Induction of Labor

Induction of labor constitutes the initiation of regular uterine contractions for the purpose of effecting delivery before spontaneous labor begins. It should not be confused with augmentation of labor, which may constitute a method or series of methods that are applied to effect vaginal delivery after spontaneous labor has occurred. Although techniques may be similar in both situations, it is important to differentiate these two procedures to provide a rational scientific basis toward a safe delivery process ensuring maximum health to both mother and baby. A quote from Munro Kerr in 1908 serves to show the dilemma that clinicians face: "What strikes one in reading the literature on this subject of artificial termination of pregnancy is the great difference of opinion expressed by obstetricians, especially the extreme position many of them take up with regard to the several indications, and how often apparent inconsistency is evidence-extreme license being allowed for one condition, and equally extreme restrictions being laid down for another."1 This quotation is as true in 1997 as it was for obstetricians in past generations. It is apparent that many of today's techniques for induction of labor also have been described during the last 200 years (see Table 1).1TABLE 1: Techniques for the Induction of Labor In the following summary, the induction of labor will be discussed within the modern context to consider elective vs. indicated induction, currently accepted methods of labor induction, which include respective success rates, and complications of labor induction. Because obstetric practice varies from community to community, the acceptance of various contemporary techniques also varies. It is not our intention to suggest that there are limited "right ways" to accomplish the task. Rather, an accepted variety of techniques will be presented with the underlying purpose of the discussion to show those techniques that are both efficacious and safe for the mother and neonate. An emphasis will be placed on scientific information, which substantiates a rational approach to the induction of labor, according to the information known from contemporary scientific underpinnings.