1. Running head: DECREASING ELECTIVE INDUCTIONS 1
Decreasing Elective Inductions
Sarah Freeman
California Baptist University
Author’s Note
This paper is being presented to Professor Teresa Hamilton, RN, MSN, in partial
fulfillment for the requirements of Research and Writing, NUR375 on March 27, 2015.

2. DECREASING ELECTIVE INDUCTIONS 2
Decreasing Elective Inductions
Inducing labor without a medical reason is associated with increased morbidity and
mortality for both baby and mother. Yet, some people still decide to electively induce labor for
convenience reasons, mostly. Whether they decide to do this because they were not educated on
the risks, or they do this because they believe the convenience and control is worth the risks,
either way, there needs to be change in the ability to freely do this for non-medical reasons. This
paper will discuss, in further detail, the risks of elective induction as proved by credible research,
as well as the best ways to reduce the number of people getting non-medical elective inductions.
Research Article Analysis
Akinsipe, Villalobos, and Ridley (2012) conducted research to evaluate the effect of
implementing hospital policies aimed at reducing elective labor induction and increasing
spontaneous labor rates. The authors explain that there are two types of induction. One is
medical induction where the indications for labor induction include things such as diabetes
mellitus (DM), pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR),
premature rupture of membranes (PROM), chorioamnionitis, fetal demise, and post-term
pregnancy. Akinsipe et al. (2012) makes it clear that in each of these circumstances, the benefit
of inducing labor outweighs the risk to the woman and/or her fetus. The opposing type is called
elective induction. This is typically done for convenience, whether it be the most convenient for
the patient, family, and/or provider, and is also done for reasons such as maternal fatigue and/or
discomfort (Akinsipe et al., 2012).
According to Akinsipe et al. (2012), "In comparison to women going into spontaneous
labor, women experiencing labor by elective induction have a significantly greater risk for
needing a cesarean section, hemorrhage due to oxytocic agents, chorioamnionitis, sepsis, uterine
dystocia, and uterine hyperstimulation with potential rupture" (p. 6). They further explain that

3. DECREASING ELECTIVE INDUCTIONS 3
"risks to the fetus/newborn include iatrogenic neonatal morbidity, pulmonary insufficiency from
premature delivery, sepsis, cord prolapse, and possible asphyxial injury" (Akinsipe et al., 2012,
p. 6).
Because of these risks stated above, Akinsipe et al. (2012) states that hospitals should
take certain considerations before inducing labor that is not medically needed. They believe that
women who are pregnant should be properly educated about the risks of elective induction and
that hospitals should have an elective labor induction policy to reduce the amount of people who
are electively inducing (p. 6). The main research question of this article is, "Does the
implementation of a labor induction policy in pregnant women being electively induced lead to
lower induction/cesarean rates, decreased maternal/neonatal morbidity, and/or increased
spontaneous labor rates?" (Akinsipe et al., 2012, p. 6).
Sample Size and Type
In this systematic review article, nine studies were reviewed, evaluating the effects of
implementing an elective labor induction policy (Akinsipe et al., 2012). Disagreements regarding
inclusion criteria were handled via discussion, which centered on finding studies whose purpose
related to answering the abovementioned clinical question. Final decisions were made by the
senior reviewer/author of this article (Akinsipe et al., 2012, p. 7). The studies used 47,840
laboring women prior to putting policies in place. These women included those carrying
singleton fetuses, many not meeting criteria for a medical induction as defined by ACOG (The
American Congress of Obstetricians and Gynecologists), and several fewer than 39 weeks
gestation at the time of induction. Studies that focused only on medically indicated inductions
were discarded (Akinsipe et al., 2012, p. 7). After implementing the elective labor induction
policy samples included a total of 69,519 laboring women. These women were also confined to
those carrying singleton fetuses, but most met some of the ACOG criteria for inductions, or were

4. DECREASING ELECTIVE INDUCTIONS 4
at least 37 weeks in gestation, and included women with no history of PROM or cesarean
deliveries. Both nulliparous and parous women were included in the pre- and postpolicy
implementation samples (Akinsipe et al., 2012, p. 13).
Findings of the Study
The findings of the research that was done indicated that implementing an elective labor
induction policy resulted in fewer cesarean births, a reduced predelivery length of stay, lower
rates of chorioamnionitis and sepsis, fewer episiotomies, reduced rates of postpartum anemia,
and others improvements as well (Akinsipe et al., 2012, p. 13). As far as the fetus and neonate
goes, the study found that there were lower rates of neonatal intensive care unit (NICU)
admissions, decreased stillbirths, reduced meconium aspiration, better apgar scores, a decline in
prematurity rates, and more. Overall, the study found that implementing this policy decreased
maternal morbidity and fetal/neonatal morbidity (Akinsipe et al., 2012, p. 13).
Synthesis
A retrospective cohort study done by Hoffmire, Chess, Saad, & Glantz (2012) was done
to compare NICU admission rates between elective and non-elective deliveries. They reviewed
delivery status charts for all singleton deliveries (2006–2007) between 36 0/7 and 38 6/7 weeks
gestation taking place at one hospital in NYS. Hoffmire et al. (2012) discovered that 32.8% of all
births were elective and it was found that infants born via a vaginal elective delivery, elective
cesarean, or a non-elective cesarean are at significantly increased risk of NICU admission
compared to infants born via a non-elective vaginal delivery (p. 1059). This finding correlates
with what Grivell, Reilly, Oakey, Chan & Dodd (2012) say in their cohort study that researches
maternal and neonatal outcomes following induction of labor. The cohort included 28,626
women with a singleton pregnancy, cephalic presentation at gestational age of 37+0 weeks or
more (Grivell et al., 2012, p. 199). Results from this study show that induction of labor in the

