Cervical Ripening

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Specializes in OB.

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?

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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.

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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%.

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Specializes in Reproductive & Public Health.

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.

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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.

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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?
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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.

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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.

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Specializes in Perioperative Patient Care Technician.

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...

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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.

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Specializes in Oncology, Med-Surg, Nursery.

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.

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Specializes in Oncology, Med-Surg, Nursery.

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:

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