39 IOL

[Surfandnurse]

Can we talk about elective Induction of Labor (IOL) at 39 weeks gestation? Is this still the norm at your facility?

I know ACOG guidelines state that there shouldn't be any elective inductions prior to 39 weeks, but at my current facility there seems to be such a rarity of spontaneous labor.

Everyone chooses induction (chemical birth) at 39 and x number of days gestation...... what happened to people going the "full 40"? And isn't there something to be said about the increased rate in Cesarean sections when elective inductions are the norm?

Is there any crackdown at your facility on OB's who are so eagerly ready to induce their patients once they hit 39 weeks?

just curious if this is still the norm.....

[Jory, MSN, APRN, CNM]

There shouldn't be, but many hospitals allow it. It's also why many c-section rates are higher at those same hospitals.

In fact, ACOG doesn't recommend an induction without an indication until 41 weeks.

[queenanneslace, ADN, MSN, APRN, CNM]

I've never worked at a hospital where IOL without indication at 39+0 weeks is the norm. It might be your hospital, or the culture of your geographic area.

[ashleyisawesome, BSN, RN]

Have you read the ARRIVE study? 39 week eIOLs are becoming more common due to the study saying it actually reduces the risk of c-section and still birth in primips, regardless of bishop score. I am not sure if ACOG has officially changed their recommendation yet, but I have heard they are going to. My hospital recently changed it's policy. In the past 39 week electives were allowed, but they had to have a favorable cervix. Now they allow them even if the patient is closed thick and high.

[LibraSunCNM, BSN, MSN, CNM]

12 hours ago, ashleyisawesome said:

Have you read the ARRIVE study? 39 week eIOLs are becoming more common due to the study saying it actually reduces the risk of c-section and still birth in primips, regardless of bishop score. I am not sure if ACOG has officially changed their recommendation yet, but I have heard they are going to. My hospital recently changed it's policy. In the past 39 week electives were allowed, but they had to have a favorable cervix. Now they allow them even if the patient is closed thick and high.

My concern is that this reaction to the ARRIVE study becomes widespread. The findings are being discussed as if they are widely generalizable, when in fact they're anything but. Rebecca Dekker from Evidence Based Birth has a great synthesis of it here: https://evidencebasedbirth.com/arrive/

[klone, MSN, RN]

The culture at the current facility where I've been working a few months is that as long as you're at least 39w0d, they can schedule an IOL. We are a community hospital with private medical practices, including one OB who single-handedly brings in half of the OB patients who always threatens to go to the hospital across town if he doesn't get his way.

I am in the process of drafting a policy that I hope to have approved that requires a woman to have a favorable Bishop score in order to schedule an elective induction. I would LOVE if we could just enact a "no elective inductions" policy, but senior leadership would never allow that to happen for fear that patients will go to the competition across town to have their babies.

[AZBlueBell]

My facility allows elective IOL at 40wk only. At 38wk1day they are allowed to try a cervical ripening. Basically they are admitted as an observation pt, they get PO cytotec (up to 2 doses) but if no significant cervical change (must meet th BISHOP requirement) they are DC’d home.

[LibraSunCNM, BSN, MSN, CNM]

7 hours ago, AZBlueBell said:

My facility allows elective IOL at 40wk only. At 38wk1day they are allowed to try a cervical ripening. Basically they are admitted as an observation pt, they get PO cytotec (up to 2 doses) but if no significant cervical change (must meet th BISHOP requirement) they are DC’d home.

Wow, so you allow some elective inductions before 39 weeks even???

[klone, MSN, RN]

On ‎2‎/‎18‎/‎2019 at 11:18 PM, AZBlueBell said:

My facility allows elective IOL at 40wk only. At 38wk1day they are allowed to try a cervical ripening. Basically they are admitted as an observation pt, they get PO cytotec (up to 2 doses) but if no significant cervical change (must meet th BISHOP requirement) they are DC’d home.

How have you not been cited by TJC/CMS? That's one of the CMS quality measures by which they score hospitals and provide funding. I'm shocked that your quality/risk department allows that. Whenever we have a "fallout" as they call it, it goes through several committees to evaluate how/why it happened.

[klone, MSN, RN]

On ‎2‎/‎19‎/‎2019 at 7:07 AM, LibraSunCNM said:

Wow, so you allow some elective inductions before 39 weeks even???

I'm guessing since they're outpatient, it's not coded as an "induction of labor" and that's how they get around it (which sounds like fraud, honestly).

[jodyangel, RN]

On 2/3/2019 at 9:21 PM, ashleyisawesome said:

Have you read the ARRIVE study? 39 week eIOLs are becoming more common due to the study saying it actually reduces the risk of c-section and still birth in primips, regardless of bishop score. I am not sure if ACOG has officially changed their recommendation yet, but I have heard they are going to. My hospital recently changed it's policy. In the past 39 week electives were allowed, but they had to have a favorable cervix. Now they allow them even if the patient is closed thick and high.

its the norm at most places Ive worked. Usually 39.1

[AZBlueBell]

On 2/19/2019 at 7:07 AM, LibraSunCNM said:

Wow, so you allow some elective inductions before 39 weeks even???

I’m sorry, that was a typo! Elective IOL allowed at 40 weeks, and cervical ripening allowed at 39w1day (not 38!). To be honest, we only have a cervical ripening probably once or twice every few months. It is not common.