Re: [ozmidwifery] Induction and third stage labour

[FIONA AND CRAIG RUMBLE]

Two more....     Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstet Gynecol. 2000 Jun;95(6 Pt 1):917-22. Maslow AS, Sweeny AL Department of Clinical Outcomes and Quality Improvement, Franciscan Health System, Tacoma, Washington, USA. OBJECTIVE: To determine the effects of elective induction on the risk of cesarean delivery in a cohort of women with low-risk term pregnancies and to evaluate the costs of elective induction services within our hospital system. METHODS: Records of 1135 eligible women with low-risk, singleton, vertex pregnancies at 38-41 weeks' gestation who were eligible for vaginal delivery were analyzed retrospectively after elective induction (n = 263) or spontaneous labor (n = 872). Outcome measures included cesarean delivery and direct costs. Variables evaluated were parity, maternal age, estimated gestational age, birth weight, prior cesarean delivery, epidural anesthetic use, and provider category. Analysis was by univariable and multivariable regression modeling. RESULTS: Elective induction placed nulliparas at a twofold higher risk for cesarean delivery (odds ratio 2.4, 95% confidence interval 1.2, 4.9) after adjustment for birth weight, maternal age, and gestational age. We found a significantly increased risk of cesarean delivery with increased birth weight for nulliparas (2-66.7%). Increasing maternal age increased the risk of cesarean delivery in all parity groups (P<.05), but particularly among nulliparas (3-26.3%) (P <.001). Electively induced labors that ended in vaginal delivery cost $273 more and required an average of 4 hours more in the hospital before delivery than did noninduced vaginal deliveries (P <.001). CONCLUSION: Elective induction significantly increased the risk of cesarean delivery for nulliparas, and increased in-hospital predelivery time and costs. PMID: 10831992 Women having their first babies are twice as likely to get sections when labor is induced Induction of labor and the relationship to cesarean delivery: A review of 7001 consecutive inductions. Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):628-33. Yeast JD, Jones A, Poskin M Saint Luke's Perinatal Center, Saint Luke's Hospital of Kansas City, Kansas City, Missouri 64111, USA. OBJECTIVE: The goal of this project was to study the increasing risk of induction of labor in a community hospital and to determine whether it had an adverse effect on the rate of cesarean delivery. Study Design: From January 1, 1990, through July 31, 1997, 18,055 consecutive singleton pregnancies in women who were candidates for labor were reviewed via a comprehensive perinatal database. The risk of and indication for induction were reviewed. Cesarean delivery rates were calculated for nulliparous and multiparous patients by indication for induction and were compared with rates for patients who had spontaneous labor. Overall trends in cesarean delivery were reviewed for the duration of the study period. RESULTS: The annual induction rate significantly rose from 32% to 43% at the conclusion of the study period. Labor was induced in nearly 40% of nulliparous patients. Postdate pregnancy was the most common indication for induction, although few patients were at or beyond 42 weeks' gestation. The cesarean delivery rate remained at or below 20% for the years of the study. No increase was noted in spite of the increasing risk of induction. However, for nulliparous patients who had elective induction of labor, the risk of cesarean delivery was twice that of nulliparous patients who had spontaneous labor. CONCLUSION: The use of induction methods has significantly increased in this community hospital. More than 40% of patients are now candidates for induction. The cesarean delivery rate remains low in this facility in spite of a marked increase in risk of operative delivery for nulliparous patients who undergo induction Comment in: Am J Obstet Gynecol 1999 Nov;181(5 Pt 1):1273-4 PMID: 10076139, UI: 99176971 Regards Fiona Rumble ----- Original Message ----- From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 04, 2005 11:21 AM Subject: [ozmidwifery] Induction and third stage labour Dear List, I’m a birth educator and prenatal yoga teacher in Townsville.  I hope these questions are appropriate for this list and would appreciate information from you:   Induction.  Andrea’s Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and that’s what I’ve always taught in my Active Birth classes.  However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD.  Can anyone clear this up for me?   Third stage of labour.  I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby.  However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing.  I’ve checked Myles textbook for midwives but it’s not clear on this.    I appreciate your support.   Best wishes, Karen Shlegeris in Townsville