A large trial performed in the US has prompted questions on whether routinely inducing labour ahead of the 40-week due date could reduce complications for both the child and mother.
The study suggested that inducing labour one week early brings many potential benefits. Published in the New England Journal of Medicine, the trial randomly allocated 6,100 healthy, first time mothers into two groups, one that waited for labour to start on its own, and one to have labour induced.
Previously, doctors believed that inducing labour early could increase the need for a caesarean section. Although C-sections are safe, they bring an increased risk of infection and longer recovery times, and therefore greater costs.
However, the study showed that inducing labour early actually lowered the risk of a C-section by 14%. Of those who were induced at 39 weeks, there were 569 caesarean sections, or roughly 18.6% of births. This was compared to 674 women, or 22.2% of births, who required a C-section while waiting for labour to naturally occur.
This amounts to one caesarean delivery being avoided for every 28 women who opted to have pregnancy induced at 39 weeks.
The study also saw cases of pre-eclampsia and gestational hypertension (high blood pressure) amongst mothers fall by more than a third. Women reported less pain during labour, and a greater sense of control over the process of giving birth. Additionally, 25% fewer babies needed breathing support.
George Macones, head of Obstetrics and Gynaecology at Washington University School of Medicine, who led the study, said; “This study is a potential game changer and will have a significant impact on the practice of obstetrics.”
In the NHS, labour is only routinely induced after 41 weeks to avoid the risks of prolonged pregnancy, which can increase the risk of a baby being stillborn.
Obstetrics experts in the UK “welcomed the results” of the large new trial and said it would be valuable in discussions with mothers about early induction, particularly those at risk of stillbirth.
“However, other factors must be considered before changing recommendations in clinical practice about when to offer induction of labour,” said Professor Basky Thilaganathan, a consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists.
“While induction is safe and studies have shown no short-term adverse impact on the mother of the baby, induction of labour is a medical intervention and can lead to a more prolonged and painful process than spontaneous labour, and with costs to the services.”