Elective inductions may raise legal risks

Compared with women who entered labor spontaneously, elective induction was associated with a 67% increased chance of requiring a cesarean delivery, according to a study on over 28,000 births in South Australia from 2006 to 2007.1

These researchers compared women who had undergone spontaneous onset of labor, induction of labor for recognized medical reasons, and induction of labor for "non-recognized" reasons. Induction for non-recognized reasons also increased the chance of the newborn infant requiring nursery care in a Special Care Baby Unit by 64%.

Compared with children born at 41 weeks, children born at 37 weeks had a 33% increased chance of having severe reading difficulty in third grade, and a 19% greater chance of having moderate problems in math, according to a just-published study of 128,000 New York City public school children.2

Greater malpractice risks

Late preterm inductions nearly tripled from 1991 to 2003, during which time obstetricians' professional liability premiums doubled.3 "Studies estimated that almost half of this premium increase is attributable to late preterm elective inductions," says James M. Shwayder, MD, JD, professor and chair in the Department of Obstetrics and Gynecology at the University of Mississippi Medical Center in Jackson.

There is clear evidence that late preterm induction results in higher neonatal morbidity and mortality rates compared with infants born at term. There is also data to support decreasing neonatal intensive care admissions for infants born between 37 and 39 weeks of gestation.4 Adverse outcomes include adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, and prolonged hospitalization.

"There is no question that resulting complications surrounding labor and delivery raise the specter of malpractice," says Shwayder. "The logical conclusion is that complications ensuing from elective induction place a physician at greater risk for suit."


  1. Grivell RM, Reilly AJ, Oakey H, et al. Maternal and infant outcomes by onset of labour at term: a population-based cohort study. Acta Obstet Gynecol Scand 2012; 91(2):198-203.
  2. Noble KG, Fifer WP, Rauh VA, et al. Academic achievement varies with gestational age among children born at term. Pediatrics; originally published online July 2, 2012. Doi: 10.1542/peds.2011-2157.
  3. Murthy K, Grobman WA, Lee TA, et al. Obstetricians' rising liability insurance premiums and inductions at late preterm gestations. Med Care 2009; 47:425-30.
  4. Oshiro BT, Henry E, Wilson J, et al. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstet Gynecol 2009; 113:804-11.


For more information on liability risks of elective inductions, contact:

  • James M. Shwayder, MD, JD, Professor and Chair at the University of Mississippi Medical Center, Jackson. Phone: (601) 815-9114. Fax: (601) 984-6904. E-mail: jshwayder@umc.edu.