Module 08: Complications of Labor and Delivery Flashcards
This is characterized as an abnormal, long, or difficult labor and delivery.
DYSTOCIA
Dysfunctional labor is related to abnormalities of the following critical factors:
(A) Psyche
(B) Passageway
(C) Powers
(D) Passenger
This is defined as the force of labor or the forces acting to expel the fetus and the placenta.
POWER
This is characterized as the involuntary uterine muscular contractions causing complete effacement and dilatation of the cervix (during the fist stage of labor).
PRIMARY FORCE
Under power, this is characterized as the use of abdominal muscles to push during the second stage of labor (voluntary bearing down).
SECONDARY FORCE
What are the three phases of contractions?
(A) Increment
(B) Acme
(C) Decrement
Contractions during labor are characterized based on what?
(A) Frequency
(B) Duration
(C) Intensity
(D) Bearing down
This is known as the time between the beginning of one contraction and the beginning of the next contraction.
FREQUENCY
This is known as the time from the beginning of the contraction to the completion of that same contraction.
DURATION
The strength (intensity of a contraction) is measured during which phase of contractions?
ACME
This is known as the strength of the contraction during acme.
INTENSITY
Under this type of intensity, the uterine wall can be indented easily.
MILD INTENSITY
Under this type of intensity, the uterine wall cannot be indented.
STRONG INTENSITY
Under this type of intensity, the condition of the uterus falls between the said two ranges (milld and strong).
MODERATE INTENSITY
This occurs when the maternal abdominal muscles contract as the women pushes. This pushing action then aids in the expulsion of the fetus and the placenta.
BEARING DOWN
What happens to the cervix when “bearing down” occurs and it is not yet fully dilated?
It can cause cervical edema, tearing and bruising of the cervix, and maternal exhaustion.
This condition refers to infrequent uterine contractions, occurring only 2-3 times in 10 minutes, with a resting tone of <10 mmHg and strength not exceeding 25 mmHg.
HYPOTONIC CONTRACTIONS
What is another term for hypotonic uterine contractions?
UTERINE INERTIA
What is the resting tone and strength of the uterus during hypotonic contractions?
<10 mmHg and the strength does not rise above 25 mmHg
What are the causes of hypotonic contractions related to uterine overstretching?
(A) Large Baby (Macrosomia)
(B) Multiple babies
(C) Polyhydramnios
(D) Multiple parity
What are the three (3) causes of hypotonic contractions?
(A) Overstretching of the uterus
(B) Bowel or bladder distention preventing descent
(C) Excessive use of analgesia
What are the different signs and symptoms of hypotonic uterine inertia?
(A) Weak or mild contractions
(B) Infrequent (every 10 to 15 minutes) and brief
(C) Can be easily indented with fingertip pressure at peak of contraction
(D) Prolonged active phase
(E) Maternal exhaustion
(F) Psychological trauma (frustrated)
This is a graph that shows how cervical dilation and labor progress over time.
FRIEDMAN’S GRAPH (CURVE)
What are some therapeutic interventions for hypotonic contractions?
(A) Ambulation
(B) Nipple stimulation (releases endogenous Pitocin)
(C) Enema (warmth may stimulate contractions)
(D) Labor augmentation with Pitocin
(E) Amniotomy
How does nipple stimulation help in hypotonic contractions?
It releases endogenous Pitocin (oxytocin), which stimulates stronger contractions.
This is known as the artificial rupture of the amniotic sac using an amniohook or amnicot to enhance labor progression.
AMNIOTOMY
This is a long crochet-type hook with a pricked end used to rupture the amniotic sac.
AMNIOHOOK
This is characterized as a glove with a small pricked end on one finger used to rupture the amniotic sac.
AMNIOCOT
Why might an amniotomy be performed instead of starting Pitocin?
It helps stimulate more natural contractions, has less risk of uterine rupture, and requires less monitoring compared to Pitocin.
What are the disadvantages of an amniotomy?
(A) Delivery must occur.
(B) Increased danger of prolapsed cord
(C) Can cause fetal head molding and compression, and caput formation
When is an amniotomy contraindicated?
When the fetal head is not engaged, and the inlet is not occluded, due to the risk of umbilical cord prolapse.
What are the nursing responsibilities before and after an amniotomy?
(A) Check fetal heart tones.
(B) Assess amniotic fluid for color, odor, and amount.
