Cleveland, OH,
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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.”

About the MetroHealth System

The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it.

The system’s more than 600 doctors, 1,700 nurses and 7,800 employees go to work each day with a mission of service, to their patients and to the community. As Cuyahoga County’s safety-net health system, MetroHealth plays an essential role in the region, caring for anyone and everyone, regardless of an ability to pay.

Founded in 1837, MetroHealth operates four hospitals, four emergency departments and more than 20 health centers and 40 additional sites throughout Cuyahoga County. The system serves more than 300,000 patients, two-thirds of whom are uninsured or covered by Medicare or Medicaid.

MetroHealth is home to Cuyahoga County’s most experienced Level I Adult Trauma Center, verified since 1992, and Ohio’s only adult and pediatric trauma and burn center.

As an academic medical center, MetroHealth is committed to research and to teaching and training tomorrow’s caregivers. Each active staff physician holds a faculty appointment at Case Western Reserve University School of Medicine. Its main campus hospital houses the Cleveland Metropolitan School District’s Lincoln-West School of Science & Health, the only high school in America located inside a hospital.

Knowing that good health is about much more than good medical care, MetroHealth has launched the Institute for H.O.P.E.™ (Health, Opportunity, Partnership, Empowerment), which uses a coordinated, collaborative and strategic approach to help patients with non-medical needs such as healthy food, stable housing and job training.

The MetroHealth Glick Center, a new 11-floor hospital, is under construction on the system’s main campus in Cleveland and is scheduled to welcome its first patients in October 2022. The billion-dollar project is the cornerstone of a wider neighborhood revitalization effort led by the system and its partners in the community.

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