Update on successful induction of labor

Induction of labor is indicated when the benefits to the mother or the fetus outweigh the benefits of continuing the pregnancy. Induction of labor involves a complex set of interventions that defies routine and presents numerous choices and challenges for clinicians and mothers. It is deemed successful when it initiates uterine contractions, progressively dilates and effaces the cervix, and leads to the normal vaginal birth of the baby with no maternal complications. Induction is deemed a failure when active labor is not achieved or cesarean delivery is required. From 1989 to 2002, the rate of labor induction in American women has more than doubled. The increasing use of labor induction has been supported by the expansion of medical indications for delivery before the onset of spontaneous labor, thanks to advances in obstetrical science. Elective induction has become more popular, as timed delivery can provide more patient and physician convenience. Other contributing factors include the ready availability of effective cervical ripeners, medicolegal issues, patient demand, and financial gain. This trend over time has important implications for clinical practice because, as several investigators have reported, elective induction consistently results in a 2- or 3-fold increase in the risk of cesarean delivery. The most important variable influencing successful labor induction is appropriate patient selection. Recent studies provide new evidence to weigh when selecting patients for induction, making optimal clinical decisions as the trial of labor progresses, and, in the long term, affecting an appropriate rate of cesarean delivery. This article is intended to assist clinicians in building the best case for success before deciding to induce labor, in addition to review the evidence that supports the decision to induce labor and the decision not to induce labor.