Induction of labor in women who have had cesarean deliveries may be necessary because of fetal or maternal indications. The potentially increased risk of uterine rupture should be discussed with the patient and documented in the medical record. Selecting women most likely to give birth vaginally and avoiding the sequential use of prostaglandins and oxytocin appear to offer the lowest risks. Misoprostol should not be used in patients who have had cesarean deliveries or major uterine surgery.