According to the Ministry of Health, labor induction is not without risk, so its use must be justified by the presence of risk factors and only performed after an adjusted risk/benefit assessment. Scheduling deliveries for non-medical reasons, but for scheduling, puts the health of women and babies at risk and disregards the recommendations of the WHO and the Ministry of Health.
In addition, according to a study published in the journal “Acta Obstetricia Et Gynecologica Scandinavica” inducing labor, in a low-risk pregnancy, can have long-term consequences on the child’s cognitive development. Research from the UMC Amsterdam based on data on pregnancy and school performance at 12 years of 226,684 Dutch children.
Researchers have combined pregnancy data from the Dutch perinatal registry with data on school performance from Statistics Netherlands to study the possible effects of induced labor on school performance in low-risk pregnancies.
And the results show a small but significant reduction in the examination scores of children born after induced labor between 37 and 41 weeks, compared with children who did not have labor induced in the same week, among low-risk pregnancies. “And while the impact on the individual child may be small, this could potentially have a large one on society, given the increasing number of elective inductions,” notes Renee Burger.
This research, which only collected data on uncomplicated pregnancies, shows that at each gestational age, up to and including 41 weeks, the group of infants born after induced labor had lower scores than those born after a wait-and-see policy. The result, on average, is 10% fewer children receiving a college-bound school board. In the group after an induction at 37 weeks, 49.8% received this advice, while 54.4% of those who did not.
If the pregnancy goes smoothly, it is common in the Netherlands to discuss with women whether they want to have an induction or wait until 42 weeks. This policy is partly based on two studies from the Netherlands and Sweden, both published in 2019, showing that inducing labor at 41 weeks produces a small reduction in the risk of the baby dying before or shortly after delivery and a small reduction in serious problems in the child after birth, with no other short-term medical risks. Therefore, induction beyond 41 weeks seems reasonable based on these studies.
Another study conducted in an American context, the trial ARRIVE, found that elective induction in low-risk women giving birth for the first time at 39 weeks’ gestation had no effect on perinatal outcomes. The fact that it led to a significantly lower frequency of cesarean deliveries means that this study has had a global impact in increasing induced labor rates.
The decision to induce labor is always a balance of risks and consequences for the child and the mother.
In the Netherlands, in 2021, 28% (47,068) of deliveries were induced; in the US, this figure is around 30%, and in Australia, more than 40% of new mothers are induced. Although there are often medical reasons that justify labor induction, such as hypertension or growth problems, the number of elective inductions – that is, without a medical indication – is increasing in all three countries. Mainly driven by an increase in inductions that are not medically necessary.
In Spain, as reported by El Parto es Nuestro, fewer and fewer births occur on weekends and holidays, which suggests an increase in the number of induced deliveries and scheduled caesarean sections with respect to the recommendations of the WHO and the Ministry of Health.
According to this organization, the percentage of inductions has increased from 19% in 2010 to 34% in 2018, thus tripling the percentage of inductions recommended by the WHO (
Long-term
“The tricky thing is that all the previous studies looked at short-term outcomes: death of the baby and serious problems soon after birth. None look at the long-term effects of induction on the child, such as cognitive development,” says Wessel Ganzevoort, a gynecologist and study author.
Both Burger and Ganzevoort stress that the decision to induce labor is always a balance of risks and consequences for the child and the mother. If there are complications in the pregnancy and therefore increased risk to the mother or child if the pregnancy continues, these risks outweigh a modest long-term adverse effect, such as school performance. However, in an uncomplicated pregnancy before 41 weeks, when there is no proven benefit of inducing labor, investigators believe that induction should be used with caution.