Methods of Stimulating the Onset of Labor: An Exploration of Maternal Satisfaction

Abstract

M.S., a healthy 20‐year‐old gravida 2, para 0010 presented at 40 and 2/7 weeks' gestation for a routinely scheduled prenatal visit. She had an uncomplicated prenatal course with a history of termination of pregnancy at 8 weeks without complications 3 years ago. Her due date was based on the date of her last menstrual period. She denied pain, vaginal bleeding, or loss of fluid, and reported positive fetal movement with occasional mild uterine contractions every 30 minutes. Leopold's maneuver revealed an estimated fetal weight of 3200 g in longitudinal lie, vertex presentation. Her vaginal exam revealed a soft, posterior cervix with dilation of 1 cm, 50% effacement, –2 station, with an overall Bishop score of 5. Her membranes were intact. The fetal nonstress test was reactive, with a biophysical profile score of 8/8 and an amniotic fluid index of 12.3 cm. At the visit, the midwife made an autonomous decision to sweep her membranes to encourage spontaneous labor in order encourage labor before 42 weeks so that M.S. would not have to transfer out of the in‐hospital birthing center, M.S.'s desired birthing location. M.S. reported discomfort during the exam. She returned home with counseling regarding fetal movement counting, danger signs, signs of labor, and instructions to eat, drink, and rest if possible in preparation for labor. Two days later, at 7:30 pm, M.S. presented to the birthing center experiencing painful uterine contractions every 5 to 7 minutes since 5:00 pm. She denied vaginal bleeding, reported positive fetal movement and a “gush of clear fluid” at 6:30 pm. Upon triage in the birthing center, the fetal heart rate was 140 bpm with moderate variability, accelerations, and no decelerations. Contractions via tocodynamometer were measured every 4 to 6 minutes lasting 60 seconds. Ruptured membranes were confirmed by sterile speculum exam. Her cervix via sterile vaginal exam was noted to be soft, midposition, 4 cm dilated, 80% effaced, –1 station, and vertex with an overall Bishop score of 10. She was admitted to the birthing center with the diagnosis of early labor, spontaneous rupture of membranes, and reassuring fetal status. Labor was monitored per protocol and she progressed to have a normal spontaneous birth of a healthy baby girl early the next morning.