Labor Management – Implementing evidence-based practices

Induction of labor (IOL) is a common in obstetrics; often, labor needs augmentation and active management during the second stage. However, methods for labor and induction management differ significantly. Implementing evidence-based practices for labor induction management can help reduce birth complications, including infection and hemorrhage, and lower cesarean delivery rates.

A recent study reviewed existing evidence on IOL and labor management strategies, focusing on induction preparation, cervical ripening, induction and augmentation techniques, and management of the second stage of labor.

This review involved examining recent original research, review articles, and guidelines on IOL from PubMed spanning 2000 to 2022.

The results suggested that preinduction pelvic floor training and perineal massage can decrease postpartum urinary incontinence and perineal trauma. Timely membrane sweeping at 38 weeks can induce spontaneous labor and prevent post-term inductions. Outpatient Foley bulb placement in low-risk, nulliparous patients scheduled for IOL shortens the time to delivery, while inpatient Foley bulb use beyond 6-12 hours offers no additional benefit. In cases where synthetic prostaglandins are required, vaginal misoprostol is preferred. For nulliparous patients and those with obesity, a high-dose oxytocin protocol should be used. Further, immediate pushing should commence once cervical dilation is complete. The use of warm compresses and perineal massage can reduce the risk of perineal trauma.

Numerous strategies are available to facilitate successful IOL and encourage vaginal delivery. Utilizing evidence-based methods can enhance outcomes and minimize complications and cesarean deliveries. These recommendations should be communicated across interdisciplinary teams to foster safe patient care.

Source: Guevara LM, Buckheit C, Kuller JA, et al. Obstetrical & Gynecological Survey. 2024 Jan 1;79(1):39-53.