Labor at term for healthy women may begin spontaneously or may be artificially induced. Factors that influence how and when labor starts for healthy women at term are complex, not universally agreed upon, and not equitably applied to all women in all clinical settings. Whether a healthy pregnant woman at term waits for labor to begin on its own or undergoes induction of labor is based on evolving evidence, patient preferences, and the opinions and philosophies of the care providers who attend the patient during pregnancy, labor, and birth, such as midwives and physicians. Some but not all women who undergo induction of labor are fully informed about their options, the process, and potential risks and benefits. Interventions to artificially initiate labor may be necessary when there is a medical indication for birth before labor begins naturally. This medical indication may be related to the condition of the woman, fetus, or both. Labor may be electively initiated in the absence of a medical indication for the convenience of the provider or the woman. Convenience and artificial interference with the labor and birth process are consistently evidenced in the natality data collected from certificates of live birth in the United States. Data are captured related to the time of day and day of the week of birth, which show distinct differences based on type of birth (Osterman et al., 2024). Critical to the success of induction of labor and to the most optimal maternal-newborn outcomes are candidates with favorable cervical status, appropriate timing based on gestational age of the fetus and maternal condition, and vigilant nursing care.

Perinatal nurses are required to have knowledge of the indications, contraindications, potential complications, and expected processes and outcomes for each of the techniques and pharmacologic agents used to ripen the cervix and stimulate labor because they provide most of the hands-on, direct care for women who undergo cervical ripening and labor induction and augmentation. Knowledge and skills in maternal-fetal assessment before initiation of the procedure and throughout labor and birth are essential to keep the woman and fetus or newborn safe and to promote the best possible outcomes. Adequate nurse staffing is required to allow frequent bedside attendance for ongoing assessment and support. Timely and accurate communication between the nurse and other members of the health care team, including the woman and her family, is vital. It is important that the woman is provided with enough information at the appropriate literacy level and language so that she can participate in decision-making before and during labor as a full partner in her own care. This monograph from the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) is designed to cover the information that perinatal nurses need to know to provide safe and effective care for women who undergo cervical ripening and labor induction and augmentation.