​Although the optimal timing is not yet clear, a policy of inducing labor at or beyond term is linked to lower rates of perinatal death and stillbirth than is a policy of waiting for spontaneous labor or an indication for induction (called expectant management), according to a Cochrane review published May 9, 2018. The researchers analyzed 30 randomized controlled trials, conducted throughout the world, of low-risk pregnancies. Labor induction had a lower rate of perinatal death, defined as intrauterine fetal death or infant death within the first week of life. In the labor induction arm of the study, 1 perinatal death occurred per 1,000 population, compared with 3 deaths per 1,000 in the expectant management arm of the study. The number needed to treat to prevent one perinatal death was 426. Labor induction also had a lower rate of stillbirth (1 stillbirth per 1,000 population, compared with 2 per 1,000 in the expectant management arm). The rate of cesarean delivery was lower in the induction arm, but the rate of operative vaginal birth was somewhat higher. Compared with the expectant management arm, the labor induction arm had lower rates of admission to the neonatal intensive care unit (NICU) and Apgar scores below 7 at five minutes. The two arms of the study had similar rates of neonatal trauma. No significant differences were observed for postpartum hemorrhage, perineal trauma, or length of the mother's hospital stay. Although the ideal time of induction for pregnancies at or beyond term is unclear, about three-quarters of participants had used a policy of inducing at 41 weeks or later. "We're moderately confident that inducing women at or after 41 weeks will reduce perinatal deaths, especially stillbirths," the lead author was quoted as saying in a May 17, 2018, post on the New York Times' Well newsletter. "There aren't many interventions that do this. This is one of them."

HRC recommends: Most babies are born healthy, and most mothers experience labor and delivery without significant adverse events. Nevertheless, each of the nearly four million births that occur annually in the United States carries a risk of an adverse outcome for mother and infant. Successful efforts are emerging to support patient safety, reduce preventable errors and adverse outcomes, and reduce malpractice litigation by identifying best practices and implementing new approaches to safe patient care. Risk managers and quality improvement professionals can work synergistically to develop perinatal patient safety programs tailored to their organizations' needs based on an analysis of the organization's perinatal outcome data, reported events, claims experience, and other related data sources.