Does this seem right to you?? Induction

Specialties Ob/Gyn

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Okay, my sister is at 40 weeks as of yesterday, has gestational diabetes (borderline), and they decided to induce on Thursday because they didn't want her going past her due date with the GD. So at 6am Thursday she is admitted to the hospital, given a few doses of cytotec (2 doses), then later on (around5pm) started on pitocin. She dilated to 1cm, was 50% effaced, baby at 0 station. No more progress, so they stopped the pitocin at midnight, restarted this am (friday) at 6am. Pitocin started at a low dose, left there for 4 hours, then upped until about 3pm. She was having mildly uncomfortable contractions every 2-3 minutes. MD said she would be by at 5pm to check her, and if having regular contractions she would break her water to help her progress. MD comes in, says that the hospital is pretty busy with people laboring, so they sent her home. SENT HER HOME! after 36 hours in the hospital, tons of meds, etc. It was the MD"s insistence that got her there in the first place, and now she is sent home and told to come back after the weekend and they will start over. She didn't care about the regular contractions, the high BP (130's over 95-100), the fact that she had family members who had driven 7 hours to get there, the 4+ pitting edema in her feet-none of it. THis is a first baby, and no mention was made of any possibility of not having the baby with an induction. Is this common? DOes this happen?? Or does this doc just suck??

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Specializes in Maternal - Child Health.

Now you see the mess that can result from scheduling inductions.

I'm sorry for your sister's situation, and sincerely hope that she will go safely and naturally into labor this weekend. But I can see both sides of the arguement.

If the doctor truly believed that it was necessary to deliver the baby to preserve mom's and baby's health, then I would assume that she would have continued with the induction regardless of how busy the unit was. By stopping the induction, the doctor sends the message that it may not have been necessary in the first place. Or that the risks of continuing (exhausted mom, stressed baby, potential for prolonged rupture of membranes if membranes were to be artificially ruptured, possible C/S for failure to progress, risk to mom and baby due to inadequate staffing), outweighed the risks of leaving the baby in utero (glucose instability in the infant).

It concerns me that your sister's elevated B/P does not seem to have been adequately addressed. If she has any signs or symptoms of pre-eclampsia (headache, visual disturbances, insensitivity to light or noise, swelling of hands or face, epigastric pain), CONTACT THE DOCTOR AND GET HER TO L&D IMMEDIATELY!

I can imagine how frustrating this must be to your family, but that family members traveled several hours to be present at the hospital is the one and only factor which does not warrant consideration in determining whether or not to continue an induction. Only the safety of mom and baby should be given weight in making such a decision.

Good luck to you all. I hope to read of a safe and happy delivery soon!

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I know that family is really not a consideration. Just mentioned it. My upset-ness is that the Dr insisted that she must come in to be induced if she did not go naturally by this past Thursday. My sister was hoping to go with a non-medicated birth, and that is out the window. The baby looked great--great variability, good rate, very mobile inside, so no issues there. Just sucks that no mention of this possiblity was ever made until we were told to leave.

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We send people home after attempting to induce them. She would not have been sent home if her B/P was dangerous. I would assume that they drew some blood work which would tell them that. She had no meds which were going to cause a problem after getting home. Her doctor is taking the conservative approach and I would applaud her efforts. The fact that family members drove 7 hours is of no consequence. That was their choice and totally unnecessary, (and in my opinion have no business being there anyway). The doctor is trying to decrease the risk of an unnecessary c/section. Your sister was there and on the monitor long enough to see that the baby was doing fine: another reason they can feel comfortable sending her home. One cm and 50% is very UNINDUCIBLE at this point. The meds just may help soften her cervix at home. THAT IS A GOOD THING!! Relax, your sister's doctor did her a big favor. I don't mean to sound unkind at all. Yes, the doc attempted an induction. Give her credit for wanting to give your sister time to do this on her own.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I have to agree with Betsy on this one. I have nothing to add but my best wishes to your family and this poor, beleaguered mommy that delivery is imminent and safe! Hang in there.

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Did she develop the edema or did it increase after being on the Pitocin?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Yes pitocin is known for possible water toxicity and edema as potential complications. Esp prolonged inductions with pitocin. Good point!

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No, she has had the edema for the past 3 weeks or so. Our big issue is that they were told they MUST come in to be induced, it was UNSAFE for her to go any further past her due date with the gestational diabetes. When she finally told her to go home, she came in saying that normally, she would bump up the pitocin a little bit more then break her water in an hour or so, but the hospital was pretty busy so she was sending her home instead. WHy have all these L&D rooms if you can't take care of that many patients?? She wasn't told that she wasn't progressing enough or that things looked bad, etc, just that the hospital was fairly busy and they weren't going to do anything more. If she MUST be induced because of unsafe conditions, then INDUCE HER!! Don't change your mind and send her home after she pays thousands of dollars to be in the hospital for 2 days on your insistence.

