In ground breaking research, the National Institute of Child Health and Human Development (NICHD) recently released a new study questioning one of the most core tenants of Obstetrical Practice in the United States today. The randomized, prospective study involving more than 6000 births over three years seems to prove that the definitive factor in whether a woman will deliver her baby vaginally or by cesarean section is the weight of the baby. This stands in contrast to decades of Obstetrical education which clearly believed that the cervical dilation, or how ripe a cervix is, was the real determinant. (The cervix is the opening of the womb into the birth canal.)
“This really changes everything when planning the timing of delivery,” Said Dr. Greg J. Marchand, a leading OBGYN in Mesa, AZ. “Whereas it was previously standard to just wait for labor whenever it would occur, there is no denying this very high level of scientific evidence. If you’re pregnant with your first baby, and you want to have your baby vaginally, you should be induced no later than 39 weeks. For years, all Obstetricians, certainly including myself, have been counselling our patients that they should wait for labor. At least for first time mothers, this is now clearly not the best idea.”
Cervical dilation or “ripeness”, refers to how open, or how soft the cervix is. Up until this point many Obstetricians would use this solely as the determinant for when to induce labor. The study was published at the annual meeting of Society for Maternal Fetal Medicine this last month in Dallas Texas. It was sponsored by the National Institute of Health and prospectively reviewed the outcome of greater than 6000 births of first time mothers. About half of those mothers were scheduled for induction at 39 weeks, the other half were left to go into labor naturally whenever it would come. The surprising outcome was a 16% decrease in cesarean section in the women in the electively induced arm of the study. Also the electively induced group has lower rates of high blood pressure and pre-eclampsia (A disease of pregnancy.) The babies born to the electively induced babies also had a lower incidence of respiratory problems, and overall needed help breathing less often than the babies in the “natural labor” arm.
Dr. Marchand went on to explain that this research will greatly change the way doctors counsel their pregnant patients at time of delivery, and that it will result in many more women being induced at 39 weeks gestation.
An abstract of the study is freely available on the website of the American Journal of Obstetrics and Gynecology: http://www.ajog.org/article/S0002-9378(17)32491-2/pdf
Dr. Greg J. Marchand is an OBGYN specializing in Minimally Invasive Surgery in Phoenix Arizona’s East Valley. To learn more about Dr. Marchand go to www.GregMarchandMD.Com
The National Institute of Child Health and Human Development is a branch of the National Institute of Health. To learn more see their webpage at https://www.nichd.nih.gov/