Augmenting Labor (particularly before 39 weeks)

klone, MSN, RN · May 29, 2015

Did the patient make change, or did they not? What kind of change?

In a situation when a patient is term, contracting uncomfortably, but not making change, we typically give them a bolus of fluid and morphine-sleep them. We would probably not augment unless the patient is 41+ weeks, or has a history of really fast labors, or was absolutely insistent.

I don't know that we have an official policy.

labordude, BSN, RN · May 30, 2015

Then there are hospitals like mine which augment the shi..crap out of everyone. There are also hospitals in the area that prefer every patient to have IUPCs and FSEs so they can just crank the pit and get the baby out to make room for the next patient who's laboring in the waiting room.

The NICU nurse side of me doesn't love to augment the slowly moving early term patients particularly those with a good strip because I have seen the train wreck babies that have come out of it.

Oh and don't even get me started on Friedman's Curve and 'how fast people are supposed to be progressing.'

Upgrading_Status, BSN, MSN, RN, NP · May 30, 2015

At my facility a pt that us less than 39 weeks contracting Q5 and 2cm will be hydrated to see if the contractions subside. If no changes she will go home. On the flip side the same pt may be sent walking to see if she makes changes, if she does she comes in, if not home she goes. For a pt to be induced

Augmentation, the pt has been 5cm for some odd hours and her contractions went from Q2 to Q5-7.

Induction....we don't start with pitocin for induction.

queenanneslace, ADN, MSN, APRN, CNM · May 30, 2015

If a patient is admitted for *labor* then they are in labor, and oxytocin would be used for augmentation. If the patient was observed as an outpatient, and there was no change in cervical dilatation, and no other reason for hospitalizing the patient (increased BPs, FHR decelerations, SROM, etc) - then this patient would be likely sent home as *not in labor*.

It's a judgement call. And a different call may be made by a different doctor on a different day depending upon mood, attitude, busy-ness of the OB unit, and maybe even the insistence of the patient.

Technically, though, if the patient is deemed a laboring patient and admitted for labor - we are not inducing labor - we are augmenting - and there's a difference. Kinda. Sorta.

Elvish, BSN, DNP, RN, NP · May 30, 2015

Totally depends on the OB. Most of our docs would probably send a patient like that home after a fluid bolus if no significant change.

We have a couple docs that are pushovers and if the patient complains would keep and pit, but I agree with nicuguy about the trainwreck that follows.

I'd much rather a patient like that come back 24-48hrs later at 9cm and blow out a baby that they labored themselves rather than a crash for pit distress or a dropped cord because someone got happy with an amnihook.

wilma30RN · May 30, 2015

It's a judgement call. And a different call may be made by a different doctor on a different day depending upon mood, attitude, busy-ness of the OB unit, and maybe even the insistence of the patient.
Technically, though, if the patient is deemed a laboring patient and admitted for labor - we are not inducing labor - we are augmenting - and there's a difference. Kinda. Sorta.

Yeah, it can definitely be a judgment call and different based on the doctor and busyness of the unit. Our patients are usually admitted as outpatients until it is determined that they are in active labor. It depends on the doc what exactly will get them deemed in "early labor" that qualifies for augmentation.

wilma30RN · May 30, 2015

Did the patient make change, or did they not? What kind of change?

Often times, they have effaced more or dilated 0.5-1 cm more: enough to say the cervix has changed but not substantially.

Red Kryptonite · May 30, 2015

At my facility a pt that us less than 39 weeks contracting Q5 and 2cm will be hydrated to see if the contractions subside. If no changes she will go home. On the flip side the same pt may be sent walking to see if she makes changes, if she does she comes in, if not home she goes. For a pt to be induced
Augmentation, the pt has been 5cm for some odd hours and her contractions went from Q2 to Q5-7.
Induction....we don't start with pitocin for induction.

Totally depends on the OB. Most of our docs would probably send a patient like that home after a fluid bolus if no significant change.
We have a couple docs that are pushovers and if the patient complains would keep and pit, but I agree with nicuguy about the trainwreck that follows.
I'd much rather a patient like that come back 24-48hrs later at 9cm and blow out a baby that they labored themselves rather than a crash for pit distress or a dropped cord because someone got happy with an amnihook.

If I could kiss you two, I would. It makes me happy to see people talking the risks seriously.

Elvish, BSN, DNP, RN, NP · May 30, 2015

If I could kiss you two, I would. It makes me happy to see people talking the risks seriously.

I tried to find a pucker-up smiley, but will have to settle for a waving one instead.

There's a time for some/all of the interventions, but they are not for standard use on every single pregnant woman who rolls in the door.

I'm pretty happy that almost everyone comes out of lady partss at my place, too. One of the lowest c/s rates in the country at

**LibraSunCNM, BSN, MSN, CNM** · May 30, 2015

Our basic standard for admission for labor is 4 cms, barring other medical complications of course. If someone came in 2 cm, and walked and made a little change to 2.5 or 3, we would still send them home. If they were 40+ weeks, there would be some midwives who would be more apt to morphine rest them and hope they wake up active (it surprisingly does work a lot of the time!), but in no way would that happen for someone 37 or 38 weeks. We wouldn't even hydrate them. Just instructions to go home, try some Benedryl, try to rest, etc. I do feel terrible for women who have days of prodromal labor, but its always better to wait for spontaneous active labor when no other complications are present. To echo Elvish, I would always rather have them come in ready to push, just to prevent the cascade of interventions.

klone, MSN, RN · May 30, 2015

I like the "6 is the new 4" motto that's going around. I've seen our triage turn away women who were 5cm, but only contracting mildly and irregularly and not making any change after several hours.