Why do inductions end in c section

Reality 2: The risk of complications with a big baby increases along a spectrum lower risk at 8 lbs. Researchers combined 10 studies called a meta-analysis and found that babies with birth weights over 4, grams 8 lbs. In these studies, the average Cesarean rate was In the meta-analysis published by Beta et al. When the researchers combined the results from all eight studies, the overall result showed that those who give birth to big babies are more likely to have severe perineal tears, also known as 3rd or 4th degree tears.

The risk of a severe tear was 1. The largest study over , pregnant participants from National Health Service hospitals examined 3rd degree tears and found the rate to be 0. In this study, pregnancies with big babies were also more likely to have longer first and second stages of labor and more use of vacuum and forceps.

The increase in the use of vacuum and forceps among big babies likely contributed to the increase in severe tears. The second largest study, which included over , hospital births in California between and , found a higher rate of 4th degree tears in big babies who were born vaginally Stotland et al. However, 4th degree tear rates in this study were very high, even among normal weight babies 1. Although having a big baby may be a risk factor for severe tears, it may be helpful to compare this risk to other situations that can also increase the risk of tears.

For example, one large study found that the risk of a severe tear with a big baby ranged from 0. Other researchers have found that a vacuum delivery increases the risk of a severe tear by 11 times.

So, if your baseline risk was 0. Researchers combined nine studies that reported on postpartum hemorrhage in people who gave birth to big babies compared to those who birthed babies who were not big Beta et al. They found a higher rate of hemorrhage with babies over 8 lbs. When the birth weights were over 4, grams 9 lbs. However, it is not clear whether this higher rate of postpartum hemorrhage is due to the big babies themselves or the inductions and Cesareans that care providers often recommend for a suspected big baby Fuchs et al.

One study compared 2, large babies with the same number of babies with normal birth weights. All babies in the study were born to non-diabetic parents Linder et al. The researchers found that big babies were more likely to have low blood sugar after birth 1.

The researchers did not say whether care providers suspected that the babies were large before labor began, or if their care was managed differently. Birth fractures, or broken collar bones or arms, are rare but more likely to occur among big babies.

Researchers combined the results from five studies and found that the rate of birth fractures among babies over 4, grams 8 lbs. Some doctors recommend Cesareans for suspected big babies because they believe there is a higher risk of stillbirth. In , researchers published a study where they looked back in time at , births that took place in Scotland between the years and They included all babies who were born at term or post-term between 37 and 43 weeks.

They did not include multiples or any babies who died from congenital anomalies Moraitis et al. Babies in this study were grouped according to their size for gestational age—4th to 10th percentile, 11th to 20th percentile, 21st to 80th percentile considered the normal group , 81st to 90th percentile, 91st to 97th percentile, and 98th to th percentile.

The gestational age of each baby was confirmed by ultrasounds that took place in the first half of pregnancy. In this study, there were 1, stillbirths, and the risk of stillbirth was highest in the groups with the smallest babies 1st to 3rd and 4th to 10th percentiles. The third highest risk of stillbirth death was seen in the babies who were in the 98th to th percentiles for weight extremely large for gestational age. Using the American Academy of Pediatrics growth curve for gestational age, the 98th to th percentiles would be roughly equivalent to a baby who is born weighing 9 lbs.

Meanwhile, the lowest rates of stillbirth were in babies who were in the 91st to 97th percentiles. The increase in stillbirth risk in the largest group 98th to th percentile was partly explained by the birth parent being diabetic; however, there was also a higher risk of unexplained stillbirth for babies in the 98th to th percentile.

Overall, the absolute risk of an extremely large for gestational age baby 98th to th percentile experiencing stillbirth between 37 and 43 weeks was about 1 in , compared to 1 in 1, for babies who are in the 91st to 97th percentile.

Another study on this topic looked back in time at , births and 3, stillbirths between in Alberta, Canada Wood and Tang, This large Canadian database study found several risk factors for stillbirth: giving birth for the first time, having higher body mass index BMI , smoking in pregnancy, older age, and having medical problems before pregnancy such as high blood pressure and diabetes. Like the previous study, small for gestational age was a strong risk factor for stillbirth.

