Pit Inductions---How much do you increase?

[LDR-RN]

Our hospital USUALLY begins pit inductions with us starting at 2mu/min and increasing by 2mu every 30 min. One of our docs has started a new routine for her pt's starting at 6mu and increasing by 6mu every 30 min. Just wondering how everyone else out there does their inductions and their thoughts on it. Thanks

[klone, MSN, RN]

Our policy used to be to start at 1mu and titrite 1-2 mu q20m. It was recently changed, and now it's 1mu to start, and titrate 1-2mu q30m. This is a hospital policy, so it doesn't really matter if the doctor's personal philosophy is to titrate more quickly (and we do have a few who think our policy is ridiculous).

[magicsauce]

Our policy states that we start with 1-2mu and can increase 1-2mu up to 20 mu q30 min as long as the FHR is reassuring and the patient isn't experiencing tachysystole. After 20 mu we have to have an MD order and place an IUPC. I have heard of places in my area also that are starting at 6mu with subsequent 6mu increases q30 but our hospital isn't one of them.

[SmilingBluEyes]

I would NOT do that. The literature does not support being so aggressive (6mu/min every 30 minutes) with pitocin. The receptors and woman's body NEED 40-60 minutes to adjust to each increase and once laboring, less is more. Read up on current AWHONN literature to see specifics on why aggressive "pitting" is far from evidence-based and will likely lead to hypoxia and possibly, acidosis and compromise in later labor and during pushing. Honestly, get your manager and risk management on this, as well. This is NOT a good policy!

[SmilingBluEyes]

PS we increase by 1mu/min every 30 minutes. I even push out to 40 like the literature says, particularly when contractions start.

[sahm02]

Each dr has different orders, but the norm is start at 2 incr 1-2 every 15-30 min, call the dr when reach 20mu.

[Meredith09]

slightly off-topic here, but I saw this thread and had to share an awesome and really enlightening book I recently read on the state of OB practice today...very interesting stuff about overuse of pitocin in labor and the effects it can have. the book is called "Pushed: The Painful Truth About Childbirth and Modern Maternity Care", by Jennifer Block.

[nrcolee6]

wow. our standing orders for pitocin are:

nulliparous: start at 4mu, increase by 4 q15mins until 7 ucs q 15mins

multigravida: start at 2mu, increase by 2 q 15mins until 7 ucs q 15mins

ive seriously been up to 24mu/hr on some pts, usually between 12-18mu

[SmilingBluEyes]

Jennifer Block also has a website:

http://www.jenniferblock.com

it's pretty good!

[klone, MSN, RN]

We can go up to 36 mu. I've seen it happen plenty of times. Usually by 30, it ain't happening though, at least not that day. Once we hit the 36 max, we'll shut it down, let her rest for 6 or 8 hours, and then restart.

[catfac]

Can you tell me where to find the evidence based studies that say to increase at 30 min. or more. We have preprinted orders for Q 20 min. the docs often cross it out and write 15. we start at 2and increase by 2. As long as we have a good strip and 1 min. resting tone between contractions.

[NurseInTexas12]

When I worked L&D, we started primips on 4 milliunits/min and increased by 4 q 15-20. 2X2 for multips. We maxed out at 40 milliunits/min. I feel like the protocol was a little too aggressive for a lot of our mamas.