Nonmedically indicated induction is widespread. The National Center of Health Statistics1 reported that in 2010 the rate of labor induction was 23.4% of all US births, and this rate would be higher if only the total number of women who could have had inductions (ie, excluding women having planned cesareans) was used as the denominator in calculating this percentage. A significant number of inductions seem to be scheduled is rising faster than the rate of pregnancy complications that would result in a medically indicated induction.2 The induction rate of 23.4% in 2010 has more than doubled in 20 years,1’3 and the rate of cesarean birth has increased by 50% .1 In 2000, the largest proportion of births occurred at 40 to 41 weeks’ gestation, but by 2009 the largest proportion occurred at 39 weeks’ gestation.4
The contribution of nonmedically indicated inductions to the primary cesarean rate is a matter of increasing concern because cesarean is associated with an increased risk for severe maternal morbidity and mortality compared to vaginal birth.5 Nulliparous women who have their labors induced also have been shown to have higher rates of cesarean compared to women who have spontaneous onset of labor.6-8 Clark et al reviewed 6562 births resulting from induction of labor, 71% of which were nonmedically indicated. And found that the cesarean rate was 50% for nulliparous women who began induction with a closed cervix.6
The Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal Fetal Medicine (SMFM), and the American College of Obstetricians and Gynecologists (ACOG) convened a workshop in