeks and the unpredictability of timing are unacceptable. Induction of labor with medication is a safe alternative that many women choose at 39 weeks. There are pros and cons to opting for a labor induction versus spontaneous labor. It is essential that we know those risks and benefits to make informed decisions about our bodies and our healthcare.
Elective (not medically required) induction of labor (EIOL) is chosen by many pregnant women to allow for the scheduling of birth. This can be practical for those who live far away from a hospital or need to coordinate family support. Elective induction of Labor has been controversial because it was suspected to increase the risk of cesarean section as compared to spontaneous labor. This holds true when comparing elective induction of labor at 39 weeks with women who spontaneously labor at 39 weeks. Many first-time moms do not go into labor until 40-41 weeks which makes the 39 week comparison only relevant to those that labor at 39 weeks. A more recent study examined elective induction of labor at 39 weeks versus spontaneous labor from 39-42 weeks, and found that the c-section rate for elective induction of labor was actually lower than that for spontaneous labor (18.6 Vs 22.2). To many, this was counter intuitive, but can be explained by how time impacts placental function and infant size. Those additional weeks of pregnancy allow the placenta to age and deteriorate which can cause a baby to not tolerate contractions. Those weeks also given the infant time to grow larger (1/2 pound per week) which can cause a baby to not fit through the pelvis as easily. Those are two of the most common reasons for c-section: fetal intolerance of labor and cephalopelvic disproportion.
With this new data indicating that 39 week elective induction of labor (EIOL) results in lower c-section rates and lesser need for infant breathing support, many physicians claim that all pregnant women should undergo at 39 weeks EIOL. This ignores some very important components of this most recent research as well as past studies. The cesarean section rates for both groups (18.6 Vs 22.2) are far lower than many hospitals across the country. Where we deliver, the most recent NTSV rate for all patients is 27.5% – much higher than the study rates. Even more striking is that the hospital NTSV rate by physician varies from 16.6% to 43.9% indicating that massive variation exists between surgeons. The research study was done by academically minded obstetricians who are more likely to follow evidence-based guidelines regarding induction and cesarean section. Because of that, those physicians are more likely to have a lower individual c-section rate. Ultimately, who you choose to be your physician is more likely to determine your likelihood of c-section than almost any other factor – making the difference between c-section rates with elective induction of labor (EIOL) and spontaneous labor less impactful.
Based on the results of this trial, the American College of Obstetricians and Gynecologists concluded that offering elective induction of labor(EIOL) to low-risk first-time moms at 39 weeks of gestation is a reasonable option that should be a shared decision of a woman and her obstetrician or midwife. Although elective labor induction is a reasonable option for patients who want to schedule their delivery date, the differences in outcomes between the two approaches are small and do not warrant a strong recommendation for one approach versus the other. It is then each individual woman’s right to choose her preference between elective induced labor (EIOL) or spontaneous labor after weighing truthful information about pros and cons. As women, we should not be required to have an elective induction of labor(EIOL) unless it is our preference. With ongoing advocacy, hopefully more women will understand that the power of choice lies in our hands.
If you are looking for an OB/GYN in Austin, Texas committed to providing high quality care during labor, induced labor and delivery, please don’t hesitate to Contact us at ObGyn North!
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