Sorry for my voice; I'm pretty sick right now. 

Labor induction doesn't lead to more C-sections, and the unintended birth rate is dropping in the United States. This is Healthcare Triage News.

[Intro]

First, from the New England Journal of Medicine, Randomized Trial of Labor Induction in Women 35 Years of Age or Older.

We've discussed in a previous episode how giving birth in the hospital is associated with higher rates of induction and c-sections, but do the inductions cause the c-sections? To the research!

This was a randomized controlled trial of first-time pregnant women who were at least 35 years old. They were randomly assigned to labor induction in the 39th week of pregnancy, or to expectant management- which means watch and only induce if there's a medical problem. The main outcome of interest was whether they had a c-section.

More than 600 women were randomized, and there were no significant differences between the groups. Overall, 32% of those in the induction group had a c-section, versus 33% in the expectant-management group.

There was, therefore, no difference. If you're interested, there was also no difference in the percentage of women who had a vaginal delivery using forceps (38% of induction and 33% of expectant-management), either.

The study wasn't necessarily powered for other outcomes, but there was still no detectable differences in maternal or infant deaths, adverse outcomes, or women's experiences. But, let's note this: the rates of c-section were high overall in both groups compared to other countries; about a third of women had one. But, there's no evidence to be found there that it's induction that's causing it to happen.

Also from the New England Journal of Medicine, Declines in Unintended Pregnancy in the United States, 2008–2011.

Despite the fact that we know how to prevent pregnancies in the United States, rates of unintended pregnancies have been shockingly high. In 2008, more than half of pregnancies in the United States were unintended.

Researchers used data from the National Survey of Family Growth, a national survey of patient who've had abortions, data from the National Center for Health Statistics, and data from a national survey of abortion providers to do this study.

But, you know, think about it. 51% of all pregnancies were unintended in 2008. Interestingly, things have been getting worse from 2001 to 2008. Why? I'll let you insert your own explanation. I have one, but it's not totally evidence-based.

But, in 2011, things looked better. Only 45% of pregnancies are unintended; however, even in 2011, rates of unintended pregnancies are highest among those who are 15 to 19 years old (75%) and 20 to 24 years old (59%). They're also higher among those below the poverty line (60%). 

We're the United States, people. This is a fixable problem. When you compare us to the rest of the world with respect to rates of unintended pregnancies, we look more like northern Africa than Europe. We can do better.

[Outro]

Healthcare Triage is supported in part by viewers like you through Patreon.com, a service that allows you to support the show through a monthly donation. Your support makes this show bigger and better. We'd especially like to thank our research associate, Joe Sevits, and thank our surgeon admiral, Sam. More information can be found at Patreon.com/HealthcareTriage.