But babies who were large for gestational age were not at any increased risk for stillbirth. In fact, being large for gestational age was protective against stillbirth in the general population. However, when researchers looked specifically at birth parents with gestational diabetes, being large for gestational age was linked with a higher risk of stillbirth.

The risk of stillbirth has historically been higher in pregnant people with Type I or Type II diabetes. However, in recent years the stillbirth rate for those with Type I or Type II diabetes has drastically declined due to improvements in how diabetes is managed during pregnancy Gabbe et al. As far as gestational diabetes goes, the largest study ever done on gestational diabetes found no link between gestational diabetes and stillbirth Metzger et al.

In the Canadian study, gestational diabetes was not linked with a higher risk of stillbirth unless the baby was also considered to be large for gestational age. In , a large study in the U. The purpose of this study was to look at the possible relationship between big babies and stillbirth, but other factors were also considered Salihu et al. It is important to note that overall, the rates of stillbirth have declined dramatically in both big and normal-sized babies over the last four decades.

The decline in stillbirths may be due to advancements in medical training and pregnancy screening. In this study population, the rate of stillbirth in big babies declined In total, more than million pregnancies were analyzed in this study. In the big baby group, there were 1.

The researchers point out that the risk of a big baby being stillborn varies from situation to situation, and so care should be individualized. In other words, not all big babies carry the same level of potential risk when it comes to the chances of stillbirth.

In their study, researchers separated the babies into 3 groups grade 1 or grams, grade 2 or grams, and grade 3 or over grams.

Babies in the grade 3 group experienced an fold increase in stillbirth 11 stillbirths per 1, pregnancies when compared to babies in the grade 1 group 1 stillbirth per 1, pregnancies.

However, grade 3 big babies made up only 1. Overall, the group with the highest risk of stillbirth was the low birthweight group The second highest rate of stillbirth was in the grade 3 big baby group. Some strengths of this study are the large data set and the classification of big babies into grades of macrosomia. When a big baby is suspected, families are more likely to experience a change in how their care providers see and manage labor and birth. The end results were astonishing.

Birthing people who were suspected of having a big baby and actually ended up having one had triple the induction rate, more than triple the Cesarean rate, and a quadrupling of the maternal complication rate, compared to those who were not suspected of having a big baby but had one anyway.

Complications were most often due to Cesareans and included bleeding hemorrhage , wound infection, wound separation, fever, and need for antibiotics. There were no differences in shoulder dystocia between the two groups. These results were supported by another study published by Peleg et al. At their hospital, physicians had a policy to counsel everyone with suspected big babies suspected of being 8 lbs. Elective Cesareans were not encouraged, but they were performed if the family requested one after the discussion.

There were participants who had suspected big babies that ended up truly being large at birth and were counseled, and participants who had unsuspected big babies that ended up being truly large at birth who were not counseled.

There was only one case of shoulder dystocia in the unsuspected big baby group, and two cases in the suspected big baby group. None of these babies experienced injuries. There was no difference in severe birth injuries between the two groups. The authors concluded that obstetricians should not be counseling pregnant people about the risks of big babies thought to be 8 lbs. They suggested that researchers should study using a higher weight cut-off such as 9 lbs.

Other researchers have found that when a first-time parent is incorrectly suspected of having a big baby, care providers have less patience with labor and are more likely to recommend a Cesarean for stalled labor.

In this study, researchers followed first-time birthing people who were all induced at term. A recent study from the U. The authors found similar results when they looked at around people who were giving birth for the first time and taking medication for high blood sugar Dude et al.

This perception—whether it is true or false—changes the way the care provider behaves and how they talk to families about their ability to birth their baby, which, in turn, increases the chance of Cesarean. Reality 3: Both physical exams and ultrasounds are equally bad at predicting whether a baby will be big at birth. Although two out of three people giving birth in the U.

They found 14 studies that looked at ultrasound and its ability to predict that a baby would weigh more than 8 lbs. This means that for every ten babies that ultrasound predicts will weigh more than 8 lbs. Ultrasound was even less accurate at predicting babies who will be born weighing 9 lbs.

