2012 to discuss how to prevent the first cesarean birth. One of the group’s consensus “Key Points” ts that “Labor induction should be performed only for medical indication; if done for nonmedical indications, the gestational age should be 39 weeks or more, and the cervix should be favorable (Bishop score more than 8) especially in the nulliparous patient. ACOG and SMFM published a joint statement on safe prevention of primary cesareans in 2014 that made a number of recommendations, including allowing more time for first and second-stage labor than conventional obstetric practice has previously dictated and not inducing before 41 0/7 weeks’ gestation unless there are maternal of fetal indications.
Spong et al identify failed induction of labor as one of the main contributors to the United States’ recent increase in cesarean births.10 The most recently reported cesarean rate, which was in 2011, was in 2011, was 32.8% Long-term health consequences of cesarean birth include repeated cesareans for future births, either by choice of due to lack of availability of trial of labor after cesarean in some regions, with associated increases in placental complications and neonatal morbidity Other adverse effects that affect long-term health include adhesions, surgical complications, and hysterectomy.11
Cesarean is not the only outcome of concern when considering risks of induction. Induction with oxytocin has been shown to increase the risk for severe postpartum hemorrhage (PPH) due to uterine atony, which is a dose-related association.12 Bateman et al found that uterine atony is the cause of 79% of cases of cases of PPH and that the 27.5% increase in the rates of PPH from 1995 to 2004 was primarily due to increased rates of uterine atony.13 Furthermore, PPH is a leading cause of rising rates of severe maternal morbidity and mortality in the United States. 14,15 Callaghan et al found a 183% increase in the blood transfusions and a 100% increase in shock during childbirth hospitalizations that occurred in 2008 to 2009 compared to those that occurred in 1998 to 1999.14