The MetroHealth System Part of National Institutes of Health Study Showing that Induced Labor After 39 Weeks in Healthy Women May Reduce Need for C Section
Approach may also reduce risk of preeclampsia, need for newborn respiratory support
Healthy first-time mothers whose labor was induced in the 39th week of pregnancy were less likely to have a cesarean delivery, compared to a similar group who were not electively induced at 39 weeks, according to a National Institutes of Health study. MetroHealth patients, under the direction of Edward Chien, MD, OBGYN, participated in the research, along with 39 other hospitals from around the country.
Women in the induced group were also less likely to experience pregnancy-related blood pressure disorders, such as preeclampsia, and their infants were less likely to need help breathing in the first three days.
The study results were presented today during the annual meeting of the Society for Maternal-Fetal Medicine.
Current guidelines recommend against elective induction of labor—inducing labor without a medical reason—in women in their first pregnancy prior to 41 weeks because of concern of increased need for cesarean delivery. Elective induction at 39 weeks, however, has become more common in recent years.
“Many people believe that induction of labor increases your chance of having a C-section and are also concerned that it may increase the risk to their child,” says Dr. Chien. “This study demonstrates that the overall risk for C-section is actually lower if induced than if you waited for labor to occur on its own.”
NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) funded this study to determine whether elective induction is beneficial or harmful compared to expectant management (waiting for labor to begin naturally and intervening if problems occur).
More than 6,100 first-time mothers in the NICHD Maternal Fetal Medicine Units Network – of which MetroHealth is a part of – were randomly assigned to induced labor or to expectant management. Cesarean delivery was less frequent in the induced labor group (19 percent) versus the expectant management group (22 percent). Preeclampsia and gestational hypertension occurred in 9 percent of the induced group and 14 percent of the expectant management group. Among newborns, 3 percent in the induced group needed respiratory support, compared to 4 percent in the expectant management group.
As far as how the study’s results will impact the doctor-patient relationship, “patients want to have control over their pregnancy,” Dr. Chien explains. “Up until now, many providers were hesitant to electively deliver women. This data provides evidence for allowing elective induction of labor in those individuals who choose it. I think patients will appreciate the greater autonomy.”
The MetroHealth System, Cuyahoga County’s public health system, is honoring its commitment to create a healthier community by building a new hospital on its main campus in Cleveland. The building, and the 25 acres of green space around it, are catalyzing the revitalization of MetroHealth’s West Side neighborhood.
MetroHealth will break ground on the new hospital in late 2018, using nearly $1 billion it borrowed on its own credit after dramatically improving its finances. In the past five years, MetroHealth’s operating revenue has increased by 44.5 percent and its number of employees by 21 percent. Today, its staff of 7,700 provides care at MetroHealth’s four hospitals, four emergency departments and more than 20 health centers and 40 additional sites throughout Cuyahoga County. In the past year, MetroHealth has served 300,000 patients at more than 1.4 million visits in its hospitals and health centers, 75 percent of whom are uninsured or covered by Medicare or Medicaid.
The health system is home to Cuyahoga County’s most experienced Level I Adult Trauma Center, verified since 1992, and the only adult and pediatric burn center in the state of Ohio.
As an academic medical center, MetroHealth is committed to teaching and research. Each active staff physician holds a faculty appointment at Case Western Reserve University School of Medicine and its main campus hospital houses a Cleveland Metropolitan School District high school of science and health.
For more information, visit metrohealth.org.