Reconsideration of the costs of convenience: quality, operational, and fiscal strategies to minimize elective labor induction.
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.
St John's Mercy Medical Center, St Louis, Missouri 63130, USA. krsimpson@prodigy.net
Kathleen Rice
KR
Simpson
D002585:Cesarean Section / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D055317:Evidence-Based Practice; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D020445:Hospitalists / Q000458:organization & administration; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000706:statistics & numerical data; D009773:Obstetric Nursing / Q000458:organization & administration; D009774:Obstetrics / Q000458:organization & administration; D010353:Patient Education as Topic; D018579:Patient Selection; D018743:Perinatal Care / Q000458:organization & administration*; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration*; D014481:United States; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000706:statistics & numerical data