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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 an essential health system committed to providing health care to everyone in Cuyahoga County, Ohio, and improving the health of the community overall. Its 7,500 employees deliver care to everyone at its main campus, just west of downtown Cleveland, and at more than 20 other MetroHealth locations. Two new hospitals have recently opened in Cleveland Heights and Parma, and MetroHealth also provides health care at more than 40 additional sites in Cuyahoga County through community partnerships.

MetroHealth is home to Cuyahoga County’s most experienced Level I Adult Trauma Center, verified since 1992 by the Committee on Trauma of the American College of Surgeons, and one of two adult and pediatric burn centers in the state of Ohio verified by the American Burn Association. MetroHealth also is home to a verified Level II Pediatric Trauma Center.

In the past year, MetroHealth provided more than 1.4 million patient visits in its hospital and health centers. MetroHealth is also an academic medical center committed to teaching and research; each of its active physicians holds a faculty appointment at Case Western Reserve University School of Medicine. MetroHealth has earned Magnet status, which places it in the top six percent of all hospitals nationwide for nursing excellence.

MetroHealth’s mission is, “Leading the way to a healthier you and a healthier community through service, teaching, discovery and teamwork.” For more information, visit