Because birth certificate data is not kept at the hospital level, the investigators used billing data from the Nationwide Inpatient Sample. "This is not perfect, as it lacks some covariates, such as parity and gestational age, but it is the best national data available currently at the hospital level," Dr. Little said. "The next step might be to look at data sets, which combine birth certificate and discharge data, or collect this data prospectively at a hospital level."
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Weak link found between induction and high C-section rates
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Too soon to dismiss link between rates of induction and cesarean deliveries
I applaud Dr. Little and her coauthors for conducting this evaluation, which highlights significant variation in the rates of induction (0%-50%), elective induction (0%-47%), and total cesarean delivery (5%-50%) between hospitals.
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Induction and cesarean delivery are both important interventions that can improve outcomes for mothers and/or their baby when medically indicated. The study highlights the importance of attention to this issue, and the importance of informed decision making regarding the potential benefits and risks of intervening in an otherwise uncomplicated pregnancy.
This is a complex issue. The need for labor induction may change over time. For example, a woman with an uncomplicated pregnancy at 39 weeks may develop preeclampsia a week later, at 40 weeks, and require induction of labor. This patient would be included in the induction group rather than the noninduction group, even though a decision had previously been made not to induce electively at 39 weeks’ gestation.
While the authors found a weak association between lower hospital induction rates and higher hospital cesarean rates, they did not specifically study the rates of cesarean delivery among those being induced versus those who were allowed to labor spontaneously; especially those without medical reasons for induction or early delivery. Including women who may have required a cesarean delivery (for placenta previa, prior classical cesarean delivery, or arrest of labor) but were not induced potentially confuses the relationship, as these would not be related to whether labor was induced or not.
Dr. Brian Mercer is the immediate past president of the Society for Maternal-Fetal Medicine, and a member of its Executive Committee. He is chair of the department of obstetrics and gynecology and director of maternal-fetal medicine at Metrohealth Medical Center and professor of reproductive biology at Case Western Reserve University, Cleveland.
FROM THE 2014 PREGNANCY MEETING