Nursing

STAFF EDUCATION and more rigorous enforcement of guidelines for labor induction can reduce the number of unwarranted inductions and lower the cesarean birth rate for first-time births, researchers reported in the April issue of Obstetrics & Gynecology. John M. Fisch, MD, of the Magee-Womens Hospital of the University of Pittsburgh Medical Center, and colleagues conducted a study before and after the strict enforcement of elective induction guidelines in their hospital in 2005. The study sample comprised 533 women who gave birth in 2004, 454 who delivered in 2005, and 1,806 who delivered from November 2006 to December 2007. The guidelines stipulated 39 weeks' gestation, and a Bishop score of 8 for first-time births and 6 for subsequent births.

The induction rate dropped from 24.9% in 2004 to 16.6% in 2007, and there was a 30% drop in the rate of elective induction, from 9.1% to 6.4%, the investigators found. Among first-time electively induced births, there was a reduction in the rate of cesarean sections, from 34.5% to 13.8%, the researchers reported.

"The cesarean birth rate, length of stay, and cost implications of improving the labor induction process are all reasons that other large institutions struggling with the demands of running an obstetric unit will find this study is of particular interest," the authors wrote.

Fisch JM, English D, Pedaline S, Brooks K, Simhan HN. Labor induction process improvement: A patient quality-of-care initiative. Obstet Gynecol. 2009;113(4):797-803.

STAFF EDITOR: MARTHA K. RAYMOND, RN, BSN, BS