Induced-Labor Necessity Notion Draws Challenge

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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

If you missed the segment about Orgasmic Birth, aired on ABC"s 20-20 on Jan. 2,
you can still catch the mini-segments:

Birth Orgasms: Women Speak Out - Is it possible to have an orgasm during childbirth?

Women Who Prefer Home Birth - For some, delivering a healthy child doesn"t involve a trip to the hospital. [Note - the associated article says, "Modern medicine means not having to go through childbirth alone." It"s more accurate to say "Responsible modern medicine means reserving risky interventions for when the benefits outweigh the risks." I know lots of responsible women who give birth at home with the perfect birth team . . . their partner, their midwife and their doula. They are definitely not alone, and they have all the medical assistance they need, just like a woman giving birth with a midwife in a hospital! Savvy people know the difference between midwife-assisted homebirth and unassisted birth.]

The Orgasmic Birth web site also has a lot of great information about birth in general:
Birth by the Numbers
The Director"s Blog
Birth Stories

04/18/1996

BOSTON (AP) Challenging a long-held view, a new study concludes doctors don't always need to induce labor when a woman's water breaks after a full-term pregnancy. Instead, it appears that letting nature takes its course is safe for both mother and baby.

For years, many doctors have assumed that waiting for labor to start naturally after the fetal membranes break could be hazardous to the baby. The fear is that germs might get into the uterus. On the other hand, some worry that when doctors use drugs to start labor, they are more likely to have to deliver the baby by Caesarean section.

A woman's ''water'' breaks when the fetal membranes rupture before the start of labor, releasing amniotic fluid. To help resolve whether inducing labor is necessary, doctors studied 5,041 women in this situation. They were randomly assigned either to have induced labor or to wait for labor to start on its own. ''There was very little difference,'' said Dr. Mary E. Hannah of the University of Toronto, who described the results in today's New England Journal of Medicine. In both groups, about 3 percent of babies had infections, and about 10 percent were delivered by C-sections.

The study was conducted in Canada, Britain, Australia, Israel, Sweden and Denmark.

Critique of Study

I assume that the report is concerning the paper reporting the results of the TERM-PROM study. Our unit was one of the collaborating centres. As has already been discussed in this group the study randomised women to one of four protocols - early IOL with PGE2, early IOL with synto/pit, delayed IOL with PGE2, delayed IOL with synto/pit.

Results were that:

The majority of women in either of the delay groups went into spont labour before the four day limit was reached.
Early induction did not increase rates of CS, forceps, need for epidural, or anything else for that matter.
Women were more likely to prefer early IOL ( retrospectively ).
There were more pyrexias and more episodes of infection with delayed compared to early induction.
Although there was no a priori hypothesis ( so no strong conclusions can be drawn ) there were no fetal/neonatal deaths in the early group whilst there were a few in the delayed group.

On this basis the newspaper report looks like either a very selective quote or a total misquote. Please don't accept the newspaper article look at the original report !

Induced-Labor Necessity Notion Draws Challenge

This Web page is referenced from another page containing related information about Prelabor Rupture of Membranes - PROM

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