January 19, 2009

UK Researchers Question The Amount Of Induced Labors In Women

A Scottish audit of 17,000 births has raised concern among doctors about pregnant women being induced "unnecessarily."

The researchers stated they could not find a medical or other explanation for the procedure in more than a quarter of cases and rates of obstetric intervention were rising, according to the Aberdeen University research team.

Experts warned in the Journal of Public Health that more studies were needed to assess whether inductions are being done without good reason.

One of the more common methods of induction includes the use of a gel containing prostaglandins to bring on contractions and start the labor process.

Reasons to induce labor include: being over 41 weeks pregnant, waters breaking but no onset of labor, or planned timing of labor because of complications. The procedure is associated with an increased likelihood of further medical interventions, such as caesarean section.

The researchers said rates of induction are rising in the UK, particularly in Scotland, but there seems to be no single explanation for the figures.

The University team showed that 5,700 (32 percent) of pregnant women had been induced after using data in the Aberdeen Maternity and Neonatal databank on births between 1999 and 2003.

Reasons for induction included the standard medical reasons as well as social factors such as living a long way from the hospital, yet 28 percent of cases remained unexplained.

Study leader Tracy Humphrey, a consultant midwife at Grampian NHS Board, said they expected to find a proportion of inductions that could not be explained.

"As good as the database is, I'm sure there are characteristics that are just not collected, but we were slightly surprised that it was as high as it was," she told BBC News.

"It raises the question that there may be some unnecessary interventions and we are planning further studies."

She said the main debate over unnecessary interventions focused on caesareans and the other interventions that go on have been forgotten.

"If a significant number of inductions are being done without cause, it is a serious problem that must be addressed," said Mary Newburn, head of policy research at the National Childbirth Trust.

"Further research is needed to identify the circumstances of induced labor where there are not good clinical reasons," she added.

Newburn said induced labor tends to be more painful and more difficult for women to manage without strong drugs.

"If women are asking for induction because they are tired at the end of pregnancy, they may need more support, and encouragement to rest as much as possible, so that they can wait a bit longer."

While the findings are interesting, it may be that reasons for induction were not properly recorded in the database, suggested Patrick O' Brien, a consultant at University College London Hospitals and a spokesperson for the Royal College of Obstetricians and Gynecologists.

He said it is important that there be a good reason for inducing labor when it happens and that more research needs to be done.

Sue Macdonald, spokeswoman for the Royal College of Midwives, said it was important that women knew why induction was being done.

"We are very interested in trying to support normal birth and ensuring an intervention is done only when it's absolutely necessary."


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