Inducing Labor Didn't Raise C-Section Risk

Cesarean section risk reduced with labor induction versus expectant management

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Twenty percent of all births are the result of labor induction. This method is often thought to increase the risk of cesarean section, but this association might be an old wives' tale.

A recent review of research found that women who had labor induced were less likely to have a cesarean section than women who used expectant management ("wait-and-see" approach) for labor.

The researchers discovered that the risks of fetal death and other complications also were lower among women who had labor induced.

"Discuss the risk of cesarean section with your OBGYN."

The lead author of this review was Khalid S. Khan, MBBS, MSc, from the Centre for Primary Care and Public Health in Barts and the London School of Medicine and Dentistry at Queen Mary University of London in London, United Kingdom.

The review included 157 previously published studies on the risk of cesarean section with labor induction versus expectant management among women who gave birth to a single baby.

The studies were published between 1975 and 2012, and there were a total of 31,085 deliveries in the studies.

Women may have labor induced for a variety of reasons, including diabetes, preeclampsia (high blood pressure and abnormal amount of protein in urine during pregnancy), overdue pregnancy, fetal distress and preterm rupture of the fetal membranes.

The findings showed that the women who induced labor had a 12 percent decreased risk of having a cesarean section compared to the women who used expectant management.

This decreased risk of cesarean section was only found in pregnancies where the baby was born during term and post-term, but not preterm.

The researchers discovered that the risk of cesarean section was lower in both high-risk and low-risk pregnancies that ended in induced labor.

In addition, women who underwent labor induction had a 50 percent lower risk of fetal death and a 14 percent lower risk of having her newborn admitted to a neonatal intensive care unit.

The method of labor did not affect the mothers' risk of death.

"Our meta-analysis showed that the risk of cesarean delivery following labor induction was significantly lower than the risk associated with expectant management," Professor Khan and colleagues wrote. "This finding supports evidence from systematic reviews but is contrary to prevalent beliefs and information from consumer organizations, guidelines and textbooks."

Professor Khan and team also suggested that these findings could help physicians determine who should undergo labor induction, and accurately explain the risks associated with it.

This study was limited because the researchers had to use previously published data — some from primary studies and some from databases of previous reviews — and therefore could not confirm the information or account for various factors that may not have been mentioned.

Also, due to the wide time span of publication, the practices, definitions and assessment of pregnancy risk associated with labor induction and expectant management may have changed over the years.

This review was published on April 28 in the Canadian Medical Association Journal.

Review Date: 
April 25, 2014
Last Updated:
April 28, 2014