Thanks for all your comments and perspectives.
I realize that I must be living in an area where induction practices have been modified to allow for longer onset of labor, diagnoses of 'failed induction' and stricter criteria for Bishop scores prior to initiating oxytocin. It is pretty uniformly practiced in my area that a nullip must have a Bishop of >10 before starting oxytocin. There are only a few providers that try to circumvent this - so yes, labors (well, cervical ripening) take a loooooooong time, but no one is put on a clock and sectioned after 24 or even 48 hours of ripening. That is just not happening. It is also more universally practiced in my local hospitals/medical centers to diagnose active labor at 6 cm dilatation, and not before. I haven't worked in a facility that worships the Friedman curve, or anything close to it. There's a random provider (physician) here and there who might be doing this - but they are usually in solo or private practice, kind of out there on their own, they are becoming few and far between.
I have to be careful to not assume that this is true elsewhere, because I'm hearing from many others that induction of labor is still in the dark ages in many places.
If I worked in a freestanding birth center I would probably not see any reason to change the way I practiced, either! Birth center clients are usually committed to natural, physiologic, spontaneous labor and birth - and very motivated to acheive that.
I work in a hospital-based practice, and have patients requesting inductions all the time. Our midwifery practice is not restricted to patients who only desire natural birth, so this creates a lot of diversity in desires for a labor and birth experience. The hospital system discourages elective IOL - in fact our guidlelines effectively prohibit it - no cervical ripening until 40+6. Medically indicated IOLs can be performed at various gestional ages based on clinical criteria.
For me, I want to accommodate choices that my patients make for themselves, based on shared decision making and informed consent. One of the hardest things for me to have learned is to accept and support choices made by my patients that I would not make for myself. Some of the choices they make come with increased risks, some with decreased risks, some just conflict with my own ideas of what an ideal birth experience is **for me**.
Example: I never wanted an epidural for labor - but I work with patients all the time who opt for epidurals, and are happy they made that choice for themselves. (There are patients who dislike the epidural experience, usually when it doesn't work, but that's a method failure in a way.) I'm delighted to work with patients who get the experience they want. Same with patients who want to give birth underwater, I'm happy to support that, if that is what they are opting for themselves. I induce patients with medical necessity, and I support the labor process and promote a positive labor and birth experience to the best of my ability when induction is indicated. I don't know any midwifery practice that functions in that old school 24-hours-to-birth after starting IOL - it seems that a midwifery managed IOL would result in lower cesearean rates, just as spontaneous labors do. (Maybe another study is indicated?)
I'm getting long-winded. Do any of you have patients requesting induction of labor by 39 weeks? How would you counsel them? I'm having a hard time not supporting this choice - it appears to not increase risk for cesarean birth. I really like that.
Also, I don't think swarms of women will be requesting elective IOL - only a few. And actually, after describing the risks and the process (this will take DAAAAAAYS), probably fewer. But right now I have no way to provide that option to any patient, due to institutional protocols against it.