Induction

Help your families understand induction and when it's necessary.

Transcript

1. INDUCTION - IN THIS MODULE - INDUCTION OVERVIEW METHODS OF INDUCTION Membrane Sweep Breaking Water Balloon Induction Medicinal Ripening Pitocin
2. ‣ Tools and procedures designed to start labor ‣ Looks differently to every person ‣ Can take hours or even days INDUCTION OVERVIEW
3. URGENT REASONS • IUGR - Intrauterine Growth Restriction • Pre-eclampsia or HELLP Syndrome • Infection inside your uterus • Placenta detaching from uterus • Rh Blood Disease • Cholestasis • High blood pressure • Other health issues
 ELECTIVE REASONS MEDICAL REASONS • Wanting to schedule your baby’s birth around a certain date • General feelings of discomfort or feeling “done” with pregnancy • When your provider is available • You’ve gone past your “due” date INDUCTION REASONS FACTORS TO CONSIDER • Gestational diabetes • Age > 35 • If your water breaks without contractions • Too much amniotic fluid • Not enough amniotic fluid • Twin or triplet pregnancy

4. INDUCTION CERVICAL EXAM
5. BISHOP’S SCORE 0 points 1 point 2 points 3 points DILATION How open is your cervix? 0 cm 1-2 cm 3-4 cm 5+ cm CONSISTENCY Is your cervix soft or hard? firm medium soft * EFFACEMENT How thin is your cervix? 0-30% 40-50 60-70 80-100 POSITION Is your cervix to the front or back? posterior center anterior * BABY’S STATION How high/low is your baby? -3 -2 -1 or 0 +1 or 2 INDUCTION BISHOP’S SCORE
6. MEDICATION INDUCTION
 Medicines to start labor. METHODS • Cytotec • Cervidil • Pitocin MECHANICAL INDUCTION
 These method use physical tools to start labor. METHODS • Membrane sweep • Balloon Induction • Break Bag of Waters INDUCTION METHODS
7. Your cervix needs to be slightly open to consider a balloon induction. INDUCTION CERVICAL BALLOON
8. ✓ Could introduce bacteria and cause infection ✓ Accidentally breaking the bag of waters ✓ Discomfort ✓ Vaginal bleeding ✓ Softens and prepares your cervix ✓ Opens your cervix approximately 3-5 centimeters ✓ This method is removable if needed ✓ You may be able to return home after placement BENEFITS RISKS INDUCTION CERVICAL BALLOON
9. INDUCTION MEMBRANE SWEEP Provider sweeps finger inside your cervix. If you have past trauma, talk to your provider about how to support you.
10. ✓ Can help your body go into labor if you’re ready ✓ Can help soften your cervix ✓ No medications or drugs to manage, your body is doing the work on its own ✓ Could introduce bacteria and cause infection ✓ May accidentally break your bag of waters ✓ Can be uncomfortable BENEFITS RISKS INDUCTION MEMBRANE SWEEP
11. INDUCTION PITOCIN ‣ Synthetic version of oxytocin (he "love hormone”) ‣ Can create contractions ‣ Can cause labor to start ‣ Can speed a stalled labor ‣ May cause more painful contractions
12. ✓ Can cause strong, regular contractions ✓ Is an effective tool for stalled labor ✓ Prevent hemorrhage ✓ Can avoid a cesarean ✓ Overstimulate uterus ✓ Stress baby ✓ Doesn’t make you euphoric ✓ Higher instances of newborn jaundice ✓ Lower APGAR scores for baby ✓ More admissions to the NICU ✓ Long-term pitocin can delay milk supply and cause you to retain water BENEFITS RISKS INDUCTION PITOCIN
13. INDUCTION CERVIDIL Medicine placed on strip inside the vagina.
14. ✓ Can soften and prepare cervix ✓ Can help you go into labor ✓ Can be removed if you have too many contractions or if your baby is stressed ✓ Too many contractions (overstimulation) ✓ Baby could become distressed ✓ Uterine rupture (rare) ✓ Cannot be used if you’ve had a previous cesarean ✓ Increased discomfort with contractions ✓ Requires continuous monitoring ✓ Requires laying down for 2 hours after inserted (may be uncomfortable to not move with contractions) BENEFITS RISKS INDUCTION CERVIDIL
15. INDUCTION Pill placed inside the vagina or given orally. CYTOTEC
16. ✓ Can soften and prepare cervix ✓ Can help you go into labor ✓ Is inexpensive ✓ Too many contractions (overstimulation) ✓ Baby could become distressed ✓ Uterine rupture (rare) ✓ Cannot be used if you’ve had a previous cesarean ✓ Increased discomfort with contractions ✓ Requires continuous monitoring BENEFITS RISKS INDUCTION CYTOTEC
17. When breaking the waters, your provider uses a crochet-hook-like instrument, called an amnihook, to snag and break the bag of waters INDUCTION BREAKING WATER
18. AFTER BREAKING WATER • Limit anything in the vagina to keep from introducing bacteria. • Discuss when cervical exams should be done to balance infection risk with getting information about progress or position. • Check your temperature regularly for fever. • Make sure baby is moving around a lot. • Make sure the fluid remains clear. * Your bag of water protects your baby from infection INDUCTION BREAKING WATER
19. ✓ Could introduce bacteria and cause infection ✓ May create a timeline for how soon birth needs to happen ✓ Cord could become compressed ✓ Without fluid, baby might not have as much room to get into a good position for birth ✓ Risk of infection ✓ Risk of cord prolapse resulting in emergency cesarean ✓ If you have a rare, undiagnosed vasa previa your baby to lose a lot of blood BENEFITS RISKS ✓ Can sometimes speed up or start labor ✓ Can sometimes cause a slowed labor to move faster if other tools aren’t working ✓ Can see if the fluid is stained with meconium INDUCTION BREAKING WATER