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Member Research & Reports

Member Research & Reports

Northwestern: Large Trial Reverses Belief that Induction Increases cesarean

For many years, obstetricians counseled women that inducing labor increased the likelihood of a cesarean birth, although there was no solid evidence in clinical trials to support that.

Now, a large national study led by a Northwestern Medicine investigator shows electively inducing labor at 39 weeks actually reduces the rate of cesarean deliveries and decreases maternal and fetal complications.

In the study, women who were assigned to the elective induction group also reported experiencing less pain in labor and a greater sense of control over the labor process than women who were not in the induction group.

The paper was published Aug. 9 in the New England Journal of Medicine.

“There’s a lot of controversy around the consequences of inducing labor. People were convinced that it increased the risk of cesarean delivery, but the reality was actually unknown,” said Dr. William Grobman, the Arthur Hale Curtis Professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “This study provides evidence that inducing labor at 39 weeks actually reduces cesarean delivery.”

In the U.S., approximately one-third of women give birth via cesarean delivery, which is associated with an increased risk of infection, hysterectomy, placenta implantation abnormalities in future pregnancies and respiratory illness in infants.

In the study, more than 6,100 women from 41 sites around the country were divided into two groups: one that waited for labor to begin on its own and one that would undergo an elective induction at 39 weeks of gestation.

The investigators chose 39 weeks because that is when babies have reached full term and have a low frequency of neonatal complications.

Key results

In addition to this large trial, a recent smaller study in Britain found that induction of labor also did not result in an increase of cesarean delivery.

“This new knowledge gives women the autonomy and ability to make more informed choices regarding their pregnancy that better fit with their wishes and beliefs,” Dr. Grobman said. “Induction at 39 weeks should not be routine for every woman, but it’s important to talk with their provider and decide if they want to be induced and when.”

Dr. Grobman is also a member of the Center for Healthcare Studies at Northwestern’s Institute for Public Health and Medicine (IPHAM).