Why are so many women experiencing induced labor?

According to birth certificates, 23 percent of women who gave birth in 2013 had labor induction. This is our “official” national rate. However, studies to check the accuracy of this item have found that many actual labor inductions are uncounted on birth certificates.

Childbirth Connection’s national “Listening to Mothers III” survey, which polled women themselves about labor induction, is likely to provide a more accurate estimate of the induction rate. It also looked at many aspects of labor induction. Among participants, who gave birth in 2011-12, 41% reported that their care provider had tried to induce labor. They reported experiencing various drugs and procedures for this purpose. In most cases, the attempts to induce did start labor, which meant that, in all, 30 percent had medically induced labor. These women told us that their labors were induced for both medical and non-medical (convenience) reasons. Some of the “medical” reasons (for example, fetus might be growing quite large) are not supported by best research. Twenty-nine percent of the survey participants tried to start their labor on their own (self-induced labor). In a previous “Listening to Mothers” survey, about one in three who took this step told us that the reason was to try to avoid a medical induction.

As discussed in this section, induction is often chosen for non-medical reasons, even though it can increase risks for mom and baby. Here are some reasons the induction rate has been increasing in the United States:

• Women's lack of knowledge about the risks, benefits and appropriate use of labor induction. Not enough women have accurate information about when it is safe for a baby to be born. In our national “Listening to Mothers III” survey, we asked women when it would be safe to deliver a baby if there were no complications calling for earlier delivery. Just 21 percent chose the recommended 39 weeks or beyond, while 35 percent identified 37 or 38 weeks – a point still considered an early term birth with known risks to babies. And 44 percent identified more dangerous earlier weeks of pregnancy. One way women can get this information is by attending childbirth education classes; use these resources to find a class near you.
• Lack of shared decision-making about induction. Shared decision-making is when a woman works with her care provider to make an informed decision that is right for her. Through a decision tool or personal discussion, she learns about her options and the pros and cons of those options. She is helped to understand how her values and preferences might relate to the options. She gets help navigating the care system and increases the likelihood of safely receiving the care that is right for her. Unfortunately, not enough women who agree to induction actually have the information they deserve about why they are being induced, or falsely believe it is for medical reasons. Again, it is important for all women to learn as much as they can and to ask questions of their care providers before and during labor.
• The perception that induction is convenient and cost-effective. Despite the seeming appeal of being able to plan birth, elective induction can result in neonatal intensive care unit (NICU) admission and increase the length of the hospital stay and the overall cost of care. In addition, elective induction in first-time mothers and when the cervix is not soft and ready to open can result in C-section, which exposes mothers to the risks of surgery, requires a longer recovery and affects choices, outcomes and costs in future pregnancies.
• Overuse of unnecessary screening tests at the end of pregnancy. Routine use of ultrasound and other fetal tests, especially in low-risk women, may raise concerns about the baby’s health for no reason, leading to induction or even C-section when they are not needed.
• The belief that the best way to manage risks is to deliver the baby. Today, very few babies born at full-term die at birth or experience serious illness or injury. But this can still happen, and doctors or midwives may recommend inducing labor to lower the chance of these problems. However injury and death are often unpredictable and induction is not a proven way to prevent bad outcomes, whereas we know induction has its own risks (C-section in some groups of women, delivery by forceps or vacuum extraction, newborn breathing problems).