Labor induction (induction of labor, IOL) is artificially stimulating childbirth.
Patient information
What is labor induction?
It's when you want to bring about childbirth, without waiting for nature to run it's course. You do something to help stimulate it.
Methods
Mechanical approaches, including:
Membrane sweeping (aka membrane stripping, stretch and sweep), where during an internal exam, the Dr moves their finger to separate the membranes around the baby (amniotic sac), from the cervix (mouth of the uterus). This causes a release of hormones, which may soften the cervix, and prepare the uterus to contract. Contractions may help the cervix open
ARM (artificial rupture of membranes)
Extra-amniotic saline infusion, where a Foley catheter is inserted into the cervix, and the distal portion with a baloon is expanded to dilate the cervix, to induce it to, itself release prostaglandins
Intrauterine catheters, which compress the cervix mechanically to generate release of prostaglandins in local tissues
Medications, including:
Prostaglandin, administered intravaginal, endocervical, or extra-amniotic, including either:
Dinoprostone (prostaglandin E2, product name Cervidil, Prostin)
Misoprostol (prostaglandin E1 analog), with Dinoprostone having most evidence behind it
Oxytocin (synthetic), administered IV, with a high dose not seeming to have greater benefits than a standard dose
Mifepristone, which is described, but rarely used in practice, as it is uced to induce abortion
Patient information
How can you artificially stimulate childbirth to start?
There are things you can do mechanically. As well as drugs you can give.
What can you do mechanically?
You can try to separate the amniotic sac suspending the baby, from the cervix, to help hormones release. You can insert a balloon and inflate it to dilate the cervix, again, to induce hormone release. You can also break the amniotic sac, by literally piercing it, which we call ARM or breaking waters.
With drugs, what can you give?
Prostaglandin. Or oxytocin.
Indications
Postterm pregnancy (i.e. pregnancy gone past the 41st week), improving outcomes for the baby by inducing at or after term, and decreasing the number of C-sections required
IUGR (intrauterine fetal growth restriction)
Health risks to the woman in continuing the pregnancy (e.g. pre-eclampsia)
PROM (premature rupture of membranes, where the membranes have ruptured, but labor doesn't start within a specified period of time)
Abortion (premature termination of pregnancy)
Fetal death in utero, or previous Hx of stillbirth
Twin pregnancy continuing beyond 38 weeks
PMH that puts risk on the woman and/or her child, e.g. diabetes, HTN
Patient information
Why artificially induce labor? Why not let nature run it's course?
If the baby's still not wanting to come out, after the due date, which we call post dates. If the baby is small for dates because there's some medical problem, which we call IUGR. There's a health risk to mom, such as impending seizure, called pre-eclampsia. The amniotic sac may already have ruptured, so it's dangerous for bub to remain in the womb. A dead fetus, due to abortion or stillbirth. If there are twins.
Prognosis
Induction in those either at or after term improves outcomes for the baby, and decreases the number of C-sections performed
Patient information
What do you say to people who say mother nature prefers it when you use the natural approach?
Research shows that if you induce at or after term, it improves the outcome for bub. And it decreases the need to do a C section.
Paperwork
In the form "Labor induction assessment", affix the Pt Label
Under Initial Assessment to Plan Method of Induction:
Indications
ACM Code(s)
EDB: __/__/____
Gestation
Gravida
Parity
BMI
Method of Induction, including ticking for PGE2, 1mg, 2mg, Dinoprostone (Cervidil), ARM, Syntocinon
Booking Date: __/__/___ (enlisting to Page a particular number)
Date of Induction: __/__/____
Midwife/Doctor booking induction
Authorized by Reg/Consultant
Tick whether Prostaglandin ordered on medication chart by Registrar/Consultant
Modified Bishop Score, as shown in an assessment table, which is a Score of 0, 1, 2, or 3, based on whether Dilation is 1, 1.2, 3.4, 5; Length Cx (cm) is 3, 2, 1 or 0; Station is -3, -2, -1.0, or +1/+2; Consistency is Firm, Medium or Soft; Position is Posterior, Mid, Anterior. Table allows the Total summation of the score. Criteria for ARM is a Bishop Score of 7 or Greater
Maternity Unit Assessment to Determine Method of Induction:
CTG, including ticks for whether Pre Prostin, or Post Prostin
Ticks for PGE 2, including ticks for 1mg or 2mg, including Date and Time
Tick for Dinoprostone (Cervidil), including tick for 10mg, and Date and Time
Tick for Bishop Score 7 or Greater: Registrar Notified
There is also a repeat Modified Bishop Score table here which can be filled
Authentication, including Inserted by Name, Signature, Designation, Date; and Supervised by Name, Signature, Designation, Date
Repeat Assessment (As Required):
CTG, including ticks of Pre Prostin or Post Prostin
Tick for PGE2, including tick for 1mg, and Date and Time
Repeat of the Modified Bishop Score
Authentication, including Inserted by Name, Signature, Designation, Date; and Supervised by Name, Signature, Designation, Date
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