And as far as family coming, this is my baby sister. She dearly wanted to have my mom and her other big sister and I there. I am her labor coach and we are great friends and I am to be in the delivery room along with her husband while the others wait in the waiting room. So yes, we do belong there. We have every right to be there. Just because you wouldn't want anyone there doesn't mean that others dont.

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Specializes in Maternal - Child Health.

alyca,

Your justifiable frustration is coming across loud and clear! Please let me clarify a few things so that we don't have a misunderstanding.

I believe that your sister's doctor was attempting to act in her best interests by scheduling the induction. Generally speaking, there is legitimate concern over allowing a diabetic patient to go past her due date, both on the part of the mother and the baby. The longer the baby remains in utero, growing, the greater the risk for a prolonged labor, complicated delivery, or C/S due to a large for gestational age baby. Also, the greater the risk for glucose instability in the immediate newborn period. Those are legitimate reasons to schedule an induction.

Unfortunately, not all inductions take. Your sister's cervix was apparently not yet ready to efface and dilate, and the Cytotec does not seem to have made a significant difference. The Pitocin has induced contractions, but they will be ineffective in bringing about delivery until her cervix is ready to change. In this instance, stopping the Pitocin seems to be the right move. Pitocin has a very short half-life, and stops acting shortly after it is DC'd. If your sister continues to have regular contractions, you can be assured that they are being caused by her own body, and not the Pitocin. If the doctor had ruptured your sister's membranes, it is possible that labor may have been enhanced. It is also possible that it might not have had a significant effect on her progress, leaving her at risk of complications such as infection due to prolonged rupture of membranes, or worse yet, a prolapsed cord.

When it became apparent that the combination of Cytotec and Pitocin was not bringing about the desired effect of active labor, the doc had to make a decision. Given that the baby was active and had a reassuring heart rate pattern, I think she made the right one. I DO fault her for not explaining things better. She should have discussed, in advance, what might happen if the induction didn't take. She should have alerted your sister to the possibility of being discharged home if the induction wasn't successful. When she made the decision to DC your sister, she should have explained her rationale that the risks of continuing the induction outweighed the benefitsat that time and in those circumstances.

I understand your frustration with inadequate staffing, but all nurses know that it is a legitimate issue. It sounds like the unit was alreay pushed to its limits with the patients on hand. It only takes one emergency to push a unit over the edge. If the doc had ruptured your sister's membranes, and she had experienced a prolapsed cord, there may not have been enough available hands to respond to the emergency, placing mom and baby at risk. And it would have been a completely avoidable emergency.

And, while I don't presume to speak for other posters, please understand that I do not mean to imply that family members and support persons are not welcome or wanted in L&D. I only meant to say that the presence of a loved one should not determine whether or not a baby is delivered at a certain time. Family members and support persons are WELCOME and NECESSARY for laboring moms. But decisions on when to schedule inductions or deliver babies must be made based on the health risks and benefits of mom and baby.

Godspeed!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I agree with the above post. PERFECTLY stated.

Op please Remember this: your sister's baby was FINE when she (however disappointed) had to go home, after failed induction. It could have been troublesome IF they persisted in inducing her and the baby became stressed out or lost all reserve and wound up being delivered by emergency csection. Try and trust that the doctor and staff were acting in the best interests of the baby as well as the mom; there are TWO patients to consider here. Prolonged induction and labor can stress fetuses out, ( they only have so much reserves to draw on before they are done)---- resulting in nonreassuring patterns and potential emergent surgery. It can get worse than it was, believe it or not.

I wish you and your sister the best. Hopefully, things will go smoothly when the baby is truly ready to come.

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Does no one else find it telling that the decision to send her home happened at 5 pm on a Friday? It's better than an unnecessary section that happens at 5pm on a Friday, anyway.

Alyca, I'm with Jolie in that this is the perfect example of the mess that can occur from scheduling an induction. Personally, I would prefer a doctor send me home than force me into an ftp c section. But yeah, I completely understand the feeling that one the one hand, doc says the pregnancy is unsafe and then on the other, has no problem letting it continue over the weekend.

Sarah

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I appreciate all the responses. I totally understand the staffing issues. I am an RN (trauma/orthopedics), and see short staffing all the time. I guess the lack of pt education from the MD frustrated us the most. If we had known this was a possiblity, we would not have been so shocked, frustrated, and in my sister's case, devastated. She has had a tough pregnancy, her life is all stressed out, her new house that was supposed to be done by Sept. 1 is still just a concrete hole of foundation so she is living in a 10x20 bedroom at my dad's house with all her life's belongings in storage and baby things squeezed in a corner. The one thing she has been totally focused on is that she finally gets her baby. They tried for quite a while to get pregnant, found out her husband has a very low sperm count and tons of malformed non functioning sperm, so they were ecstatic to be able to conceive. She is not such a patient person in general, so having to keep waiting after she expected a baby a few days ago is really tough. But, such is life...

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