a. Definition.

Induction of labor is the deliberate initiation of uterine contractions prior to their spontaneous onset and after the period of viability.

b. Indications for Induction.

(1) When continuation of the pregnancy would affect maternal or fetal well-being.

(2) When fetal well-being would be compromised by remaining longer in the uterus. Possible problems could be:

(a) Intrauterine growth retardation (IUGR).

(b) Decreased placental circulation (evidenced by late decelerations).

(3) When done electively (occasionally).

(a) Induction may be done for the convenience of the physician or patient due to the patient being a long distance from the hospital, history of rapid labor, and term pregnancy with a history of herpes but two negatives cultures at present.

(b) This procedure is not strongly supported due to risks of the medications, possibility of delivery of a preterm infant, and the possibility of cesarean section due to failure of progress.

(4) When complications of pregnancy are present that may affect the fetus. The complications are diabetes, hypertensive disease, hemolytic disease, postmaturity, and premature rupture of membranes if term and no labor has started after twelve hours.

c. Techniques Used for Induction.

(1) Enema. An enema may stimulate contractions if the patient is ready.

(2) Oxytocin induction. Pitocin® or Syntocinon® may be used and administered by slow intravenous drip.

(3) Vaginal gel. Porstaglandin E-2 vaginal gel has been used in some cases.

d. Nursing Interventions.

(1) Never leave the patient alone. There may be potential hazards to the patient and fetus during oxytocin administration. Check the IV rate of flow frequently to ensure it is accurate.

(2) Alleviate fears of the mother that induction may harm the fetus. The patient needs reassurance that her contractions will not differ in their effects from those of the full-term patient. Instruct the patient in breathing techniques. This will help in relieving discomfort.