Is morning or evening induction of labour safer?

So it’s been 40 long weeks, your due date is here and you’re ready to pop! Your birth plan was written weeks ago, your bag is packed and you’re on high alert waiting excitedly for that first important twinge. The bad news is you may still be waiting up to two weeks later!  In the Western world one in four of every pregnant women have to have their labour induced. This is often because of prolonged pregnancy and associated risks to the baby’s growth but also for reasons such as high blood pressure, pre-eclampsia and diabetes risk to the mother.

Is it possible that best practise would actually be to start labour induction in the evening to coincide with the circadian rhythm of natural birth?

Is it possible that best practise would actually be to start labour induction in the evening to coincide with the circadian rhythm of natural birth?

There are many methods used to induce labour medically including the sweeping of membranes, the use of vaginal or intracervical prostaglandins, oestrogens and intravenous oxytocin. In most hospitals the induction will start in the morning, this is traditional as it coincides well with the working day. Interestingly though, studies of both animals and humans have shown that spontaneous labour has a circadian rhythm, favouring starting in the evening. Is it possible that best practise would actually be to start labour induction in the evening to coincide with the circadian rhythm of natural birth? You might think so, especially when you learn too that spontaneous labour that starts in the evening is associated with a shorter duration of labour and delivery and fewer obstetric interventions.

A recent Cochrane review investigated whether induction of labour starting in the evening improved the outcome of labour compared with induction of labour starting in the early morning. After a search of relevant databases they identified three high quality randomised controlled trials (RCTs) that were suitable for inclusion, involving 1150 women that were induced in the morning or evening. One trial used intravenous oxytocin in women with a dilated cervix or ruptured membranes and two trials compared the administration of prostaglandins in women whose cervix was not ripe. These methods of induction work through different mechanisms so were assessed separately. This is what they found:

  • Administering prostaglandins in the morning or evening showed no clear differences between groups on outcomes for the mother or infant
  • The risk of a vaginal birth using instruments, or risk of a caesarean section and use of epidural anaesthesia did not clearly differ between groups
  • The majority of women were more satisfied with administration of prostaglandins in the morning and reported a better quality of sleep the night before the start of the induction than women admitted in the evening

But:

  • There were only three studies included in the review and the resulting data was insufficient to make an informed decision in favour of morning or evening induction of labour

The authors concluded that:

This review, with only three studies with two different comparisons, concludes that induction of labour in the evening is as effective and safe as induction in the morning.  However, given the preference of most women, administration of prostaglandins should preferably be done in the morning.

If you’re lucky enough to go into spontaneous labour you don’t have to worry about potential induction choices such as these. Perhaps your biggest decision has been whether to have the baby at home or in hospital, see the link below for more interesting debate on this whole other issue!

Of course, people try all sorts of methods to get their labour going, from eating hot curry or pineapple, washed down with raspberry tea, to having a nice long walk followed by some nipple stimulation!  Last but not least is the good old rumpy-pumpy method. Just what you need when your bump is the size of a house!?

Links:

Bakker JJH, van der Goes BY, Pel M, Mol BWJ, van der Post JAM. Morning versus evening induction of labour for improving outcomes. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007707. DOI: 10.1002/14651858.CD007707.pub2.

Cochrane summary of this review

Roberts A.  Childbirth: why I take the scientific approach to having a baby.     www.guardian.co.uk (2013)