(C) Provide perineal care.
(D) Monitor contractions.
(E) Check temperature every 2 hours.
This is known as the softening and effacing of the cervix.
CERVICAL RIPENING.
What medications are used for cervical ripening?
(A) Prostaglandin E2: Prepidil gel, Cervidil
(B) Prostaglandin E1: Cytotec
What are the nursing responsibilities for cervical ripening?
(A) Monitor maternal vital signs
(B) Assess cervical dilation and effacement
(C) Monitor fetal heart rate (FHR) for reassuring patterns
(D) Manage hyperstimulation if it occurs
What is the management for hyperstimulation?
(A) Remove the medication.
(B) Turn the patient for side lying position.
(C) Provide oxygen via facemask.
(D) Give terbutaline.
It is used for the augmentation of labor by stimulating stronger contractions.
PITOCIN (OXYTOCIN)
What must be checked before administering Pitocin?
Cephalopelvic disproportion (CPD) must be ruled out before starting the infusion.
How is Pitocin administered?
10 units in 1000 cc fluid, given as a secondary infusion, never as primary.
What are the nursing responsibilities when administering Pitocin?
(A) Monitor contractions (ensure they are increasing but not tetanic)
(B) Assess cervical dilation and effacement
(C) Monitor vital signs and fetal heart tones (FHTs)
(D) Ensure no signs of hyperstimulation before increasing the dose
This condition is characterized by an increase in resting tone of more than 15 mmHg and may occur because more than one pacemaker is stimulating contractions.
Hypertonic Contractions
Hypertonic contractions occur because?
Muscle fibers of the myometrium do not repolarize or relax after contractions. The lack of relaxation contraction may not allow OPTIMAL UTERINE ARTERY FILLING (which could lead to FETAL ANOXIA).
True or False. Hypertonic contractions are more painful than usual contractions.
TRUE
In which group of mothers do hypertonic contractions most often occur?
PRIMIGRAVIDAS
Describe the uterine contractions in hypertonic contractions.
They’re erratic, ineffectual, uncoordinated, and have poor quality that involve only a portion of the uterus. The frequency increases but the intensity decreases, thus not bringing about any dilation and effacement of the cervix.
What are the signs and symptoms of hypertonic contractions?
(A) Painful contractions due to uterine muscle anoxia
(B) No cervical dilation or effacement despite frequent contractions
(C) Prolonged latent phase (stuck at 2-3 cm dilation)
(D) Early fetal distress due to high uterine resting tone and decreased placental perfusion
(E) Mother becomes anxious and discouraged
This is a good guideline for expected progression in labor and therefore helpful to note abnormal labor patterns
Friedman’s curve
What are the differences in labor duration for nulligravida vs. multigravida in the active phase of the 1st stage of labor?
(A) Nulligravida: 6-18 hours, dilates ~1 cm/hour
(B) Multigravida: 2-10 hours, dilates ~1.5 cm/hour
When is labor considered arrested in the active phase of the 1st stage of labor?
> 2 hours without cervical dilation for both nulligravida and multigravida.
What is the normal duration of the 2nd stage of labor?
(A) Nulligravida: 0.5 - 3 hours
(B) Multigravida: 5 - 30 minutes
What is the normal duration of the 3rd stage of labor?
0 - 30 minutes for both nulligravida and multigravida.
What is the goal in managing dysfunctional labor during the 1st stage of labor?
To relieve pain and promote a normal labor pattern.
What are comfort measures for managing pain during labor?
(A) Warm shower
(B) Mouth care
(C) Imagery
(D) Music
(E) Back rub (therapeutic touch)
What are additional interventions for dysfunctional labor pain relief?
(A) Mild sedation
(B) Bed rest or position changes
(C) Tocolytics to reduce high uterine tone
(D) Hydration
What causes ineffective maternal pushing during labor?
(A) Incorrect pushing techniques
(B) Maternal exhaustion
(C) Decreased urge to push
(D) Fear of injury
How is ineffective maternal pushing managed?
Health teaching to guide proper pushing techniques.
This condition occurs when more than one pacemaker is initiating the uterine contractions and when the receptor points in the myometrium may be acting independently of the pacemaker.
UNCOORDINATED CONTRACTIONS
What are the three phases of labor where uncoordinated contractions occur?
