Document Detail

Reconsideration of the costs of convenience: quality, operational, and fiscal strategies to minimize elective labor induction.
MedLine Citation:
PMID:  20147829     Owner:  NLM     Status:  MEDLINE    
Elective induction of labor is at an all-time high in the United States despite known associated risks. It can lead to birth of an infant too early, a long labor, exposure to a high-alert medication with its potential side effects, unnecessary cesarean birth, and maternal and neonatal morbidity. There is a cascade of interventions related to elective induction such as an intravenous line, continuous electronic fetal monitoring, confinement to bed, amniotomy, pharmacologic labor stimulating agents, parental pain medications, and regional anesthesia, each with their own set of potential complications and risk of iatrogenic harm. These risks apply to all women having the procedure, however for nulliparous women before 41 weeks of gestation with an unfavorable cervix, the main risk is cesarean birth after unsuccessful labor induction with the potential for maternal and neonatal morbidity and increased healthcare costs. When cesarean occurs, subsequent births are likely to be via cesarean as well. Elective labor induction before 41 weeks is inconsistent with quality perinatal care, and performance of this unnecessary procedure should be minimized. Convenience as the reason for labor induction is contrary to a culture focused on patient safety. A review of current evidence, followed by changes in practice, is warranted to support the safest care possible during labor and birth. Various strategies to reduce the rate of elective induction in the United States are presented.
Kathleen Rice Simpson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of perinatal & neonatal nursing     Volume:  24     ISSN:  1550-5073     ISO Abbreviation:  J Perinat Neonatal Nurs     Publication Date:    2010 Jan-Mar
Date Detail:
Created Date:  2010-02-11     Completed Date:  2010-05-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801387     Medline TA:  J Perinat Neonatal Nurs     Country:  United States    
Other Details:
Languages:  eng     Pagination:  43-52; quiz 53-4     Citation Subset:  N    
St John's Mercy Medical Center, St Louis, Missouri 63130, USA.
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MeSH Terms
Cesarean Section / statistics & numerical data
Continuity of Patient Care / organization & administration
Cost-Benefit Analysis
Evidence-Based Practice
Health Care Costs / statistics & numerical data
Hospitalists / organization & administration
Labor, Induced* / adverse effects,  statistics & numerical data
Obstetrical Nursing / organization & administration
Obstetrics / organization & administration
Patient Education as Topic
Patient Selection
Perinatal Care / organization & administration*
Quality Assurance, Health Care / organization & administration*
Reimbursement Mechanisms / organization & administration
Safety Management / organization & administration*
Surgical Procedures, Elective / adverse effects,  statistics & numerical data
United States
Unnecessary Procedures* / adverse effects,  statistics & numerical data

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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