The rate of induction of labor (IOL) in the United States in 2021 was 32.1% (Osterman et al., 2023). The rate is likely underreported. Providers' response to the ARRIVE trial results (Grobman et al., 2018) increased IOL for non-medical reasons (Ayala & Rouse, 2022). Absence of comprehensive IOL patient education and advocacy presents a major patient safety concern.

Nurses are ethically obligated to promote patient autonomy. Shared decision-making is foundational to labor and birth (Breman & Neerland, 2020; Declercq et al., 2020). However, patients are often undereducated about the reason for and process of IOL (Declercq et al., 2020). They deserve robust education about the IOL process, potential for significantly longer labor, and anticipated side effects (Carlson et al., 2021; Tsakiridis et al., 2020). Nurses are ideal clinicians to educate and inform patients about IOL. Higher levels of education and childbirth education are associated with women declining elective IOL (Breman & Neerland, 2020; Declercq et al., 2020).

Patients commonly reflect on feeling pressured into an IOL (Breman & Neerland, 2020; Declercq et al., 2020). Nurses may feel obligated to continue IOL, even when the patient reports inadequate education or wishes to reconsider. Unit policies should reflect how true informed consent is obtained to ensure a standard of shared decision-making. Nurses must equally advocate for the desired birth experiences of those who choose to undergo or decline an elective IOL. The labor nurse's responsibility for advocacy extends beyond supporting the patient's decision. Nurses must be knowledgeable about the care of patients with non-pharmacological comfort measures and recognize IOL requires increased latent labor support (Breman & Neerland, 2020). We must be clear with patients about anticipated timelines to avoid frustration and dissatisfaction (Declercq et al., 2020).

Nurses must promote research-driven IOL procedures to minimize unnecessary cesareans and follow guidelines for determining an unsuccessful IOL (Ayala & Rouse, 2022). Clinicians must provide adequate time for cervical ripening. The Bishop score is the most reliable indicator of a successful IOL based on systematic reviews (Carlson et al., 2021; Tsakiridis et al., 2020). IOL will be most successful when awaiting a Bishop score of 6 for multiparous and 8 for primiparous patients before beginning oxytocin (Carlson et al., 2021). Patients should receive at least 12-18 hours of oxytocin administration following membrane rupture to attempt reaching the active phase of labor (Ayala & Rouse, 2022). Nurses should promote ambulation, hydrotherapy, and adequate nutrition to increase patient comfort and successful IOL (Breman & Neerland, 2020).

A comparison of international guidelines for IOL found the World Health Organization's to be the most robust and evidence based (Tsakiridis et al., 2020). Nurses can promote patient safety during IOL by leading their unit to develop clear policies and procedures based on the tenets of patient autonomy and these clinical guidelines.

References