Not So Fast: "Induction Reduces Cesarean" Study Overlooks Major Issues

Results from a large study -- the ARRIVE Trial -- released this week and showed that people in the study who were induced at 39 weeks instead of waiting until labor begins on its own had a lower chance of having a c-section.

Results of this study are significant because it has been long believed that induction increases a person's risk of cesarean. Many organizations, including Lamaze International, are cautioning families and doctors against using the results of this study as a go-ahead to choose induction at 39 weeks when not medically necessary. You can read a good round-up of comments on the study, including input from Lamaze, in this article in the NY Times.

The study included a total of 6,106 low-risk women who were having their first baby. Of that group, 3,062 were assigned to be induced at 39 weeks and the rest were assigned to wait until labor begins on its own. Severe complications between the two groups were about the same -- no significant difference. In the 39 weeks induction group, the cesarean rate was 18.6% while the wait to give birth group's c-section rate was 22.2%.

While the lower rate of cesarean occurrence in the planned induction at 39 weeks group is positive, it doesn't tell the whole story and should not be used as evidence for low-risk first-time parents to request induction at 39 weeks to lower their chance of having a cesarean. Given the numbers from the study, 28 women would have to have an elective induction at 39 weeks in order to avoid one cesarean. There are many other, less risky things that can be done to reduce a person's risk of cesarean! For example, when continuous labor support is present it only takes 14 women using this safe support measure to avoid one c-section. Unlike induction, continuous labor support is risk free!

Let's take a look at the other issues from the results of this study.

The Issues

Induction Isn't for Everyone

Only 27% of the people eligible to participate in the study agreed to do so. It is possible that this number was so low because people are not willing to agree to an induction for a non-medical reasons. Many first-time parents do not realize all that is involved in an induction. Often, people think: "A date to schedule my birth?! Perfect!" The reality is that induction can and often is a long and drawn out, highly medicalized procedure. There are more medical interventions that are necessary with an induction, often more time spent leading up to birth, restrictions on movement and eating and drinking, and it can have additional effects on mom and baby during and after birth. Induction with pitocin can increase stress to your baby and uterus, and usually necessitates an increased need for pain medication, including epidural.

Parents Don't Represent the Majority

The majority of the people in this study were in their early 20s, which is not representative of the childbearing population at large. The group also did not represent a well balanced mix of ethnicity, which means it's hard to apply the results generally to the population at large.

Cost for Induction

The cost to induce may be more expensive since it requires significantly more medical interventions and a potentially longer hospital stay. Depending on a person's insurance, this could mean a much higher out-of-pocket bill to pay for birth, unnecessarily.

Other Factors that Reduce Cesarean

Instead of a study that looks at induction to reduce poor outcomes and cesarean, why not look to practices we know are actually helpful in improving outcomes and reducing c-sections, like continuous labor support person, allowing more time to labor and for pushing, and taking into consideration baby's position before birth?

When significant new research gets published and subsequently shared widely, it's important to read and research the details, beyond what is shared in the media. Often, new research becomes translated into a blanket "this is now safe/better/recommended" statement, when in reality, there is still work needed to determine the most safe and beneficial practice. Ultimately, in order to make the best decision for you and your baby, you must consider your unique situation and health and look at current, best evidence and practices to make choices that are right for you.

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