Provider documentation and elective induction of labor: a 6-month experience at a university medical center

  • Lloyd D. Holm
    Reprints: Lloyd D. Holm, DO, Department of Obstetrics and Gynecology, University of Nebraska Medical Center, 983255 Nebraska Medical Center, Omaha, NE 68198-3255
    Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE
    Search for articles by this author


      This retrospective study investigated the documentation of clinical history that assured fetal lung maturity, presentation part, and gestational age by 3 provider groups (university obstetricians, family practice, and private obstetricians) before the elective induction of labor.

      Study Design

      This study was conducted at a large university-based medical center. All labor/delivery admissions (n = 1297) and all elective inductions of labor (n = 268) were reviewed. The variables that were compared included provider group vs delivery percentages, induction rates, and cesarean deliveries.


      Nine percent of elective inductions occurred before 39 weeks of gestation; 12.7% of the inductions lacked documentation of the presenting part; 17.6% of the inductions failed to meet any commonly accepted screening criteria that assured fetal lung maturity. Rates of elective inductions varied between 16% and 31% when the 3 groups of providers were compared (P < .0001).


      Adequate documentation is lacking in electively induced patients. A statistically significant relation exists between provider group and clinical behavior as they relate to the elective induction of labor.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ventura S.J.
        • Martin J.A.
        • Curtin S.C.
        • Matthews T.J.
        Births: final data for 1997.
        Nat Vital Stat Rep. 1999; 47: 1-96
        • Macer J.A.
        • Macer C.L.
        • Chan L.S.
        Elective induction versus spontaneous labor: a retrospective study of complications and outcome.
        Am J Obstet Gynecol. 1992; 166: 1690-1697
        • Yeast J.D.
        • Jones H.
        • Poskins M.
        Induction of labor and the relationship to cesarean delivery: a review of 7001 consecutive inductions.
        Am J Obstet Gynecol. 1999; 180: 628-633
        • Battista L.
        • Chung J.H.
        • Lagrew D.C.
        • et al.
        Complications of labor induction among multiparous women in a community-based hospital system.
        Am J Obstet Gynecol. 2007; 197: 241.e1-241.e7
        • Nooh A.
        • Baghdadi S.
        • Raouf S.
        Induction of labour: how close to the evidence-based guidelines are we?.
        J Obstet Gynaecol. 2005; 25: 451-454
        • Lydon-Rochelle M.T.
        • Cardenas V.
        • Nelson J.C.
        • Holt V.L.
        • Gardella C.
        • Easterling T.R.
        Induction of labor in the absence of standard medical indications: incidence and correlates.
        Med Care. 2007; 45: 505-512
        • Rayburn W.F.
        • Zhang J.
        Rising rates of labor inductions: present concerns and future strategies.
        Obstet Gynecol. 2002; 100: 164-167
        • Beebe L.A.
        • Rayburn W.F.
        • Beaty C.M.
        • Eberly K.L.
        • Stanly J.R.
        • Rayburn L.A.
        Indications for labor induction: differences between university and community hospitals.
        J Reprod Med. 2000; 45: 469-475
        • Seyb S.T.
        • Berka R.J.
        • Socol M.L.
        • Dooley S.L.
        Risk of cesarean delivery with elective induction of labor at term in nulliparous women.
        Obstet Gynecol. 1999; 94: 600-607
        • Bishop E.H.
        Pelvic scoring for elective induction.
        Obstet Gynecol. 1964; 24: 266-268
        • Caughey A.B.
        • Washington A.E.
        • Laros R.K.
        Neonatal complications of term pregnancy: rates by gestational age increase in a continuous, not threshold fashion.
        Am J Obstet Gynecol. 2005; 192: 185-190
        • Cheng Y.W.
        • Nicholson J.M.
        • Nakagawa S.
        • et al.
        Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation.
        Am J Obstet Gynecol. 2008; 199: 370.e1-370.e7