(A) Latent phase,
(B) Active phase,
(C) Transition phase
What is a prolonged latent phase?
When contractions become ineffective and labor is prolonged beyond:
(A) >20 hours in nullipara
(B) >14 hours in multipara
What can cause a prolonged latent phase?
Excessive analgesia on the early signs of labor.
What are the nursing interventions for a prolonged latent phase?
(A) Change the line and woman’s gown.
(B) Darken the room lights.
(C) Decrease noise stimulation.
What is the protracted active phase of labor?
Ineffective myometrial activity, often due to fetal malposition or cephalopelvic disproportion (CPD).
When is the active phase considered prolonged?
(A) >12 hours in primigravida
(B) >6 hours in multigravida
What is the normal cervical dilation rate in the active phase?
(A) ≥1.2 cm/hr in nullipara
(B) ≥1.5 cm/hr in primigravida
What medication may be prescribed for a protracted active phase?
Oxytocin (Pitocin) to enhance uterine contractions.
What is a prolonged deceleration phase?
When the deceleration phase lasts:
(A) >3 hours in nullipara
(B) >1 hour in multipara
What causes a prolonged deceleration phase?
Abnormal fetal head position.
What is secondary arrest of dilatation?
No progress of cervical dilatation for >2 hours.
What defines the 2nd stage of labor?
From full cervical dilation until expulsion of the fetus.
What is prolonged descent in labor?
(A) <1cm/hr for nullipara
(B) <2cm/hr for multipara
Prolonged descent lasts for about how many hours in multipara?
> 2 hours
Describe the uterine contractions during prolonged descent.
Contractions become infrequent, poor quality, and dilatation stops.
What nursing interventions are done for prolonged descent?
(A) Artificial rupture of membranes (amniotomy)
(B) IVF with oxytocin
What is macrosomia?
Infant weight >8 lbs. 13 oz. (4000g).
What is shoulder dystocia and how is it managed?
Shoulder dystocia is known as the obstruction of fetal shoulder during delivery.
It is managed through:
(A) Mcdonald’s maneuver
(B) Suprapubic pressure
What are common malpositions?
Posterior position, which often causes back pain for the mother.
What are the common malpresentations?
(A) Brow
(B) Breech
(C) Face
(D) Transverse
This condition is characterized when there is a large baby and a small pelvis. It is usually diagnosed when there is an arrest in descent and the station remains the same.
Cephalopelvic Disproportion (CPD)
Cephalopelvic disproportion (CPD) is also caused by what?
Multiple fetus (Twins, triplets, etc.)
This condition is characterized as descent of the umbilical cord through the cervix alongside or ahead of the fetal presenting part.
Prolapsed Umbilical Cord
What are the risk factors for prolapsed umbilical cord?
It can occur anytime the inlet is not occluded and the fetus is not well engaged.
What is the goal of managing prolapsed umbilical cord?
Relieve the pressure on the cord and support the mother and family.
What are the types of umbilical cord prolapse?
(A) Occult (hidden) prolapse – Cord is compressed but not visible.
(B) Complete cord prolapse – Cord protrudes through the cervix or vaginal wall.
What are the nursing interventions for umbilical cord prolapse?
(A) Relieve pressure on the cord.
- Trendelenberg position
- Knee chest position
- Elevate part with sterile gloved hand
(B) Assess fetal heart tones (FHT).
(C) Do not attempt to replace the cord.
(D) Cover the exposed cord with a sterile wet gauze.
(E) Give O2 per mask at 10 liters.
(F) Stay with the patient and offer support.
This approach pertains to the introduction of warmed, sterile NS or RL into the uterus via an intrauterine pressure catheter (IUPC) to improve fetal oxygenation.
AMNIOINFUSION
Amnioinfusion is used to treat what?
(A) Oligohydramnios
(B) Meconium stained amniotic fluid
(C) Cord compression and variable decelerations.
What is the nursing management for amnioinfusion?
(A) Monitor fetal and maternal vital signs.
(B) Monitor intake and output of the fluid.
(C) Assess contractions.
(D) Provide comfort measures.
What are the recommended positions to aid fetal repositioning?
Hands and knees position, lunge to the side.
This approach pertains to the alteration of fetal position by abdominal or intrauterine manipulation.
Version
This pertains to the infusion of sterile fluid into the uterine cavity.
Amnioinfusion
When are forceps typically applied during labor?
