Induction of labor in the United States has more than tripled since it first began to be recorded from certificates of live birth in 1989; from 9% of births in 1989 to 31.37% of births in 2020 (Figure). Although the rate has risen slowly but steadily over the past 30 years, the last several years have seen a steeper increase (National Center for Health Statistics [NCHS], 2022a, 2022b). It is important to consider these rates are likely underreported. Differences by state and facility in how data are collected about obstetric procedures and other birth certificate elements are contributing factors (Brumberg et al., 2012). Most, but not all, facilities require the birth attendant, the mother, and a birth certificate clerk to review data and check its accuracy on the birth certificate worksheet before data are electronically transmitted. Although there have been 10 revisions to the U.S. standard certificate of live birth since 1900 (Brumberg et al., 2012), it has not been updated since November 2003.
Analyzing U.S. natality data can be challenging. Review of natality data from NCHS for induction of labor rates for each year reveals reports with slightly different rates depending on which publication is used (NCHS, 2022b). The figure displays rates for that year's reported natality data rather than some of their later published summary tables that have slightly higher numbers (NCHS, 2022a, 2022b).
Induction of labor has a significant effect on nurse staffing needs. As the rate has risen, so have the nursing resources required in the inpatient setting to provide safe, high-quality nursing care during the labor and birth of a patient having induction of labor. Maternal and fetal assessments every 15 minutes and careful titration of oxytocin to promote adequate labor progress while maintaining fetal wellbeing, avoiding tachysystole, and providing labor support are factors in the necessity of 1 nurse to 1 woman in labor having induction of labor with oxytocin. Many natality trends, including induction of labor, have direct implications for patient safety.
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