Induction of Labor Rates in the U.S.

One notable shift in US maternity care has been the sharp rise in medical induction of labor. This upward trend has been significant, following the publication of the results from the ARRIVE trial in 2018.

Provisional data for 2022 suggests that the induction rate did not experience its typical increase, marking the first time in over a decade. While a single year does not establish a definitive trend, the fact that the US induction rate may have leveled off after such rapid growth is noteworthy.

It is crucial to assess the impact of this shift on hospital resource allocation and birth outcomes, particularly amidst a backdrop of increasing scarcity in nurse staffing.

While there are proven benefits of inducing labor in certain scenarios, it can also come with risks that must be properly discussed with any patient. These risks can include:

• Heart rate problems for the baby: Medications used for labor induction, such as oxytocin or prostaglandins, may cause abnormal or excessive contractions, reducing the baby's oxygen supply and affecting their heart rate.

• Infection: Certain labor induction methods, like rupturing the mother's membranes, may increase the risk of infection for both the mother and baby.

• Failed Induction: Approximately 25% of women who undergo induction with an unripened cervix may require an emergency C-section if labor stalls.

• Uterine Rupture: This rare but life-threatening complication occurs when the wall of the uterus tears or ruptures. This rupture can occur along the scar line from a prior cesarean section (C-section) or other uterine surgeries, or it can happen in an area of the uterus that hasn't been previously operated on. It can lead to severe bleeding for the mother and/or oxygen deprivation for the baby.

• Post-Partum Hemorrhage: Labor induction may increase the risk of excessive bleeding within 24 hours of childbirth due to various reasons, including uterine atony, abnormal contractions, and/or instrumental delivery.

As labor induction has the potential to increase risks to both mom and baby, it is absolutely crucial that medical providers adequately monitor the process to decrease the chance of any adverse outcome.