Labor Readiness
RIPENING OF THE CERVIX
A “Ripe” cervix: Prerequisite for successful
induced labor. Bishop score is most often
used to determine readiness for labor
❖ Five factors evaluated, each factor
scored 0 to 3
❖ Score ≥8: Associated with
successful oxytocin-induced labor
❖ Score ≤5: “Unripe” cervix or
unfavorable
Never schedule an induction without
asking the bishop score.
Methods of Cervical Ripening
Mechanical methods
❖ Membrane stripping
❖ Inserting a catheter into the cervix and
inflating the balloon holds 30-80cc of fluid
❖ Laminaria: Cervical dilators “seaweed”
Pharmacologic methods
❖ Prostaglandin E2 (dinoprostone)
❖ Cervidil (string)( tampon like)
❖ Prepidil (gel)
❖ Prostaglandin E1 (misoprostol) ( can cause
rough labor)
❖ Cytotec
Assisted Delivery
Episiotomy: Perineal surgical incision to enlarge the vaginal
opening immediately pre birth
Forceps: Instruments with curved, blunted blades are placed
around the head of fetus to facilitate rapid delivery
❖ Low, outlet forceps are more common than mid
forceps
❖ Maternal indications: Fatigue; certain chronic
conditions; prolonged second stage of labor
❖ Nonreassuring fetal strip
❖ monitor for skull fracture, bruising, and hypoxia
Vacuum-assisted delivery: RN assisted: Suction cup
connected to fetal head; suction is applied, used to guide
delivery
❖ Can be hazardous to infant, causing
❖ Scalp trauma, stop vacuum after 3 pop offs
❖ Subgaleal and intracranial hemorrhage
❖ Death
Potential complications of operative vaginal delivery
❖ Neonatal cephalohematoma; retinal, subdural, and subgaleal hemorrhage occur more
frequently with vacuum extraction than with forceps
❖ Facial bruising, facial nerve injury, skull fractures, and seizures: More common with forceps
❖ Potential maternal complications
❖ Extension of episiotomy into anal sphincter
❖ Uterine rupture, perineal pain, lacerations, hematomas, urinary retention, anemia, and
rehospitalization
Fetal readiness labor indicators
The Fetus should be mature. There are several ways to assess
maturity:
❖ ≥38 weeks’ gestation
❖ Fetal lung maturity is major point of consideration
❖ Measuring the lecithin/sphingomyelin (L/S) ratio via
amniocentesis assesses lung maturity. An L/S ratio greater
than 2 indicates fetal lung maturity.
Induction of Labor
Artificial rupture of membranes (AROM) – amniotomy
❖ Causes release of prostaglandins, which enhance
labor
Nursing interventions
❖ Observing, documenting amniotic fluid color
❖ Monitoring fetal heart rate
Oxytocin induction of labor
❖ IV oxytocin (Pitocin) is the most common agent
used
❖ IV line initiated: Infusion pump required
❖ Baseline fetal heart assessment before induction .
The RN can titrate the PIT until fetal distress
occurs, however they must call the HCP to obtain
an order to decrease the PIT
Potential complications of
oxytocin induction IV Pitocin
Potential risk for C-section doubles
❖ Primigravidas versus multi gravidas
❖ Hyperstimulation of uterus leading to one
contraction after another without substantial rest
periods in between : can blow the uterus. Give 02
10-12L via mask. IV bolus
Water retention may cause
❖ Hyponatremia
❖ Confusion; convulsions
❖ Coma
❖ Congestive heart failure; death
Nursing actions
❖ monitoring mother and baby during
pharmacologic induction interventions
❖ Assist with pelvic examination in mechanical
ripening of cervix or ROM
❖ Document fetal heart rate before and after ROM
❖ Communicate changes as needed