Inducing Labor Could Cut C-Section Rate
A new method of evaluating the optimal time for pregnant women to deliver, and then inducing labor if the pregnancy goes past that due date, appears to cut the risk of Cesarean births almost in half.

The method, called Active Management of Risk in Pregnancy at Term (AMOR-IPAT), was the subject of a four-year study reported in July, and yielded a 5.3 percent C-section rate – compared with an 11.8 percent rate among women who received traditional care.

There are two major causes of Cesarean birth, according to James Nicholson, M.D., a professor at the University of Pennsylvania School of Medicine: the size of the baby and the condition of the placenta. AMOR-IPAT helps identify women at risk for having a baby too large for a vaginal delivery, or having a placenta too weak to support the baby through labor.

When necessary, doctors can then set an earlier due date – inducing labor if needed – and have the birth before the baby gets too big, or the placenta too weak, for a vaginal delivery.
While many experts believe that induction of labor actually increases the risk of both Cesarean birth and intensive care admissions for babies, Nicholson, the lead researcher in the study that was reported in the Annals of Family Medicine, says that AMOR-IPAT changes this dramatically.

“The way that we’re applying this method of care, our rates of both of those things seem to be lower,” he says. Part of the reason for this, he believes, is that labor inductions are currently done mainly in women who are already having problems – such as being past their 40th week of pregnancy. AMOR-IPAT inductions are done before problems can occur.

“They’re being done at a healthier time for the pregnancy,” he says.

It could be several years, however, before all doctors approach pregnancy management this way. “We’ve been taught for decades that induction of labor is bad and you shouldn’t do it unless you have to,” Nicholson says. Further study, which is already under way, is needed before doctors will change their thinking.

– Christina Elston