pit induction protocol

Ours is:
Low-dose: start on 2 milliunits and increase by 2 milliunits every 15 minutes until pt is in adequate labor. (Maximum of 40 milliunits)

I'm sorry to say that we also have a high-dose protocol that some of our MDs like to use: 6 milliunits q15 (same as above). I always try to ignore them when they tell me to jet-pit!

wow you guys jump that pit.

our protocol is get a Nst (NON STRESS TEST)first....once fetal heart tones are determined to be reassuring, then we start pit.

Pit is to be started at 1 mu/min and is increased 1-2 mu/min every 30 minutes to a maximum of 30 mu/min. Vital signs are to be done on mom every 30 minutes and fetal heart monitoring is continuous while on pitocin. WE go "up" on pitocin until moderate-firm contractions are achieved every 3-5 minutes. Pitocin is to be discontined in the presence of repeated late decelerations or non-reassuring variable decelerations that are worsening. Pit is taken very lightly by many in the OB community, I think. I personally err on the side of caution and conservative use. If a physician pushes me to "up" it and I don't feel it is safe, I refuse. I don't take pitocin augmentation or induction lightly.

Our protocol is about to be changed that will make it even MORE conservative and require closer physician oversight/involvement. It will be a real time-consumer, from what I can see.

In the old days (7 years ago) where I used to work we did "rambo pit" which is what you describe in the other paragraph. It was start at 6 mu and go up by 6 incrementally to 40mu/min. I think that is WAY too much too fast. A prescription for trouble, if you ask me.

Our pitocin induction policy is the same as the low dose Shea Tab listed above. I am not aware of any of the MD's using a high dose. I would love to have a more conservative policy in place. I swear, the more I work with pitocin, the more I hate it! I dislike it most when the OB uses on the pt who says, "I just don't feel like being pregnant anymore." Sorry, off on a tangent !

AWHONN has a wonderful paper on active labor management....check it out if you can.

We typically only go to 20mu. One doc likes 30mu..another 26mu. You know..if they aren't in labor after 20mu's...they just aren't ready. We overload those uterine receptors so much that we end up hearing the drip drip dripping of blood on the floor after delivery.

I agree, and call aggressive pit protocols the "pit to distress, then cut" routine. Docs who have high c/s rates and like doing them, are the same ones that like the rapid fire knock em down/drag em out pit routines.

WHAT'S THE BIG HURRY? oh ya, LDRP turnover, and daylight obstetrics.

I am so grateful for the nurses who try to soften the blow to moms and babies with gentle care practices.

Ahhhh...daylight obstetrics. I am so glad someone else is suffering from that. We have a few docs who like to get the pit up high..then shut them off at 4 and restart in am...do the same..then section by noon. Makes my blood boil.