With labor induction on the rise, hospitals and healthcare organizations are questioning the benefits and the risks of this and other procedures previously thought to be safe, states Los Angeles Times reporter Shari Roan.

“No one knows how many of those inductions were prompted by legitimate medical concerns. But various studies have put the number of inductions for convenience at 15 to 55 percent of the total number,” reports Roan. Government statistics report 21 percent of women had their labors induced in 2004, compared with fewer than 10 percent in 1990.

William Rayburn, Department of Obstetrics and Gynecology, University of New Mexico, cites “widespread use of cervical ripening agents, pressure from patients, conveniences to physicians, and litigious constraints” as reasons for the doubling of induction rates.

Despite the increase in labor induction, the practice appears to vary widely among hospitals and physicians. A study published in the journal Birth (September 2003) examined a birth database from a region of upstate New York and found that the percentage of elective inductions ranged from 12 to 55 percent among hospitals and 3 to 76 percent among physicians.

Amid growing concern, Intermountain Healthcare implemented strict guidelines for elective labor induction in 1999. Fifty-three percent of all babies born in Utah are served by Intermountain Healthcare, which manages 21 hospitals in Utah and Idaho. Physicians must obtain permission from a supervisor before inducing labor in any mother prior to 39 weeks gestation. In addition, the woman’s cervix must be favorable for labor; in other words, it must be effaced (thin) and dilated (open).

Today, Intermountain Healthcare is considered a model for other facilities seeking to limit the use of non-medically indicated birth interventions. Since the guidelines were implemented, the number of elective labor inductions performed before 39 weeks gestation declined from 28 percent in 1999 to less than 4 percent in 2006. During that same time period, there has been a decrease in the rate of cesarean birth and the number of admissions to the neonatal intensive care unit (NICU). Additionally, the length of labor decreased on average two hours per patient.

And Intermountain Healthcare is not alone. Last year, Ascension Health, the largest nonprofit healthcare system nationwide with facilities in 20 states, requested that doctors only proceed with elective induction if a fetus is at 39 weeks’ gestation, in a specific size range, and has established lung maturity, and if the woman has not begun having contractions. Other healthcare organizations and hospitals have applauded Intermountain and Ascension’s efforts, the Times reports.

Nonetheless, some physicians maintain that elective labor induction is not harmful. A study published in the July 31 issue of the Annals of Family Medicine suggest that a preventive approach to obstetric care including risk-guided, prostaglandin-assisted labor induction can result in lower cesarean birth rates without increases in rates of other adverse birth outcomes.

Clearly more data is needed. In the meantime, I’m trying to envision active management of labor in other mammals.

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