American Academy of Family Physicians

View all recommendations from this society

Released February 21, 2013

Avoid elective, non-medically indicated inductions of labor between 39 weeks, 0 days and 41 weeks, 0 days unless the cervix is deemed favorable.

Ideally, labor should start on its own initiative whenever possible. Higher Cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care clinicians should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

1–5: The American Academy of Family Physicians (AAFP) list is an endorsement of the five recommendations for Family Medicine previously proposed by the National Physicians Alliance (NPA) and published in the Archives of Internal Medicine, as part of its Less is More™ series. The goal was to identify items common in primary care practice, strongly supported by the evidence and literature, that would lead to significant health benefits, reduce risks and harm, and reduce costs. A working group was assembled for each of the three primary care specialties; family medicine, pediatrics and internal medicine. The original list was developed using a modification of the nominal group process, with online voting. The literature was then searched to provide supporting evidence or refute the activities. The list was modified and a second round of field testing was conducted. The field testing with family physicians showed support for the final recommendations, the potential positive impact on quality and cost, and the ease with which the recommendations could be implemented.

More detail on the study and methodology can be found in the Archives of Internal Medicine article: The “Top 5” Lists in Primary Care.

6–10: The American Academy of Family Physicians (AAFP) has identified this list of clinical recommendations for the second phase of theChoosing Wisely campaign. The goal was to identify items common in the practice of family medicine supported by a review of the evidence that would lead to significant health benefits, reduce risks, harms and costs. For each item, evidence was reviewed from appropriate sources such as evidence reviews from the Cochrane Collaboration, and the Agency for Healthcare Research and Quality. The AAFP’s Commission on Health of the Public and Science and Chair of the Board of Directors reviewed and approved the recommendations.

In the case of the first two items on our list – “Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age” and “Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks, 0 days and 41 weeks, 0 days unless the cervix is deemed favorable” – we collaborated with the American College of Obstetricians and Gynecologists in developing the final language.

11–15: The American Academy of Family Physicians (AAFP) has identified this list of clinical recommendations for the third phase of the Choosing Wisely® campaign. The goal was to identify items common in the practice of family medicine supported by a review of the evidence that would lead to significant health benefits, reduce risks, harms and costs. For each item, evidence was reviewed from appropriate sources such as the Cochrane Collaboration, the Agency for Healthcare Research and Quality and other sources. The AAFP’s Commission on Health of the Public and Science and Board of Directors reviewed and approved the recommendations.

AAFP’s disclosure and conflict of interest policy can be found at www.aafp.org.

Sources

American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care 6th ed. Elk Grove Village (IL): AAP; Washington, DC: ACOG; 2007. 450 p.

Induction of labor. ACOG Practice Bulletin No. 107. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114:386–97.

Gulmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term (review). The Cochrane Collaboration. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD004945. DOI: 10.1002/14651858.CD004945.pub3. Available from: onlinelibrary.wiley.com/doi/10.1002/14651858.CD004945.pub3/abstract;jsessionid=242792D050CDB79D0D80C0F6FDE85031.d02t03