Elective induction of labor

Abstract

I T IS 0~1: opinion that the elective induction of labor has a useful place in present-day obstetrics with advantages to both patient and doctor. If the procedure is applied to the proper patient at the proper time, no serious complications should result. As Eastman1 points out in commenting on Hanley’s; paper, “It is the abuse of the procedure, or its application to the wrong patient that is fraught with danger, not the procedure itself.” It should no longer be necessary to do this procedure secretively or with apologies to one’s confreres or to the nursing staff, provided the cervix is “ripe,” which means that the cervix is partially dilated and 50 per cent or more effaced; in addition, the vertex should be well in the pelvis, the pelvis normal, and the patient at or close to term. The advantages to the patient who is a proper candidate for induction and who lives at a considerable distance from the hospital are obvious. It is these patients who often have to race to the hospital in a breakneck contest with t,ime in which they occasionally fail. It gives both the patient and doctor greater peace of mind knowing that they can plan a particular delivery without detriment to the mother or her offspring. It, also lightens t,he load for the busy obstetrician who is often called upon to exercise his best judgment when he is physically at low ebb. When the patient is admitted to the hospital, the vulva is shaved, scrubbed, and prepared for a sterile vaginal examination in the labor room. The operator scrubs in the same way as he would for a delivery, puts on sterile gloves, and examines the patient. If the cervix is at least, 1 to 2 cm. dilated, 50 per cent or more effaced, and the vertex well in the pelvis, the membranes are ruptured with an ordinary dressing forceps. We usually strip the membranes from the cervix and lower uterine segment before rupturing them, and then allow a considerable amount of fluid to escape. We feel that stripping of the membranes shortens the latent period before contractions set, in. A small dose of Seconal (llhL grains) is frequently given to the patient on admission. After the membranes have been ruptured the patient is given a soapsuds enema. Pituitrin, 1/3 t,o 1 minim doses, repeated every 20 to 30 minutes, has frequently been used in the hope of shortening the latent period. In recent years, some of us have used intravenous Pitocin (3 minims to 500 cc. of 5 per cent glucose in water) for the same purpose.