Low forceps or outlet forceps are usually applied after crowning.
This treatment for complications related to the baby pertains to the application of a disk-shaped cup over the vertex of the fetal head, and vacuum suction is applied.
Vacuum extraction
This treatment pertains to a surgical incision made to enlarge the vaginal opening.
Episiotomy
What are the treatments for complications of the passenger?
(A) Positioning
(B) Version
(C) Amnioinfusion
(D) Forceps delivery
(E) Vacuum extraction
(F) Episiotomy
This is a procedure used to change fetal presentation through abdominal manipulation.
External Version Procedure
What is the criteria for external version procedure?
Fetus is not engaged, reactive non-stress test (NST), and gestation of 36+ weeks.
What are contraindications for external version?
(A) Multiple gestation
(B) Non reassuring FHR
(C) A complicated pregnancy.
What are key nursing interventions for external version?
(A) Administer terbutaline prior to the start of the procedure.
(B) Monitor maternal and fetal vital signs.
(C) Post assessment for contractions and kick counts.
This is a surgical incision of the perineal body made to enlarge the outlet for delivery.
EPISIOTOMY
What are the predisposing factors for episiotomy?
(A) Primigravida
(B) Large baby, macrosomia
(C) Posterior position of the baby
(B) Use of forceps or vacuum extractor
What are the preventative measures for episiotomy?
(A) Perineal massage
(B) Side-lying and gradual expulsion
What is the nursing management for patients who have undergone episiotomy?
(A) Provide comfort and patient teaching.
(B) Apply ice pack and assess the site after delivery.
This is used to shorten the second stage of labor and assist in maternal pushing efforts.
Forceps-assisted delivery
What are the fetal risks of forceps-assisted delivery?
(A) Facial edema or lacerations
(B) Caput succadeneum
(C) Cephalohematoma
What are the maternal risks of forceps-assisted delivery?
(A) Birth canal lacerations
(B) Perineal bleeding
(C) Bruising or edema
What are the key nursing interventions after forceps delivery?
(A) Reduce forceps use
(B) Provide patient education
(C) Assess newborn and perineum post delivery
What are the risks of vacuum extraction?
(A) Cephalohematoma
(B) Caput succedaneum
What are the key nursing interventions for vacuum extraction?
Keep the mother and partner informed during the procedure and assess the newborn afterward.
This is a surgical procedure where the fetus is delivered via an abdominal and uterine incision.
Cesarean birth
True or false. Cesarean birth may have a higher chance of VBAC.
TRUE
What are the criteria for a woman to be a candidate for VBAC?
(A) Previous C-section with low transverse incision
(B) Adequate pelvis (no pelvic dystocia)
(C) Previous successful VBAC
(D) Hospital must be equipped for emergency C-section
What is a major complication of VBAC?
Uterine rupture
What is the primary nursing care for VBAC?
Frequent monitoring of the woman and fetus
What factors determine the adequacy of the passageway for labor?
(A) Size of the maternal pelvis (diameters of the pelvic inlet, midpelvis, and outlet)
(B) Type of maternal pelvis
(C) Cervical dilation and effacement
(D) Ability of vaginal canal and external vaginal opening to distend
What are the four classic types of maternal pelvis?
(A) Gynecoid – Favorable for vaginal birth
(B) Android – Not favorable; slow descent; fetal head enters in transverse or posterior position
(C) Anthropoid – Favorable for vaginal birth
(D) Platypelloid – Not favorable; fetal head engages in transverse position; difficult descent
What are the major pelvic bones?
Two innominate bones (ilium, ischium, pubis around the acetabulum), sacrum, coccyx
What are the two divisions of the pelvis?
(A) False Pelvis
(B) True Pelvis
This division of the pelvis supports the pregnant uterus and directs the fetal parts to the true pelvis.
FALSE PELVIS
This division of the pelvis must be adequate
for normal fetal passage during labor and at birth. It consists of the inlet, pelvic cavity, and the outlet.
TRUE PELVIS
The size and shape of this are determined by assessing 3 anteroposterior diameters.
PELVIC INLET
This anteroposterior diameter of the pelvic inlet runs from the subpubic angle to the middle of the sacral promontory (12.5 cm).
DIAGONAL CONJUGATE
This anteroposterior diameter of the pelvic inlet runs from the middle of sacral promontory to ~1 cm below pubic crest (DC - 1.5 cm = OC).
