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Rising Rates of Labor Induction: Present Concerns and Future Strategies

Rayburn, William F. MD; Zhang, Jun MD, PhD

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The rate of labor induction nationwide increased gradually from 9.5% to 19.4% between 1990 and 1998. Reasons for this doubling of inductions relate to widespread availability of cervical ripening agents, pressure from patients, conveniences to physicians, and litigious constraints. The increase in medically indicated inductions was slower than the overall increase, suggesting that induction for marginal or elective reasons has risen more rapidly. Data to support or refute the benefits of marginal or elective inductions are limited. Many trials of inductions for marginal indications are either nonexistent or retrospective with small sample sizes, thereby limiting definitive conclusions. Until prospective clinical trials can better validate reasons for the liberal use of labor induction, it would seem prudent to maintain a cautious approach, especially among nulliparous women. Strategies are proposed for developing evidence-based guidelines to reduce the presumed increase in health care costs, risk of cesarean delivery for nulliparas, and overscheduling in labor and delivery.

A national doubling of the labor induction rates during the past decade is attributable to many reasons that are often not evidence based.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, New Mexico; and Epidemiology Branch, National Institute of Health and Human Development, National Institutes of Health, Bethesda, Maryland

Address reprint requests to: William F. Rayburn, MD, University of New Mexico Health Sciences Center, Department of Obstetrics and Gynecology, 2211 Lomas Boulevard NE (ACC 4), Albuquerque, NM 87131–5286; E-mail: wrayburn@salud.unm.edu.

Received December 28, 2001. Received in revised form March 1, 2002. Accepted March 14, 2002.

© 2002 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.