There are increasing numbers of inductions and a growing sense that it is becoming the ‘go to’ option in risk-averse maternity services, where doing something is regarded as better than doing nothing. But doing something has consequences and unless there is a clearly evidenced overall benefit, being able to say ‘well, we tried’ is just not a good enough justification.
Dr Sara Wickham is providing a really useful analysis of the research coming out at the moment with both summaries and longer appraisals of the evidence and a critique of how this research is being presented generally. Follow her on FB at sarawickham.com for up to date information. She quotes: “A small absolute increase in risk on its own, without any other medical risks or complications during pregnancy, does not justify a policy of routinely offering induction of labor without strong evidence of the benefits of that policy.”
These words are from a discussion paper by Seijmonsbergen‐Schermers et al (2019), which has been co-authored by a string of experts. They explain that induction and other birth interventions can cause avoidable harm and note that “experts at the World Health Organization and authors of the Lancet Series on Caesarean Section, have recently also warned against excessive use of obstetric interventions”.
Proponents of routine induction of labour focus on the possibility that some groups of women may face a very small increase in risk. But, as I often point out, we do not have good evidence that induction will reduce that risk, and yet we DO have good evidence that induction has other downsides.
Seijmonsbergen‐Schermers et al (2019) also note this:
“Inducing women to prevent small absolute risks based on trials undertaken with very discrete populations neglects these warnings. Besides, a small increase in absolute risk does not necessarily mean that outcomes will be improved if labor is induced. Without the full picture of longer term outcomes from single and multiple cumulative interventions, and in the absence of a clear understanding of the compiled morbidity that may eventuate over a woman’s life time of reproduction, it is not possible to achieve fully informed judgements.”
It’s great to see more papers unpacking the evidence. It is clear that the pro-induction argument is not as sound as proponents would like us to think.
Induction of labour will be the right decision for some women, and not for others. There is a bigger story to understand here.
Seijmonsbergen-Schermers A E et al (2019). Which level of risk justifies routine induction of labor for healthy women? Sexual and Reproductive Healthcare doi.org/10.1016/j.srhc.2019.100479