Induction craze

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My unit is being overwhelmed by inductions. I work on a LDRP unit and as labor nurses we triage, circulate in the OR, L&D, recovery, early newborn care and occasionally go to the main OR's to monitor pregnant pts undergoing other surgical procedures. Most days there just are not enough of us to go around. We find ourselves spread dangerously thin and inductions really push us over the edge. We have tried putting policies in place to cancel and reschedule inductions that are not medically necessary but now the doctors give diagnosis to make all of them medically necessary by claiming oligo, macrosomia, and early PIH. Are other units finding this to be a problem?

I didnt know that some L&D nurses viewed inductions so negatively... I am a cardiac/ICU nurse who also happens to be a control freak so I was all for inductions on my last 3 children. I loved walking into the hospital at 0800, suitcase in hand, smile on my face with nurses who were caffeinatted and ready to go.

Things went so much more smoother for me than my 1st experience going to hospital at 10pm, sent home (after waiting in waiting room for slow old lady to prepare papers for me to sign just to leave, allowing all in the lobby to see crazy girl in pain) then to come back in worst pain of my life and the look on docs face was to send me back home and I said 'NOT going home'... this was a small rural hospital before I was a nurse. That whole 20 hours of labor, I had one IM injection (of Demerol - I think). The only time I recall seeing a nurse was when one briefly stepped in and told me to stop screaming because I was scaring the other pts. In between my uncontrollable sounds, I could smell the coffee and popcorn and hear the laughter... it wasnt until nursing school that I learned I could have been 'coached' and all that... Soon after that I was told that it was the reputation of that department to 'let the young unmarried ones feel the pain'... I know this went off topic but it adds a little history why I am all for induction and epidural and in the end, I enjoyed/appreciated the birth just as much, just didnt have the dry cracked lips after...

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Specializes in cardiac, diabetes, OB/GYN.

Yep, sounds familiar....Lots of inductions for PIH they tell us , are because of the change of parameters for seriousness as far as PIH goes....We seem to have a lot more oligo inductions than I remember and according to our docs, it is all about litigation, litigation, litigation, although it seems quite the social induction craze to me..Now that we no longer do VBACs ( insurance) we do have more scheduled csections...Maybe that will change in the next round of studies they do...And,when we are slow, we don't only get the gyns, we get the left over surgicals of every variety and they don't get turfed back when deliveries pick up.....Busy busy busy....

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Originally posted by Rhon1991

I didnt know that some L&D nurses viewed inductions so negatively

I don't think any L&D nurse views medically indicated induction negatively. But, for elective inductions....... when you open the door to intervention, you invite more in, KWIM? Inductions can result in snowball effects that can be negative for Mom and babe. Naturally occurring labor is much safer for both, even if it means driving to the hosp in the middle of the night, only to be sent home.

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Originally posted by fourbirds4me

We have policy of 3 scheduled deliveries/day (c-sections or inductions)

Sigh! I wish we only had three a day. Up to 8 scheduled inductions and up to 4 scheduled c-sections. (when I say induction I mean people who schedule ahead of time not people who have their naturally occuring labor augmented with pitocin. some people get confused by the distinction)

I don't view all inductions negatively, just the ones the DRs lie to get on the books. Getting induced at 41 weeks is one thing but at 38 weeks because you are "term"... no. Also why a lot of nurses may seem negative towards inductions is becuase if the pt isn't ready or doesn't go fast enough for the DRs schedule she ends up in C-Section @5p. Or the Dr breaks her water at 1cm while he's on his break from the office @10a and then she gets a c-section @ 8p becuase her water has been broken "too long". Almost all nurses are concerned about the pt and her baby and don't like to see them end up with a surgery she doesn't need. Anyway, my tendency to favor naturally occuring labor for most pts is why I am probably on nights.:p

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My last baby was born on Christmas. I was the only patient there. I left on the 27th and things started to up again.

