Skip to content
View in the app

A better way to browse. Learn more.
allnurses

A full-screen app on your home screen with push notifications, badges and more.

To install this app on iOS and iPadOS
  1. Tap the Share icon in Safari
  2. Scroll the menu and tap Add to Home Screen.
  3. Tap Add in the top-right corner.
To install this app on Android
  1. Tap the 3-dot menu (⋮) in the top-right corner of the browser.
  2. Tap Add to Home screen or Install app.
  3. Confirm by tapping Install.
Discussion

Cervical Ripening

Hello OB nurses,

I work as a CNM in a hospital with a pretty high rate of induction of labor, due to the high-risk population we serve. Tons of diabetics, hypertensives, obesity, other co-morbidities. However, despite these factors, I think we do a pretty good job with the induction process itself, and very rarely have C/S due to failed progress of an induction. We only do cervical ripening with Cytotec or a Foley balloon, due to the cost of Cervadil. Our guidelines about cervical ripening say we continue it until the patient has a Bishop's score of 6, at which time we start Pit (if needed).

Yesterday I was flipping through the channels, caught an episode of "16 and Pregnant," (yes, yes, I know, total trash, but to me it's sort of like a car crash, can't look away!) right as the teen mom was heading into the hospital to be induced (I missed the reason as to why). When she gets to the hospital, they don't say what her lady partsl exam is, but they start her right on Pit. I thought that was odd, but thought maybe she already had a favorable cervix. Then they show her 4 hours later being examined by her doctor, who said she'd now progressed to 2 cms. So she definitely wasn't favorable and got no cervical ripening, unless she had a Foley balloon at the same time or something, and they failed to mention it (we don't use that method of cervical ripening, but I've heard of it being done).

So it got me thinking---how many hospitals out there have providers inducing people with no cervical ripening? Do you see this often? I know that, unlike where I work, at an all-private hospital, providers kind of do whatever they want, but I don't really know why they would proceed right off the bat with Pit when we know how important cervical ripening is in the induction process. Just impatience? Don't believe the research?

Just curious---what do you guys see?

  • Quote

    • Featured Replies

    The only time I ever see pit started without ripening is in the case of severe pre-eclampsia. Even then, my providers are still trying to take the time to ripen and increase odds of lady partsl delivery. Way back in the day, yeah, I saw a lot of inductions with just pitocin and no ripening, but that is something I rarely see now.

  • Quote

    Nope, nothing I've ever seen, even in cases of severe maternal disease prompting a medically-indicated IOL (if anything, our docs are more aggressive about cervical ripening in those populations so as to increase the likelihood of lady partsl birth. I mean, why not do it right from the start--the OR isn't going anywhere!). Our multips have to have a Bishop of 6 just to get an elective IOL, primips have to have a Bishop of 8. Even then, our docs usually use cervical ripening if mom is less that 3cm/50%.

  • Quote

    I have never seen someone do pit on an unripe cervix without at least ATTEMPTING to ripen first. Even with severe pre-e, if she is stable enough for a TOL I am having trouble seeing why you wouldn't want to ripen first, because otherwise you are essentially attempting to ripen the cervix with pitocin. I can't imagine the overall time to delivery will be delayed by any clinically significant amount by doing some miso or throwing in a foley balloon. But I haven't been doing deliveries for a while now, so I may be totally wrong here.

  • Quote

    We are BIG on cervical ripening. In the old days we just used Pitocin. But we do 39 week elective inductions which is sad sad sad.

  • Quote
    We are BIG on cervical ripening. In the old days we just used Pitocin. But we do 39 week elective inductions which is sad sad sad.
    Wow, how do y'all get away with that with the new insurance and medicaid guidelines? Do people just pay out of pocket, or do the providers "come up" with reasons to induce?
  • Quote
    Wow, how do y'all get away with that with the new insurance and medicaid guidelines? Do people just pay out of pocket, or do the providers "come up" with reasons to induce?

    The answer is often "suspected macrosomia" or maybe cpd, or low fluids. So many options for them to fudge unfortunately.

  • Quote
    The answer is often "suspected macrosomia" or maybe cpd, or low fluids. So many options for them to fudge unfortunately.

    Ah. Yeah, gotta hate that. Then they wonder why their c/s rates are so high, and it makes you just want to scream.

  • Quote

    I would hope they did some sort of ripening... We have a pretty strict/research based induction algorithm that we follow, but I guess I have seen low-dose Pit administered with a cook cath in for ripening... But on those occasions I think there was a couple of unsuccessful doses of Miso given first...

  • Quote
    Wow, how do y'all get away with that with the new insurance and medicaid guidelines? Do people just pay out of pocket, or do the providers "come up" with reasons to induce?

    We electively induce at 39 weeks all.the.time. Just elective. No other reason listed. However, we do get a lot of "PIH," as reasons to induce... with pressures in the normal range all throughout labor... hmm.

  • Quote

    We have one OB that is notorious for doing this. Everyone else uses some form of cervical ripening. We have one that always uses the balloon. We have one that likes Cytotec. Everyone else likes Cervidil.

  • Quote

    Oh yes. Sometimes when I see a 40 weeker come through for a specific OB we call them a unicorn. It is about as rare!

    :no:

  • Quote

    Maybe she was a TOLAC? Then cytotec would be contraindicated....could still use foley bulb, though.

    I see many ridiculous reasons for inductions all of the time, and I see many failed inductions as well. Sad, really. Many women don't even know why they are being induced.

  • Quote

    • Join the conversation

    You can post now and register later. If you have an account, sign in now to post with your account.

    Guest
    Add a Comment
    Go to topic listing

    Currently Reading 0

    • No registered users viewing this page.

    Account

    Navigation

    Search

    Search

    Configure browser push notifications
    Chrome (Android)
    1. Tap the lock icon next to the address bar.
    2. Tap Permissions → Notifications.
    3. Adjust your preference.
    Chrome (Desktop)
    1. Click the padlock icon in the address bar.
    2. Select Site settings.
    3. Find Notifications and adjust your preference.