Labor Induction Should Only Be Done When Necessary, AWHONN Says

Stephanie Cajigal; Lynn K. Erdman, MN, RN; Debra Bingham, DrPH, RN


September 23, 2014

Editor's Note: Induced labor should only be done when medically indicated, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) says in a new position statement. According to AWHONN, the timing of the statement corresponds with data showing that the number of inductions of labor in the United States has more than doubled since 1990, an increase that does not correspond with a similar rise in medical problems during pregnancy.[1,2]

In this interview, two AWHONN representatives, CEO Lynn Erdman, MN, RN, and Debra Bingham, DrPH, RN, Vice President of Research, Education, and Publications, explain why patients may not be informed of the risks they undertake when consenting to elective inductions.

Lynn K. Erdman, MN, RN

Medscape: Other professional societies, such as the American College of Obstetricians and Gynecologists (ACOG), have already published guidance stating that induction of labor should be reserved only for certain medical circumstances. Why did AWHONN feel the need to publish its own guidelines at this time?

Ms. Erdman: Our position statement and guideline is complementary to ACOG's and is also complementary to statements put out by the Society for Maternal-Fetal Medicine and the American College of Nurse-Midwives. The reason we felt strongly about our statement is that it goes beyond that issued by ACOG, by recommending that inductions be performed only for medical reasons—that is, when the benefits clearly outweigh the risks. Instead of saying to wait for a particular time, such as 41 weeks, we really don't believe that is what the evidence shows. Our statement explains that waiting for labor to occur naturally has lots of benefits for the mom and the baby. We felt like we needed to go farther than ACOG had done in this particular area.

We also published this statement because we know there has been a rise in inductions of labor, especially since 1990.[1] We have seen a pretty dramatic rise, and we have not seen the rate of medical conditions rise at the same rate.[2] Part of the reason that we are seeing inductions done is personal preference, whether from the patient or the physician.

Debra Bingham, DrPH, RN

Medscape: Are there any data to back up the idea that these are being done out of personal preference?

Dr. Bingham: We recognize that there are increased rates of complications in pregnancy over the last few years, but the rates of induction are exceeding the rates of increase in complications.

To underscore another key point that Lynn made earlier, one of the things we wanted to highlight is the point that labor is a complex physiologic event. We are concerned about people becoming too cavalier about it. We currently don't have a lot of knowledge about all of those hormonal interactions and how inductions and augmentations may be interrupting a very intricate process.


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