Reducing Inductions and Cesareans
What One Hospital Did to Decrease Unnecessary Interventions
Apr 16, 2009
With the induction rate hovering around 40% in some areas and a cesarean rate that is climbing every year in most parts of the world, nearly all medical care providers, birth advocates and parents agree that change is needed. However one of the biggest problems is how to make the changes that are necessary to reduce the rate of unnecessary inductions and cesareans. Fortunately we now have a successful model from one US hospital for how to reduce unnecessary interventions.
Setting Goals to Reduce Inductions
Published in the April 2009 issue of Obstetrics and Gynecology is a study that outlines exactly how medical providers can work together to bring about these needed changes. The study took place at the University of Pittsburgh School of Medicine and Magee-Women's Hospital of University of Pittsburgh Medical Center from 2004 to 2007. Researchers set out to see if additional medical staff education and changing the guidelines for scheduling inductions would have any effect on the induction rate.
Initiating the Study and Changing Guidelines for Elective Induction
As the study began in 2004, the medical staff at this hospital was limited to scheduling elective inductions (or those without a medical indication) after completing 39 weeks of pregnancy. Another guideline initiated in the study required that first-time mothers (known as primips) have a Bishop's score of at least 8. Mothers who were expecting their second or later baby (multips) needed to have a Bishop's score of at least 6. (The Bishop's score is a way of assessing the mother's cervix and position of the baby to see if her body is ready for an induction of labor.)
Results after New Guidelines to Reduce Inductions
After implementing the above guidelines over a three year period, the overall induction rate fell from 24.9% to 16.6%. This represented a 33% change in the rate of elective inductions. The percentage of elective inductions prior to 39 weeks of pregnancy decreased from 11.8% to 4.3%, which was a 64% difference. Just as impressive was the fall in the cesarean rate with mothers expecting their first babies. The cesarean rate among first-time mothers after an elective induction dropped from 34.5% to 13.8%, a 60% reduction!
Reducing Your Chance of an Unnecessary Induction or Cesarean
The exciting thing about this study is that you can use the same guidelines to reduce your own chances of an unnecessary induction or cesarean. Be sure that you have a definitive medical indication if you are being advised to have an induction prior to the completion of week 39 of your pregnancy. Discuss with your care provider about the need for an accurate assessment of your Bishop's score prior to scheduling an induction.
You can also discuss with your provider ways to naturally induce your labor since some of those methods can also help to ripen your cervix, thereby increasing the success of a labor induction.
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