Labor induction, the process of stimulating uterine contractions before natural labor begins, has become increasingly prevalent in recent years. In the United States, induction rates surpassed 30% in 2020, while latest data shows France experienced a rise from 22% between 2010 and 2016 to nearly 26% in 2021. In India, the prevalence varies a lot from study to study: a study published by TS Cheng in Lancet shows the prevalence up to 40% (2 out of every 5 women), whereas another study published in IJOGR estimates the incidence to be around 20%.
Several factors contribute to this trend, including:
1. Changing Maternal Demographics
- Advanced Maternal Age: More women are delaying childbirth, and older mothers often have higher risks of pregnancy complications, making induction a safer option.
- Rising Obesity Rates: Obesity is associated with gestational diabetes, hypertension, and other complications that may necessitate early delivery.
2. Increase in Pregnancy Complications
- Conditions such as gestational diabetes, preeclampsia, fetal growth restriction (FGR), and post-term pregnancies often lead to medically indicated inductions to prevent adverse outcomes.
3. Advances in Medical Technology & Monitoring
- Improved ultrasound, fetal monitoring, and diagnostic tools allow doctors to detect potential risks earlier, leading to more proactive decisions about induction.
4. Availability of Improved Induction Methods
- Newer and more effective induction techniques, including mechanical methods (balloon catheters), pharmacological agents (misoprostol, oxytocin), and membrane sweeping, have made the process safer and more efficient.
Inducing labor before 39 weeks of gestation without medical necessity is generally discouraged due to the heightened risk of complications associated with prematurity, such as respiratory difficulties, infections, feeding challenges, jaundice, and increased neonatal intensive care unit admissions. Conversely, post-term pregnancies extending beyond 41-42 weeks are linked to elevated risks of stillbirth, neonatal death, and cesarean delivery, risks that can be mitigated through timely labor induction.
Extensive literature on labor induction presents mixed findings regarding perinatal outcomes and cesarean section (CS) rates. A study published in Cochrane concludes that IOL at or beyond term is linked to a reduced risk of perinatal mortality and a lower likelihood of CS compared to expectant management.
The ARRIVE trial notably influenced induction practices by demonstrating that elective induction at 39 weeks could lower cesarean rates and reduce gestational hypertensive conditions, albeit with minimal impact on perinatal mortality. These findings led the American College of Obstetricians and Gynecologists to endorse elective induction at 39 weeks. In France, the trial’s outcomes sparked discussions about balancing medical intervention with maternal autonomy.
As labor induction becomes more common, ongoing research and dialogue are essential to ensure that practices align with the best interests of both mothers and infants, minimizing unnecessary interventions while safeguarding health outcomes.