Monday, 20 May 2013

Inductions and Caesarean Sections

I posted a flowchart on my Facebook Page showing the results from a U.S. survey-based study researching women's experiences giving birth - Listening to Mothers III: Report of the Third National U.S. Survey of Women;s Childbearing Experiences. This image compared vaginal versus caesarean section births relating to induction of laour and epidurals. 

A friend posted the comment "I'm actually surprised the percentage isn't higher for the induced mum's who have an epidural."  and I've got to say so am I. I my experience, these statistics don't seem right. So I went searching and came across a South Australian study of over 28 000 women who birthed in 2006 and 2007. Only pregnancies with a single baby, in cepalic presentation (head-down) with a gestational age of 37 completed weeks or more were included in the study.

This study quotes that "25% of births in Australia are induced". That is a scary number. The complications associated with an induction are many and I will discuss them at another time.

The study looks at inductions for "recognised maternal and fetal complications" and "non-recognised maternal and fetal complications".

"Recognized indications for induction of labor in the perinatal dataset included diabetes (both gestational and pre-existing diabetes), premature rupture of the membranes, hypertensive disorders, fetal growth restriction, isoimmunization, fetal distress, fetal death, chorioamnionitis, prolonged pregnancy, twins and antepartum hemorrhage."

All other inductions were placed in the non-recognised category.

Unfortunately, this study did not produce statistics comparable to the American study in terms of induction/epidural/caesarean section but it did produce some interesting numbers.

"Women were more likely to require epidural or spinal analgesia with induction for both recognized and non-recognized indications when compared with spontaneous onset of labor. Similarly, women were more likely to have complications following induction for non-recognized indications compared with spontaneous onset of labor. Women were least likely to achieve vaginal birth following both induction for recognized and non-recognized indication when compared with spontaneous onset of labor. Conversely, women whose labor was induced for non-recognized indications had an increased risk of cesarean birth." 

Here are the figures-

73.17% of women with a spontaneous onset of labour had a vaginal birth, compared to
66.62% of women induced for a recognized complication and only
58.89% of women induced for a non-recognized complication.

13.86% of women with a spontaneous onset of labour had an emergency caesarean section, compared to
17.98% of women induced for a recognized complication and
26.10% of women induced for a non-recognized complication.

This tell us what we already know, that an induction increases your chance of having a caesarean section by at least 50% (67% of the induction is for a non-recognized reason)!

There are risks for baby too.

"Induction of labor for non-recognized indications significantly increased the chance of the infant requiring level 2 nursery care or treatment when compared with the spontaneous onset of labor." 

Here are the figures-

8.19% of babies born following a spontaneous onset of labour required level 2 nursery care, compared to
9.13% of babies born following an induction for a recognized comlication and
14.03% of babies born following an induction for a non-recogniszd complication.

Wow! That's almost a 50% increased risk for baby with an induction for a non-recognized complication - and that's just those babies requiring level 2 nursery care.

This is going back to basics. If we interfere with nature when it is not medically indicated, we cause big problems. Of course, sometimes in induction is medically necessary, and obviously if the induction is for a compromised baby, then you are more likely to find a pathological CTG (or fetal distress) prompting a caesarean section. Induction can be a wonderful tool when medically needed (and risk-wise far better than going straight for a caesarean section) The point is, for those inductions that are not medically indicated, the risks are large and far reaching.

Have a look at the report and see the other findings for yourself.

When planning where to have your baby and who your caregiver will be, do some research. Ask them their statistics on induction of labour (is it over the average 25%?). Places like My Birth have statistics for various hospitals, birth centres and care providers all over the country. For example, in 2009 the hospital with the highest induction rate in NSW was Inverell at 44% - a sobering statistic for the women of Inverell (who are more than an hour away from the next hospital with maternity services).

Educate and empower yourself.


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