All you L&D nurses, please help!!!

[azzurra29]

Hi there,

I'm still in nursing school and doing my OB rotation right now. I would appreciate any comments/helpful hints about something I'm pondering here:

In clinical the other day I had a patient (G2P1) who came in at 0900 for induction of labor d/t post dates. The fetus was already at 41.4 wks and the AFI at admission was 9.0. Mom's first baby was NSVD and she has no other obstetric/medical/surgical history. They gave her Misoprostol 50 mcg suppository q4 hours and as of 1330 she was only 1/0/-3. By 1730 her SVE revealed no further change. By the time I left that night she was getting her fourth miso suppository. So, my instructor was saying she had an "unfavorable cervix". The nurse I was working with told me they'd go up to five suppositories and after that consider Pitocin... I'm still not sure what is commonly done.

Now that I'm critically analyzing this I'm trying to figure out why an unfavorable cervix occurs and what is normally done to address it in terms of MD and nursing interventions.???

I read somewhere that parous women have thicker cervixes throughout the course of labor compared to nullparous women. That's as far as I got and I searched the web trying to come up with some answers. My textbook is really limited so ANY COMMENTS/HINTS would be GREATLY APPRECIATED :)

THANKS from a desperate nursing student!

[madwife2002, BSN, RN]

A unfavorable cervix normally means that the cervix is undialated, high and not ready for induction. Rub your finger from side to side on the end/tip of your nose and that is what an unfavorable cervix can feel like. Hard yes, a favorable cervix has normally softened and hopefully you can insert a finger or more into the end.

[SmilingBluEyes]

Would be senseless to pit this cervix. It would be rather like hitting a brick wall. That is the definition of "unfavorable". Does not sound like she is responding to the miso much. Let us know the updates, if you get them!