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Specializes in cardiac, diabetes, OB/GYN.

How about stripping the membranes of some 35 or 36 weekers just to get the patient in "naturally" in labor with ruptured membranes so you can pretty much count on them coming in when you are on call since you get paid by the delivery you do? I have seen that too...

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All these post sound so familiar........I work at a University Hospital that also specializes in high risk pregnancies as well. In our schedule book we have spaces for up to 8 inductions, that doesn't count the scheduled C/S or BTL's. I find that at our hospital we generally have more inductions on Mon and Fri (Fridays being the worst), this does not count the pt who come in laboring, PPROM, PIH, or any regional referals from outlying hospitals. Lets not talk about the inductions before any of the holidays, when our doc's don't want to be there so they can spend time with their families. But the ones that get us are the pt's that come from the office either for C/S or inductions and strangly enough have been NPO since midnight (coincidence......I think not!) Or here is one that we have seen a lot here recently, induction for "short stature"......okay that's a C/S waiting to happen! Or occassionally get "social inductions" because the pt is a friend of a doctor. Somedays we are spread so thin that we never get a chance to get a break or even go to the bathroom for that matter. But we do have an awesome nurse manager who has been trying to get things changed. Only time will tell. Just glad to know it's not just us.

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I just had to add this story that I heard last night. One of the nurses at work that has been there for awhile said that we used to have a DR (who is retired now- thank goodness!) who would put Cytotec in his pts at the office so they would come in "in labor". The nurses would find the half dissolved tablet in the pt when they went to do a cervical check. Most of the time the pts didn't even know what he had done! I am so glad he was gone before I came. Can you believe that?:eek:

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Specializes in OB, lactation.

I am still in BSN school, and I think I wrote about this before, but we have a doc in town that apparently routinely schedules ALL his patients for 38 wk induction. A trustworthy friend of mine told me that when she went for her 37 wk appt. with him, he said "Ok we have to schedule your induction" and she was like "what?" and he said, "yes, didn't they tell you up front when you got pregnant? Everyone gets induced at 38 wks and if you don't like it you have to go somewhere else. What's good for me (getting my sleep) is good for the other patients" (paraphrased) I sort of know the guy (we are in a small town) and I know that docs do this, but to do it in so many words, such a formal routine... *sigh* I have another friend due to deliver with him in the next week and she is so clueless about all the intervention stuff... she thinks he hung the moon so I just don't say anything.

I want to be a midwife and it's all so discouraging. :o

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Most of our deliveries are inductions--"TOBP" seems to be the reason. 39 weeks is the magic number around here. (LDRP, 50-60 deliveries/mo). I am always amazed at some of the crazy comments that I have heard..."why can't we induce at 35 weeks? I had a baby at 34 weeks and she was ok". Even our CNM routinely schedules inductions (for nonmed reasons).

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I am a nursing student just browsing here, and I am also 39 weeks pregnant. My last baby died at 5 weeks old, he had Osteogenesis Imperfecta and had many complications. Since I was about 20 weeks with this pregnancy, I have been extremely stressed and in a panic about this baby. I am just so afraid of something happening before she is born, it is interferring with my daily life, I can't eat or sleep, just struggling to get through each day because of this fear. I am afraid I am too stressed and won't be able to go into labor on my own. I would rather not be induced, but am considering asking. Do you think I would have a valid reason? Please be honest.

Heidi

3rd semester ADN student

mother to Anna born 11-5-01

Ethan 5-4-03 to 6-10-03

EDD 6-30-04

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Specializes in Telemetry, Case Management.

I am not an OB nurse, but I doubt you will be too stressed out to go into labor! I had a lot of stress and worries with a couple of my pregnancies, but when the time came, so did the baby. I do know I have heard people say induced labors are harder, but don't know if this is so.

I will let the OB nurses answer this, but I just wanted to say good thoughts are coming your way that the new baby and you will be healthy and your labor easy! :)

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