HI greyhorse and If I did not do so already, WELCOME TO THE FORUM. Glad you are joining us!
This is generally how we do inductions (I work 2 hospitals):
Inductions are done for several reasons, most non-medical, unfortunately. Most are "social" and a few are for "postdates" (40 weeks, is actually sited as "postdates" often). A few ARE done for LGA, PIH, Diabetic complications or potential problems such as low AFI or fetal indications.
Most of the time, for unripe cercives, we do misoprostol (cytotec). At the one hospital it's oral cytotec, 50mcg q3 hours, unless otherwise indicated. We don't generally use cervidil or prostin anymore. At the other hospital, it's Cytotec, 25mcg in the posterior fornix of the cervix (such fun getting that wee lil pill in there). Same thing; q3 hours unless contra-indicated. If nothing changes, no labor/cervical changes--- and mom and baby are ok, they go home, usually w/orders to return in 2-3 days for a re-evaluation.
If they stay, usually, the next morning at about 5 or 6--- after eating dinner and sleeping--- we begin LOW DOSE pitocin. We have become much more conservative w/pit use in both hospitals to avoid hyperstim situations. Usually, it's begun at 1 mu/min and go up by 1-2 mu each 30 minutes, NOT 15 or 20 minutes, anymore. NONE of our docs do the "rambo pit" of days gone by. You know, when you start at 6mu and go up by 6mu every 30 min. It got us into too much trouble. We generally look to have contractions q4-5 minutes that palpate moderate to strong. If I can possibly get an IUPC in there, I do. I prefer to pit by montevideo units for accuracy and safety. If not, I am very careful to watch the fetus for s/s of trouble due to hyperstim. The biggest challenge to me is the "fluffy" patient whose cervix is 2 miles high (so no internals) and how to guage accurately the amt. of pitocin is best. I am careful. Hyperstim is nothing to play with. If I see evidence of hyperstim, I back the pit down by 1/2, place O2 on and observe. If all is ok, then I creep up slowly again. If still problems, I turn it off and call the dr/midwife.
The doctors DO like to use the Friedman curve to assess if labor is adequate. If they fall off, they are looking hard at a csection. Does the rise in induction rates correspond w/the rise in rate of csection? (close to 25% nationwide)? I think so, but it's not been proven absolutely. Very controversial.
I did hear something interesting at a perinatal conference two days ago. The current recommendation ACOG is now looking to offer? A csection as an option to ALL expectant women (even those who are primip with NO KNOWN RISK FACTORS!), who desire NOT to go thru trial of vaginal labor/delivery. The wisdom? To avoid bladder and perineal trauma (which studies are saying occurs much earlier in labor than thought, NOT 2nd stage pushing but prolonged first stage). This would purportedly avoid subsequent problems and unnecessary GYN surgeries (such as bladder repair, uterine prolapse repair, etc), later on. Whether we come on line w/this or not in the USA remains to be seen. I will be watching and waiting to see what AWHONN has to say on this, too!