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Abstract
It is generally believed that inducing labour leads to an increase in caesarean sections. The grounds for this belief are studies comparing women induced at, say, 38 weeks with women labouring spontaneously at 38 weeks. But are these two groups comparable? Certainly not, as in the induced group there is some indication for delivery, so caesarean section rates are higher than those labouring spontaneously—presumably with normal pregnancies. This renders the comparison unscientific; so how does one gauge the effect of induction on caesarean section rates without becoming enmeshed in the underlying pathology? Caughey et al. from California applied their collective minds to the issue and conclude that induction/caesarean section rates at any given gestation can only be compared with expectant management of the same or similar women (AJOG 2006;195:700–5). Or put another way, if you fail to induce a woman, what are her chances of a caesarean section later? We have clear data that inductions at 42 weeks result in fewer caesarean sections than expectant management, but can we extrapolate these figures ‘forwards’ to, say, 41 or even 40 weeks? There are no randomised trials that show inductions result in an increase in caesarean section rates. Those trials that are published, such as in postdates or diabetic pregnancies where macrosomia is suspected, all show reduced caesarean section rates. Is the dogma associating induction with raised caesarean section rates then true or not? The…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 2,400 participants or records.
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