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?
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.
In my case, she was sixteen and having her first baby, so she definitely wasn't a TOLAC. Thanks for the responses, everyone. It's interesting to see the variations in practice around the country. I continue to be grateful that I work at a facility that does not do any elective inductions of labor.
Really? I work at two different hospitals and both do 39 week inductions on the regular.
There has has been talk that Medicaid is going to stop paying for elective inductions but I have no idea if that is true or not.
i am wondering where you all are from that don't do elective inductions (which I think is awesome I just can't believe it!!). I'm in the Midwest.
As as far as cytotec vs Pit, some providers do cytotec if they are unfavorable and some go straight to Pit.
my personal opinion is that if you have to have cervical ripening on an elective induction you shouldn't be allowed to be induced. I was on a committee last year for reducing our NTSV c/s rate and primips with an initial Bishop of less than 8 that were less than 40 weeks had something like a 50% c/s rate. It might have been higher- my stats sheet is at home.
mamagui
434 Posts
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.