Augmentation vs Induction of Labor & Dysfunctional Labor

Augmentation of Labor

• Definition: Labor has already started but is not progressing well (e.g., contractions are too far apart or weak).

• Example: Contractions are irregular or ineffective.

• Intervention: Give Pitocin (IV oxytocin) to strengthen or increase contractions.

• Best practice: Allow labor to begin naturally whenever possible.

Induction of Labor

• Definition: Labor has not started, and medical or mechanical methods are used to start it artificially.

• Medications:

  • Misoprostol (Cytotec): Pill placed intravaginally to ripen the cervix.

  • Cervidil: Vaginal insert with a string, left in place for up to 12 hours, can be removed once no longer effective.

• Limit: Up to four rounds of Cervidil can be used.

Augmentation vs Induction

Augmentation vs Induction

Indications for Augmentation/Induction

• Dysfunctional labor: Ineffective or stalled labor progression.

• Need for timely delivery: To promote optimal fetal outcomes.

• Maternal/fetal comorbidities: Health conditions requiring intervention.

• Anatomical disproportion: Between mother and fetus.

• Use of Friedman Curve: To assess labor progress and identify dysfunction.

Dysfunctional Labor

Risks:

• Postpartum uterine atony and hemorrhage.

• Altered maternal-infant bonding and breastfeeding difficulties.

Care considerations:

• Psychosocial support and pain management.

• Thorough patient and family education.

• Obtain informed consent.

• Patient advocacy.

Dysfunctional Labor: Interventions

• Adequate staffing (preferably 1:1 nurse to patient ratio).

• Follow facility protocols for labor management.

• Provide thorough patient and family education.

Non-invasive support strategies:

• Ensure hydration and nutrition.

• Encourage ambulation and position changes.

• Support bladder emptying.

• Promote relaxation techniques.

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Fetal Demise and Labor

• Augmentation or induction may be necessary.

• Provide grief and loss support to the patient and family.

• Ensure pain management and support from healthcare team members.