Scared of Being Induced? Now Your Labor Can Be Shorter, Say Experts

pregnant female in surgical room hospital
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Expectant mothers who have their labor induced never know how long after that their babies will come. Sometimes it takes a few hours -- and sometimes a day or two. (Gulp!) What if we told you there's a way for moms-to-be who need to be induced to deliver several hours earlier? A new study suggests that using combined labor-inducing treatments can reduce labor time -- and could spare moms-to-be who get induced an estimated 2.4 million hours of labor each year. Yes, really!

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Whether you go past your due date or have a medical condition -- like gestational diabetes or preeclampsia, for example -- there's no denying that a good number of women get induced. In fact, it's estimated that roughly one-quarter of US mommies undergo labor induction each year, making this study, published in the journal Obstetrics & Gynecology, quite welcome in the delivery room. 

Experts involved in the study believe combining two specific labor induction treatments can reduce a pregnant woman's labor time, on average, by four hours or more. The benefits also appear to extend to hospitals, as researchers note mothers will likely spend less time in the delivery room, thus lowering health-care costs associated with labor.

So what, pray tell, is the winning combination, you ask?

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Researchers at the Perelman School of Medicine at the University of Pennsylvania performed one of the largest clinical trials that involved close to 500 expectant mothers at the Hospital of the University of Pennsylvania who needed their labor induced. Investigators randomly assigned the women one of four commonly used labor-inducing treatments: 1) the drug misoprostol, 2) the Foley catheter technique (or Foley bulb induction), 3) using misoprostol and the Foley catheter methods together, and 4) the use of a synthetic version of the hormone oxytocin with the Foley catheter.

Experts discovered the combined use of misoprostol and the Foley catheter helped reduce labor time in a pretty major way.

Investigators say moms who used these two labor-inducing treatments together labored for 13.1 hours on average, compared to moms who used misoprostol alone (17.6 hours), and the Foley method alone (17.7 hours). Moms who used a combination of the Foley catheter method and oxytocin saw a reduction in labor time (14.5 hours), but not as much as laboring mothers who used misoprostol-Foley.

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Dr. Lisa Levine, lead author of the study and assistant professor of obstetrics and gynecology at the Perelman School of Medicine at the University of Pennsylvania, says in a statement about the study, "Using combination methods in every case of labor induction in America would spare pregnant women more than 100,000 days of labor annually." She continues:

That in turn would reduce hospital costs, reduce the health risks to mother and child that come with prolonged labor, and reduce the stress that mothers experience while awaiting delivery.

....  Our results clearly show that the misoprostol-Foley combination method could significantly reduce the total time mothers spend in the delivery room -- potentially leading to a reduction in labor-associated healthcare costs and risks to mothers and their babies.

It's also worth a mention that Dr. Levine notes that the results from the study do not show noticeable differences in Cesarean delivery rates or medical complications for Mom and baby.

Doctors like Heather Rupe, DO, OB/GYN, and WebMD contributor, feel the result of this study provide great promise when it comes to labor induction. 

"I found the study to be extremely well done and was thankful to finally have some better data on induction," Dr. Rupe tells CafeMom. "Hopefully this will help with forming standardized procedures which can then improve quality and processes."

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"I can't speak for all ob-gyns, but I think it [data from this study] will affect how I practice," she adds. "It has been long debated among ob-gyns as to which is the method for induction, so having solid data on safety and efficacy should be extremely helpful in decision-making. This study is specifically looking at finding better ways to induce women who have a medical/pregnancy condition that makes continuing the pregnancy risky, but whose cervix [is] nowhere near ready for labor."

As wonderful as it is to imagine induced moms getting a break in the labor department -- including 100,000 less days a year inside the delivery room -- this study does raise a few questions.

Currently, the FDA only approves misoprostol use to treat and prevent gastric ulcers (in the US), though it's a recommended treatment for miscarriages and inducing abortion -- as well as labor induction.

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Tracy Donegan, a hospital-trained midwife and founder of GentleBirth, a company that empowers a positive birth experience through education, birth science, and technology, agrees the thought of reducing labor after induction sounds attractive, but thinks aspects of this study sound a bit misleading.

"The language by the researchers suggesting that this method involves a 'gentle coaxing' of the cervix to open is misleading in my opinion," Donegan tells CafeMom. "Many women find the Foley bulb extremely painful in an unripe cervix. Would a mom choose the option of Foley and synthetic oxytocin knowing her labor might last an additional hour? That is a decision only mom can make with all of the facts."

Tracy continues:

It's also worth considering what percentage of the reported 100,000 hours [of labor spared each year by using the recommended labor-inducing combination] could be reduced by awaiting a spontaneous start to labor whenever possible when there is no medical indication for induction. 

As a hospital-trained midwife my initial thoughts are that women who have a clinical need for induction should be supported to have the safest and most positive birth possible. This means moms will have an in-depth discussion with full disclosure on the risks/benefits of each method of induction rather than being influenced to choose the option that suits her care provider or hospital due to time and cost savings. Moms would also be informed that induction of labor is not always successful and is associated with increased risk for Cesarean birth and its associated complications for first-time moms.

Dr. Rupe wishes experts involved in the study were able to see noticeable results in C-section reduction, telling CafeMom, "I was disappointed that none of the methods showed a decrease in C-section rate. A shorter labor is good in that it reduces the risk of infection and maternal fatigue, but having an induction method that clearly helped lower the chance of C-section would be even better."

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I can only hope that mothers who need to be induced, and do elect combining the recommended labor-inducing treatments, have a speedier birthing experience that allows them to snuggle with baby sooner rather than later -- and not have attached risks with doing so. (The study alludes to there not being any increased risks for Mom and LO.)

This study makes me think about my mother and the 23-plus hours she spent in childbirth with me. (There's not a year that goes by that she doesn't remind me.) I can't even imagine what that felt like (my first labor lasted seven hours and my second a little under three hours), but I remember my mom advising me not to induce labor -- unless, of course, it was necessary -- as she believes it prolonged her delivery time. 

You know, after reading this again, I think I should call her!

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