Rates of Induced Labor Have Jumped in the Past Decade

Labor induction has risen across demographic groups and gestational age categories during the past decade, an analysis of National Vital Statistics System data found.

Among singleton deliveries, induction of labor rates increased from 24.9% in 2016 to 34.5% in 2024, reported Joyce Martin, MPH, and Michelle Osterman, MHS, of the CDC’s division of vital statistics, in a National Center for Health Statistics data brief.

Mothers between ages 30 and 39 saw the largest increase (23.3% to 32.7%), but still had the lowest overall rate of induction; the highest rates were among moms younger than 20 in both 2016 and 2024 (28.4% and 38.3%), they reported.

Back in 1989, fewer than one in 10 births were induced, the authors noted. Medically or surgically induced labor “can help protect maternal and perinatal health by reducing the complications of continuing the pregnancy,” they added, “but it may also carry risks.”

Timothy Wen, MD, MPH, perinatologist at UC San Diego Health, told MedPage Today that while induction is safe and common, it’s still a medical intervention. Plus, it’s possible that an induction won’t be successful, necessitating cesarean delivery.

“But in a medically indicated situation, that risk is a secondary concern compared to the safety of the patient and the baby,” he said.

Nikki Zite, MD, MPH, professor of obstetrics and gynecology at the University of Tennessee Graduate School of Medicine in Knoxville, said that it’s important to look deeper into why inductions are on the rise; rates are shaped by ongoing risk-benefit assessments for both the pregnant person and their neonate.

“Finding that sweet spot of decreasing risks for everybody seems to be somewhere between 37 and 39 weeks when you’ve got someone with hypertension or diabetes that’s not well controlled, and then, if you’ve got no medical complexities, maybe in that 39th week,” Zite explained.

CDC researchers found that labor induction rates increased in all gestational age categories with the largest bump for early-term births at around 37 to 38 weeks’ gestation (19.9% to 32.6%). Wen said this “seems to suggest that the pregnant population is becoming more medically complex and thus requiring early-term inductions for maternal-fetal health.”

Asian non-Hispanic moms saw the biggest jump — from 19.3% to 32.3% — and white moms had the highest induction rates in both 2016 and 2024 (28.1% and 37.2%).

Induction rates rose in all states except New Mexico, where the rate stayed the same. On the low end, only 18% of Utah births were the result of induced labor in 2024 while on the high end nearly half of births in West Virginia were.

Melissa Simon, MD, MPH, vice chair of obstetrics and gynecology research at Northwestern University in Chicago, told MedPage Today that she’s not surprised by these trends in induced labor because of the pivotal ARRIVE trial, which found that pregnant people randomized to induction of labor at 39 weeks’ gestation versus those who were expectantly managed had reduced cesarean delivery, reduced preeclampsia, and there was no difference in neonatal outcomes.

As a result, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine both issued statements on elective induction of labor in low-risk nulliparous women at term. Another trial from a few years ago found that more than two-thirds of nulliparous women achieved vaginal delivery after outpatient induction of labor.

Zite added that these new data suggest that inductions were already on the rise before the ARRIVE trial.

Induction of labor may be indicated for medical reasons, Simon noted, such as gestational hypertension, poorly controlled chronic hypertension, poorly controlled diabetes, advanced maternal age over 40, and morbid obesity. “These chronic conditions are increasing in individuals in the U.S.,” she said.

Moreover, “there are no strict contraindications to induction of labor at 39 weeks other than any reason a pregnant person should not have a vaginal birth,” Simon added. This could include malpresentation of the fetus or placenta or vasa previa.

As for induction at 39 weeks without medical indication, Wen said it’s a deeply personal decision that “comes down to a patient’s specific goals for their birth experience and a candid conversation with their provider about the risks and benefits.”

In a second analysis of National Vital Statistics System data, Osterman and Claudia Valenzuela, MPH, of the CDC’s division of vital statistics, looked at epidural or spinal anesthesia use among singleton vaginal deliveries and found that three-quarters (75.4%) of moms used epidural or spinal anesthesia in 2024, up from 69.8% in 2016. Use of epidurals increased across most groups but it did decrease among those who self-paid for deliveries (43% to 41.2%).

Wen pointed out that the equitable rise across patient subgroups may reflect a broader cultural shift in birth trends. “As the authors noted, patients have a right to pain relief upon request, and the trends suggest that patients are viewing epidurals as a core component of the birthing experience,” he said. Healthcare infrastructure, especially in labor and delivery, needs to keep up with patient needs for anesthesia, he said.

Zite said that for decades, evidence has suggested that epidurals are safe.

“I just think that sometimes it takes a long time to debunk old information,” she said.