OBSTETRIC CONJUDATE
This anteroposterior diameter of the pelvic inlet runs from the middle of sacral promontory to middle of pubic crest (~10.5-11 cm).
TRUE CONJUGATE
This is a curved canal with a longer posterior than the anterior wall. A change in the lumbar curve can increase or decrease the tilt of the pelvis and can influence the progress of labor.
PELVIC CAVITY
Where is the pelvic outlet located?
At the lower border of the true pelvis.
How is the size of the pelvic outlet determined?
By assessing the transverse diameter (bi-ischial/intertuberous diameter)
This helps determine the shape of the pelvic inlet; largest diameter, measured using the linea terminalis as a reference point.
TRANSVERSE DIAMETER
What soft tissues must stretch to allow fetal passage?
Cervix, vagina, and perineum
What hormones facilitate softening and elasticity of maternal soft tissues?
Progesterone and relaxin
This occurs when the fetal presenting part reaches or passes through the pelvic inlet.
ENGAGEMENT
What does engagement confirm?
Adequacy of the pelvic inlet
How is engagement determined?
Through vaginal examination
When does engagement occur in primigravidas vs. multiparas?
(A) Primigravidas: ~2 weeks before term
(B) Multiparas: During labor or just before labor
This is known as the measurement of how far the fetal presenting part has descended in the pelvis.
STATION
What is the reference point for station measurement?
ISCHIAL SPINES
What is the reference point for station measurement?
0 station
What do positive and negative stations indicate?
(A) Negative station (-1, -2, etc.) → Fetal presenting part is above the ischial spines
(B) Positive station (+1, +2, etc.) → Fetal presenting part is below the ischial spines
What does “high” or “floating” mean in terms of station?
The fetal presenting part is unengaged and still above the pelvic inlet
Can a full bladder lead to dysfunctional labor?
Yes. A full bladder can lead to a dysfunctional labor as it applies unnecessary pressure.
When is labor considered prolonged?
If it lasts more than 18-24 hours or fails to progress in dilation or effacement
What are normal rates of cervical dilation?
(A) Primigravida: 1.2 cm/hr
(B) Multigravida: 1.5 cm/hr
What are normal rates of fetal descent?
(A) Primigravida: 1 cm/hr
(B) Multigravida: 2 cm/hr
What are causes of prolonged labor?
(A) Cephalopelvic disproportion (CPD)
(B) Malpresentation or malposition
(C) Labor dysfunction
What are key nursing interventions for prolonged labor?
(A) Provide comfort measures
(B) Conserve energy
(C) Offer psychological support
(D) Encourage position changes
When is labor considered precipitous?
Less than 3 hours from onset of contractions to delivery
What causes precipitous labor?
(A) Lack of resistance of maternal tissues
(B) Hyper-intense uterine contractions (no time for uterus to relax)
(C) Small baby in a favorable position
Why is precipitous labor risky?
The cervix does not have time to dilate and efface, leading to complications.
What are possible complications of precipitous labor?
(A) Cervical lacerations
(B) Uterine rupture
Where can a rapid delivery occur?
In an uncontrolled setting (e.g., LRT, jeepney, public places)
What emotional response does the mother typically have?
Frightened, angry, feels cheated
What is the most important nursing intervention?
Do not leave the mother alone
How can the nurse help prevent birth complications?
(A) Help the mother pant to reduce the urge to push
(B) Apply gentle pressure on the fetal head to prevent sudden pressure changes
(C) Deliver the baby between contractions to control delivery
(D) Suction or keep baby’s head low and place on mother’s abdomen
(E) Allow breastfeeding and document everything
This condition pertains to the spontaneous rupture of membranes before labor starts.
Premature Rupture of Membranes (PROM)
What are common causes of PROM?
(A) Infections
(B) Fetal abnormalities
(C) Incompetent cervix
(D) Sexual intercourse near term
What is the major risk of PROM?
Ascending intrauterine infection
What are key nursing interventions for PROM?
(A) Monitor time of rupture and assess for labor onset
(B) Check temperature frequently (for infection)
(C) Describe amniotic fluid characteristics
(D) Check WBC levels
(E) Provide psychological support
What medications are given to accelerate fetal lung maturity?
Betamethasone (Celestone) and Dexamethasone (Decadron)
Why are these drugs administered?