5. DECREASING ELECTIVE INDUCTIONS 5
absence of maternal or fetal indications increases the risk of cesarean section as well as other
complications for the woman neonate such as more likely to require epidural or spinal analgesia,
significantly increased the chance of the infant requiring level 2 nursery care, increased risk of
the infant requiring resuscitation, admission to the neonatal intensive care unit, and phototherapy
(Grivell et al., 2012, p. 200). Both of these research articles agree with Akinsipe et al. (2012) in
that they all conclude that elective inductions put mothers and babies at a much higher risk for
morbidity and mortality.
Application to Practice
The results of the previously stated articles definitely indicate the need for change in this
area. The goal should be to reduce elective inductions significantly in order to increase positive
health outcomes in both mothers and babies. One simple way to help accomplish this is to
educate patients more effectively. Instead of only stating all of the bad risks associated with
elective induction of labor, it would be beneficial to educate them on the benefits of waiting until
they naturally go into labor. The Association of Women’s Health, Obstetric and Neonatal
Nursing (AWHONN) launched a campaign "that takes a holistic approach to pregnancy, labor,
and birth" (2013, p.190). It is called “40 Reasons to Go the Full 40” weeks and was meant to
"inspire women who may be feeling impatient near the end of pregnancy to wait for labor to start
on its own" (2013, p. 190). This is a good example of a way to encourage patients to not get
induced.
It should no longer be acceptable to induce labor on patient who do not have a medical
reason to do so. Some hospitals are already implementing a policy that encourages this and
finding that the results are affirmative ones. The American Congress of Obstetricians and
Gynecologists (ACOG) did a study comparing singleton births at a hospital before and after a
policy was implemented that restricted elective labor inductions.

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Policies restricting elective labor induction reduce time from admission to delivery, as
well as reduce cesarean delivery rates, according to new research presented today at the
Annual Clinical Meeting of The American College of Obstetricians and Gynecologists.
Researchers say the policies benefit both mothers and babies (ACOG, 2013).
This study shows the positive impact the policy had on patient outcomes. Implementing a policy
in hospitals to make it so that non-medical elective inductions are not readily available is a solid
and effective way of reducing elective inductions and therefore decreasing the amount of patients
with morbidities/mortalities associated with it.
After determining that there is a higher risk for maternal and neonate morbidity when the
mother has an elective induction, Akinsipe et al. (2012) found that (as cited in Clark et al., 2010)
out of three different approaches to reduce the amount of people getting elective inductions, a)
“hard stop” in which hospital staff members were empowered to refuse scheduling elective
deliveries <39 weeks of gestation; b) “soft stop” whereby attending physicians were allowed to
order exceptions, which were then referred to a local peer review committee for evaluation and
potential action; and c) “education only” which provided available literature to attending
physicians, the first approach ("hard stop") was found to have the greatest positive impact on
outcomes (Akinsipe et al., 2012, p. 13). There would be less elective inductions if nurses and
healthcare workers did their part in doing everything in their power to not schedule the
inductions. Hospitals empowered to enforce this “hard stop” policy will improve the quality of
their services and positively affect the safety of the women and newborns they serve (Akinsipe et
al., 2012, p. 15).
Conclusion
Studies by Hoffmire et al. (2012), Grivell et al. (2012), and Akinsipe et al. (2012) reveal
that patients who receive an elective induction without medical need put themselves and their

7. DECREASING ELECTIVE INDUCTIONS 7
fetus/baby at higher risk for many unnecessary morbidities that could have been avoided if they
would have only waited until labor took its natural course. Effects such as higher incidences of
cesarean sections, an increase in the number of neonates admitted to the NICU, and other serious
complications all were found out to be risks of elective induction of labor. The need for a
reduction in elective inductions is apparent and can be implemented by educating patients more
effectively on the benefits of waiting until they naturally go into labor, implementing policies
restricting elective labor induction, and making sure the staff members of a hospital/health care
setting are empowered to refuse scheduling these elective inductions. Implementing all of these
actions would decrease elective inductions and would therefore lower the risks of maternal and
neonate morbidity. The sooner these applications to practice are carried out in the healthcare
system, the sooner we will start to see less complications in the process of giving birth.

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References
Akinsipe, D. C., Villalobos, L. E., & Ridley, R. T. (2012). A systematic review of implementing
an elective labor induction policy. JOGNN: Journal Of Obstetric, Gynecologic &
Neonatal Nursing, 41(1), 5-16. doi:10.1111/j.1552-6909.2011.01320.x
Bingham, D. D. (2013). Don't rush me . . . go the full 40: AWHONN's public health campaign
promotes spontaneous labor and normal birth to reduce overuse of inductions and
cesareans. Journal Of Perinatal Education, 22(4), 189-193.
Grivell, R. M., Reilly, A. J., Oakey, H., Chan, A., & Dodd, J. M. (2012). Maternal and neonatal
outcomes following induction of labor: a cohort study. Acta Obstetricia Et Gynecologica
Scandinavica, 91(2), 198-203. doi:10.1111/j.1600-0412.2011.01298.x
Hoffmire, C., Chess, P., Ben Saad, T., & Glantz, J. (2012). Elective delivery before 39 weeks:
the risk of infant admission to the neonatal intensive care unit. Maternal & Child Health
Journal, 16(5), 1053-1062. doi:10.1007/s10995-011-0830-9
The American Congress of Obstetricians and Gynecologists. (2013, May 6). Restricting elective
inductions reduces cesareans - ACOG. Retrieved from http://www.acog.org/About-
ACOG/News-Room/News-Releases/2013/Restricting-Elective-Inductions-Reduces-
Cesareans