American College of Nurse‐Midwives Clinical Bulletin Number 18: Induction of Labor

Abstract

Induction of labor is an increasingly common component of intrapartum care in the United States. This rise is fueled by a nationwide escalation in both medically indicated and elective inductions at or beyond term, supported by recent research showing some benefits of induction over expectant management. However, induction of labor medicalizes the birth experience and may lead to a complex cascade of interventions. The purpose of this Clinical Bulletin is twofold: (1) to guide clinicians on the use of person-centered decision-making when discussing induction of labor and (2) to review evidence-based practice recommendations for intrapartum midwifery care during labor induction.

Development and testing of a decision aid to achieve shared decision‐making for routine labor induction

“…13,14 For labor induction counseling, The American College of Obstetricians and Gynecologists (ACOG) and American College of Nurse-Midwives (ACNM) both call for shared decision-making (SDM). 3,5 Informed consent becomes SDM when it goes beyond consent for a procedure based on accurate, up-to-date, comprehensible information and becomes a profoundly respectful process that allows a patient to make an evidence-informed and values-aligned decision for themselves. 15 A pregnant person's involvement in decision-making, particularly if there is SDM, increases their satisfaction with their provider and their birth overall.…”

“…In the United States (US) in 2020, as many as 600,000 people with a pregnancy at or beyond 39 weeks had a medical induction of labor with gestational length as the primary indication 1,2 . While clinical guidelines in the US and from the Word Health Organization recommend routine labor induction between 41 and 42 weeks, 3–5 there is disagreement with respect to ideal timing 6,7 and evidence of practice variation 8,9 . Laws, regulations, and professional guidelines in the US dictate that pregnant people have the right to accurate, up‐to‐date, comprehensible information and decision‐making power in their maternity care 10–12 yet evidence suggests pregnant people have many unmet needs with respect to information they receive about labor induction 13,14 …”