To stimulate fetal lung development and reduce the risk of respiratory distress syndrome (RDS)
How long does the effect last?
About 7 days; needs to be repeated
What are common causes of preterm labor?
(A) Urinary tract infections (UTI)
(B) Premature rupture of membranes (PROM)
When is labor considered preterm?
Between 20 and 37 weeks of gestation.
What is the goal of preterm labor management?
STOP the labor! Suppress uterine activity to prevent preterm birth.
What are the main tocolytic drugs used to stop labor?
(A) Magnesium Sulfate
(B) Calcium Channel Blocker (Nifedipine)
(C) Prostaglandin Synthesis Inhibitor (Indomethacin)
(D) Beta-Adrenergic Agonists (Terbutaline, Ritodrine)
What are the contraindications for tocolytics?
Do NOT give if:
(A) Active labor (cervix dilated ≥ 4 cm)
(B) Severe pre-eclampsia
(C) Fetal complications or demise
(D) Hemorrhage
(E) Ruptured membranes
What are common side effects of Beta-Adrenergic Agonists like Terbutaline?
(A) Palpitations, tachycardia (~120 bpm)
(B) Tremors, nervousness, restlessness
(C) Headache, severe dizziness
(D) Hyperglycemia
What is the toxic effect of tocolytics?
Pulmonary edema (rales, crackles, dyspnea)
What is the antidote for tocolytic toxicity?
Inderal (Propranolol)
This medication is used to decrease the frequency and intensity of uterine contractions.
Magnesium sulfate.
How is it administered?
IV infusion pump (4-6 g loading dose over 20 minutes)
What are the common side effects of magnesium sulfate?
(A) Lethargy, weakness
(B) Sweating, flushing
(C) Nausea, vomiting, headache, slurred speech
What are signs of magnesium toxicity?
(A) Absent reflexes
(B) Respiratory depression
How does nifedipine work in preterm labor?
Blocks calcium channels → decreases smooth muscle contractions
How is it administered (nifedipine)?
Orally or sublingually
What are common side effects (nifedipine)?
(A) Hypotension, tachycardia
(B) Facial flushing
(C) Headache
When is indomethacin used for preterm labor?
For pregnancies <32 weeks, but not given for more than 72 hours
This medication is given to inhibit prostaglandin synthesis thus reducing uterine contractions. Although this is not usually the medication given for preterm labor.
Indomethacin
What lifestyle modifications can help prevent preterm labor?
(A) Rest
(B) Drink 2-3 quarts of fluids daily
(C) Empty bladder every 2-3 hours
(D) Avoid heavy lifting & overexertion
(E) Modify sexual activity
What are key nursing instructions for preterm labor patients?
(A) Take medication on time
(B) Check pulse (>120-140 bpm = call doctor)
(C) Monitor fetal movement (kick counts)
(D) Drink 8-10 glasses of water per day
(E) Lie on the side
(F) Keep bladder empty
This is known as the spontaneous or traumatic uterine rupture.
Ruptured Uterus
What are the causes of ruptured uterus?
(A) Previous C-section scar rupture (scar cannot stretch)
(B) Prolonged labor
(C) Excessive Pitocin (Oxytocin) use → uterine overstimulation
(D) Excessive manual pressure on the fundus after delivery
What are the signs and symptoms of a ruptured uterus?
(A) Sudden, sharp abdominal pain & tenderness
(B) Cessation of contractions
(C) Absence of fetal heart tones
(D) Shock symptoms
What is the immediate intervention for uterine rupture?
Emergency Cesarean Delivery (C-section)
This is known as the artificial stimulation of uterine contractions before spontaneous labor.
LABOR INDUCTION
When is labor induction indicated?
For post-term pregnancies (≥ 40 weeks) to prevent meconium staining.
This is known as the gloved finger separates the amniotic membranes from the lower uterus. This is characterized to release prostaglandins to stimulate contractions.
MEMBRANE STRIPPING
What is the goal of Pitocin (Oxytocin) infusion?
To achieve contractions every 2 minutes with good intensity and relaxation in between
Pitocin (oxytocin) infusion is used for what?
INDUCTION AND AUGMENTATION
What are the other methods of induction?
(A) Ambulation
(B) Nipple stimulation
(C) Warmth of enema may stimulate contractions.
(D) Herbs
(E) Insertion of balloon catheter