This means that for every ten babies the ultrasound identified as weighing more than 9 lbs. The researchers found three studies that looked at the ability of ultrasound to predict big babies in pregnant people with diabetes. The ultrasound test probably performs better in diabetics simply because diabetics are more likely to have big babies.

Currently, there is no reason to believe that three-dimensional 3D ultrasound is any better at predicting birth weight and big babies than two-dimensional 2D ultrasound Tuuli et al. Research is ongoing to determine if 3D measurements can be combined with 2D measurements to better predict macrosomia. There is also no evidence that magnetic resonance imaging MRI improves the accuracy of fetal weight estimates.

The first prospective clinical study to compare estimated fetal weight from 2D ultrasound versus MRI is currently being conducted in Belgium Kadji et al. The researchers think that MRI at 36 to 37 weeks of pregnancy could be much more accurate than ultrasound at predicting big babies.

However, even if MRI is found to be superior, it is very expensive and probably not practical. Compared to using ultrasound, care providers are just as inaccurate when it comes to using a physical exam to estimate the size of the baby.

However, ultrasound appears to provide more accurate estimates when pregnant people are plus size Preyer et al.

Overall, when a care provider estimates that a baby is going to weigh more than 8 lbs. This means that out of all the babies that are thought to weigh more than 8 lbs. Unfortunately, all the studies that looked at diabetes and the accuracy of ultrasound lumped people with gestational diabetes and those with Type I or Type II diabetes into the same groups, limiting our ability to interpret these results.

In a study by Rosati et al. Many weight estimation formulas have been published new 2D and 3D formulas are added every year , and researchers continue to debate whether they are accurate. Weiss et al. Reality 4: There is conflicting evidence about whether induction for suspected big babies can improve health outcomes.

In a Cochrane review, researchers Boulvain et al. Labor induction is done in a hospital or birthing center, where you and your baby can be monitored and labor and delivery services are readily available.

However, some steps might be taken prior to admission. There are various methods for inducing labor. Depending on the circumstances, your health care provider might:. Keep in mind that your health care provider might also use a combination of these methods to induce labor. How long it takes for labor to start depends on how ripe your cervix is when your induction starts, the induction techniques used and how your body responds to them. If your cervix needs time to ripen, it might take days before labor begins.

If you simply need a little push, you might be holding your baby in your arms in a matter of hours. In most cases, labor induction leads to a successful vaginal birth. If labor induction fails, you might need to try another induction or have a C-section.

If you have a successful vaginal delivery after induction, there might be no implications for future pregnancies. If the induction leads to a C-section, your health care provider can help you decide whether to attempt a vaginal delivery with a subsequent pregnancy or to schedule a repeat C-section. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version.

Sections for Labor induction About. Overview Labor induction — also known as inducing labor — is the stimulation of uterine contractions during pregnancy before labor begins on its own to achieve a vaginal birth. Request an Appointment at Mayo Clinic. Uterine incisions used during C-sections Open pop-up dialog box Close. Uterine incisions used during C-sections A C-section includes an abdominal incision and a uterine incision.

Share on: Facebook Twitter. Show references Wing DA. Although cesarean delivery is safe for mother and baby, it is major surgery and does carry risks. It takes longer to recover from a C-section, compared to vaginal birth, and the surgery may increase the risk of problems with vaginal birth in future pregnancies.

Elective induction — labor induced when there is no medical need to do so — before 39 weeks is known to pose health risks for newborns. However, elective induction at 39 weeks, or one week before the due date, has become more common in recent years, said Dr.

NICHD funded the current study to determine the potential risks and benefits of elective induction at 39 weeks, compared to expectant management, or waiting for labor to begin naturally, with health care practitioners intervening if problems occur. Roughly half of the women were assigned at random to have their labor induced in the 39 th week of pregnancy; the remaining women received expectant management. The primary outcome occurred in 4. However, the proportion of cesarean delivery was significantly lower for the induced group Similarly, the rate of blood pressure disorders of pregnancy was significantly lower in women who were induced 9.