Mamas on Bedrest: The End of Elective Inductions??

May 24th, 2013

Many American hospitals and Obstetricians have put a “hard stop” on elective labor inductions. As a result many hospitals and physicians are seeing a significant drop in still births, NICU admissions, cesarean sections and post partum hemorrhage. Data presenting the effects of such hospital practice policies was presented at the American Congress of Obstetricians and Gynecologists (ACOG) 61st Annual Clinical Meeting.

The United States has long been noted to have adverse birth outcomes that, in some instances, rival those of developing nations with far fewer resources. With the world’s eye upon us, many hospitals adopted a no elective labor before 39 weeks gestation policy. This means that under no circumstances is a mama to be induced before 39 weeks gestation unless it is absolutely medically necessary; there is danger to the life of mama or baby. Otherwise, Mamas and babies have to “tough it out” to term. Additionally, many hospitals are adopting strict policies against obstetricians who perform elective inductions in an effort to deter the practice.

The results of the policy has shown the following results according to researchers Nathaniel DeNicola, MD, from the University of Pennsylvania, in Philadelphia, Andrew Healy, MD, medical director of obstetrics at Baystate Medical Center, in Springfield, Massachusetts and Angela Silber, MD, director of maternal-fetal medicine at Summa Akron City Hospital, in Ohio:

Dr. DeNicola’s Study (A Survey Study)

  • Many hospitals have adopted specific policies against elective induction
  • Nearly two thirds of more than 2600 hospitals have “no elective induction” policies in place.
  • 67% of hospitals have a formal policy against non-medically indicated labor induction, and among those without a formal policy, just over half said it was against their standard of care.
  • 69% of formal hospital policies were hard-stop, meaning strictly enforced, as opposed to soft-stop or strongly discouraged.

Dr. Healy’s study

  • Compared 9515 singleton births before the policy and 2641 singletons after the policy found a significant decrease of 5.9 hours in the median time to delivery (P = .002).
  • The cesarean section rate for elective inductions also decreased from 16% before the policy to 7% after (= .05).
  • NICU admission rates decreased by a third. Before the policy, 3% of term babies got admitted to the NICU and after the policy that went down to 2%” (= .02).
  • No increase in the stillbirth rate

Dr. Silber’s  pre- and post policy comparison

  • Decrease in stillbirths and NICU admissions
  • Comparing 9806 singleton deliveries before the policy and 6041 singletons after, the number of stillbirths decreased significantly from 16 to 3 ( = .023), with a trend toward significance in the reduction of NICU admissions (from 867 to 587; P = .06).
  • There was no significant difference in macrosomia (Large for gestational age) rates (P = .718)

Other data not fully analyzed shows a decrease in cesarean sections as well as postpartum hemorrhage.

As a result of these studies, many obstetricians and hospitals are really questioning the practice of induction and no longer performing inductions unless absolutely medically necessary. According to these researchers, this data may be what makes elective inductions history!

Summarized from MedScape News,  OB/GYN & Women’s Health by Kate Johnson, May 23, 2013

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