Induction and Augmentation of Labor (Nursing)

00:01 The next procedure is an induction of labor.

00:04 So we did the cervical ripening, and now we're ready for an induction.

00:08 So what an induction actually means is that we are stimulating labor contractions before it happened on its own.

00:15 So, nothing's going on, and then we start the party with an induction.

00:20 So let's talk about the indications for induction.

00:22 The first one is a post-term pregnancy.

00:25 If a pregnancy continues past 41 or 42 weeks, there increased risk for poor perfusion.

00:31 It might be a better idea to get the fetus outside and let them breed this good air.

00:37 The next one is prolonged rupture of membranes.

00:40 Now, when the water breaks, that breaks the seal and allows for bacteria, or if the patients in the hospital and we're doing vaginal exams to check for cervical dilation, there's the possibility of increased infection.

00:54 So if the membranes have been ruptured longer than 24-36 hours, and there's no labor, that provider might begin to suggest an induction.

01:03 Hypertensive disorders such as preeclampsia.

01:07 If the fetus passes away, or dies in utero, then an induction of labor will be indicated.

01:13 If the client has maternal diabetes, we know that prolonged exposure to irregular blood sugars is not good for the fetus.

01:21 So an induction of labor might be indicated for that as well.

01:24 Fetal growth restriction implies that the fetus is not receiving enough oxygen, or enough other nutrients so that they can grow.

01:33 And sometimes it's better if they're delivered rather than stay in that environment.

01:37 Chorioamnionitis.

01:39 So we just talked about prolonged rupture of membranes and the potential for an infection beginning inside the amniotic sac.

01:46 Sometimes that can happen even without rupture.

01:49 And that condition is called chorioamnionitis.

01:52 Oligohydramnios refers to a small amount of fluid Oligo in general means small or little.

01:59 So small amount of fluid is bad, because the fluid is what provides a cushion for the cord and avoids compression.

02:06 The next two indications are both complications of pregnancy.

02:10 Cholestasis of pregnancy and alloimmunization.

02:13 So in both of these conditions, it's far better often for the fetus to be extra utero than inside.

02:20 And also the final indication may be twins, because the uterus can only get so big, and the placenta sometimes favors one twin more than the other.

02:29 And the best thing to do is to get the twins out.

02:33 During an induction of labor, the client is given oxytocin exogenously.

02:38 Meaning we give it as a medication, and it's administered IV.

02:42 And it's titrated over time to simulate the increase of labor contractions over time.

02:50 So it's very important in this procedure, that the patient first be consented.

02:54 So they know what's going to happen during the procedure, that an IV is started.

02:58 That we have a baseline fetal heart rate.

03:01 So again, the nonstress test is going to be very important.

03:04 Once we start the oxytocin, it is vital that the client stay on continuous fetal monitoring, because one of the largest risks of induction of labor is overstimulation.

03:15 So even though we're trying to deliver the baby, the goal is to deliver the baby vaginally, and not because of an emergency cesarean section.

03:23 The next thing we want to do is make sure we're monitoring comfort for the mother.

03:27 It's very possible that over time, and it's actually expected that the contractions are going to become stronger and stronger.

03:33 So really making sure that the client has a plan for how they want to manage their comfort is going to be important.

03:40 So what about when labor has started, but it's not strong enough.

03:44 Then we do what's called an augmentation of labor.

03:46 So if someone is in spontaneous labor all by themselves, and yet the cervix is not opening over time, then we may supplement the labor with a little more oxytocin.

03:57 Or we could actually use nipple stimulation as a way to pick up the contractions make them stronger.

04:04 So what's the indication then when contractions are hypotonic? Meaning too far apart, to really make any cervical change.