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

Induced-Labor Necessity Notion Draws Challenge

04/18/1996

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:

1. The majority of women in either of the delay groups went into spont labour before the four day limit was reached.
2. Early induction did not increase rates of CS, forceps, need for epidural, or anything else for that matter.
3. Women were more likely to prefer early IOL ( retrospectively ).
4. There were more pyrexias and more episodes of infection with delayed compared to early induction.
5. 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.