New Study: Preventative Induction Reduces the Risk of C-section

[erin_brycesmom]

http://uk.reuters.com/article/health...1?feedType=RSS

What do you all think of this new study? Has anyone seen the actual study?

[dynamicdoula]

Here's a link to the full article.

Here's a link to the study.

*The pilot study for this project was funded by Forest Pharmaceuticals,
Inc., in 2000. In addition, Forest Pharmaceuticals has provided, at no cost,
its dinoprostone vaginal insert cervical ripening product for use in an
ongoing randomized clinical trial of AMOR-IPAT *

Pretty much obvious what I think... at least I would hope it is.

[erin_brycesmom]

Thanks Kristina, this is exactly the info that I was looking for.

[dis]

Here's a PDF of the actual study. If there's someone out there who wants to wade through it and address it, that'd be great - might was well be written in a foreign language for all the sense I can make out of it!

[DucetteMama21842]

Originally Posted by dynamicdoula

Here's a link to the full article.

Here's a link to the study.

*The pilot study for this project was funded by Forest Pharmaceuticals,
Inc., in 2000. In addition, Forest Pharmaceuticals has provided, at no cost,
its dinoprostone vaginal insert cervical ripening product for use in an
ongoing randomized clinical trial of AMOR-IPAT *

Pretty much obvious what I think... at least I would hope it is.

Exactly. :

[channelofpeace]

Originally Posted by dynamicdoula

Here's a link to the full article.

Here's a link to the study.

*The pilot study for this project was funded by Forest Pharmaceuticals,
Inc., in 2000. In addition, Forest Pharmaceuticals has provided, at no cost,
its dinoprostone vaginal insert cervical ripening product for use in an
ongoing randomized clinical trial of AMOR-IPAT *

Pretty much obvious what I think... at least I would hope it is.

Wow, how nice of them

[pamamidwife]

how on earth can forcing a labor to start reduce cesareans than the ones that start on their own?

bah!

I will sit down and piece apart the study....but I'm wondering if it's one of those cases where the study shows something different from the "study summary" that they release to the press. (Mainly because it's so daunting to actually LOOK at a study rather than the "summary")

[dis]

I think, having skimmed it, that it boils down to 'this particular set of interventions leads to fewer c-sections than this other set of more typical interventions'. As per usual, the proper control group (women who are JUST LEFT ALONE) isn't included.

That's after a superficial reading, however, so please no one quote me on that. I'd like an expert to pick it apart. Also, the chart in appendix 1 scares me - it basically lists all sorts of 'problems' and how many days prior to 41 weeks, 6 days you should induce a woman if she has any of those problems. I'm all in favour of OBs working out more effective protocols to reduce their number of c-sections for mainstream women. But these sorts of things will be used to try and justify induction on all women, including those of us who want natural childbirth. I don't want some stat-happy OB insisting I 'need' an induction because I gained more than 30 pounds during my pregnancy when I have no intention of accepting any of the standard hospital interventions that lead to most of the childbirth problems in the first place!

[shellbell]

Disgusting, that they would lie to women like this. Although, why would anyone choose to believe that their body would handle labor better if someone else started it??? It's like saying you poop better (under normal body conditions) with an enema! Ridiculous.

[bryonyvaughn]

Originally Posted by dis

I think, having skimmed it, that it boils down to 'this particular set of interventions leads to fewer c-sections than this other set of more typical interventions'. As per usual, the proper control group (women who are JUST LEFT ALONE) isn't included...

They're basically saying P2 prostaglandin induction results in fewer cesareans than P1 prostaglandin inductions... something we already knew *but* now it has a patented drug associated with it.

~BV

[wannabe]

here's the link to the abstract
http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum

Will read the full article after bedtime. I'm only on page two and I'd hate for my blood pressure to get so high my midwife has to induce me

ETA: BLAH! Even the abstract shows some serious design flaws. what they've shown is that practicioner choice determines your c-section risk. Any surprise to anyone here? And ironically, next to their first publiched paper was one titled "Cesarean delivery after elective induction in nulliparous women: The physician effect" (American Journal of Obstetrics and Gynecology (2004) 191, 1511–5), their conculsion: "Nulliparous women are at a significant increased risk of cesarean delivery if elective induction is performed. The individual physician has a contributing effect to this increased risk."

Because most of the patients who were delivered by
family physicians at our institution had been exposed to
the AMOR-IPAT method of care, all nonexposed
subjects came from offices that were staffed by obstetricians.

Between 1993 and 1997, different hospital practitioners used risk-guided prostaglandin-assisted preventive labor induction with differing intensity. We used a retrospective cohort design, based on the practitioner providing prenatal care, to compare birth outcomes in women exposed to this alternative method of care with those in women not exposed. Multiple logistic regression analysis controlled for patient characteristics and clustering by practitioner.

Randomized controlled trials of this method of care are warranted.

They can say THAT again!

Their hearts are in the right place, though

From one study, although most women
would choose to achieve vaginal birth, those women
who were interested in elective cesarean would do
so for such reasons as scheduling and concerns about
pain, as well as recovery from labor. These potential
concerns about vaginal delivery pale in comparison
to the higher rates of maternal hemorrhage, infection,
and even death associated with cesarean delivery

Further, current cesarean delivery affects maternal and
neonatal outcomes in subsequent pregnancies.12,13
One management scheme that may appease women
interested in enhancing their chances of achieving vaginal
birth while affording more control to the parturient
with respect to scheduling is elective or preventive
induction of labor.

For anyone else trawling the literature, the real stuff is in American Journal of Obstetrics and Gynecology (2004) 191, 1516–28

To reduce the likelihood iatrogenic fetal
lung immaturity caused by preventive labor induction
the lower limit of the optimal time of delivery (LLOTD)
was set at 38 weeks 0 days of gestation.

:headbang

[Damien]

Originally Posted by dis

Also, the chart in appendix 1 scares me - it basically lists all sorts of 'problems' and how many days prior to 41 weeks, 6 days you should induce a woman if she has any of those problems.

I would think that is a improvement over things today when it seems most OBs induce at 40 weeks regardless.

[SamuraiEarthMama]

Some interesting responses from the medical community, from the comments from the publishing periodical (including a response from the main author):

http://www.annfammed.org/cgi/eletters/5/4/310

I think at least part of the problem here is the media play of this study as some big breakthrough, while even the author steps back from implication of a causal relationship.

Thanks for pointing this out! Very interesting stuff... having worked with compromised populations, it's very tempting to try to find a threshold point of induction to maximize good outcomes (specifically, smoking moms). But there are just so many factors to include, it must be nearly impossible to create a nice, neat formula that says "With x and y and z risks, you have XX% better outcomes with induction." I'm married to a scientist... I know how they love to try to find the simplification that explains and predicts things. I just don't think it's going to work with birthing moms.

[the elyse]

Originally Posted by shellbell

It's like saying you poop better (under normal body conditions) with an enema! Ridiculous.

so true.

[amyro]

New AMOR-IPAT Resource from Henci Goer

Hot off the presses, here's a detailed critique of the AMOR-IPAT study by Henci Goer on the "When Research is Flawed" section of the Lamaze web site.

http://www.lamaze.org/Research/WhenR...5/Default.aspx

Enjoy! She completely rips it apart. It is a dangerous study and she does an expert job of deconstructing why we shouldn't trust it's findings for a minute.

-Amy