Righto,

I have amended the original glossary post slightly to reflect that Amniotomy is most often used as a part of the induction process, as well as sometimes being used as a method of induction in it's own right. This reflects my own experience in practice, if anyone would like to add/amend feel free to get in touch with me (I don't bite!).

If NICE have taken into account the 2003 paper in their new draft guidelines, then this is not reflected in their reference list, which states only the Cochrane review from 2000 (ref 180 on their list) was considered. Maybe the point made in the cochrane review that further research into the appropriate timing of commencing syntocinon (if required) following ARM is justified should have been considered further, but having said that, who would fund such research, bearing in mind that noone really stands to gain finanially from this line of research (yes, I know that there could be cost savings for the NHS), and in fact the manufacturers of the oxytocic drugs, IV fluids, giving sets and equipment may stand to lose.

In my experience, women who have come into the unit for induction of labour and have had an ARM rather than prostin first have generally not needed syntocinon to be used, they have been multips with extremely favourable cervixes and babies in good positions, who have had an ARM then cracked on and given birth. There is always the exception to the rule. And it is perfectly valid to ask why induce these women when they probably would have laboured anyway.

Was 'persuading' this woman to have an ARM wise? As you said, the issue and likelihood of syntocinon being required should have been part of the discussion prior to the ARM, rather than an 'oops!' moment after - but then I don't know any other information about this woman. Having said that, should this one woman/scenario have a bigger impact on future practice than the many who have an ARM in the evening and are feeding their babies well before breakfast time?

__________________
Love Dory xxx
Just keep swimmin', just keep swimmin'....

Have you just been offered a place? If so and you want a mentor please post in post this forum (also post here if you would like a mentee)

No clearly, if someone is choosing ARM rather than prostin because they would prefer to do it a more "natural" (i.e. drug free) method of induction then they need to understand that a) there is nothing natural about ARM and b) drugs may be required further down the line, though you hope not. And no, using the line that ARM is a more natural method is not a good way to persuade who doesn't really want induction to have one, but people do resort to funny tactics when they are convinced in their own minds that induction is the best course of action, regardless of how induction is achieved.

I don't think very many units would want to ARM, and then just leave be beyond four hours. Lots of units reassess after 2 hours and synto put up at that point. If you are having lots of successful ARM-only inductions without synto in multips, then I suspect it is because you have a pretty selective policy when it comes to ARM, and that prostin is widely used in women with a favourable cervix. (i.e. your local practice regards being "ARMable" as a necessary but not sufficient reason to ARM, whereas many - perhaps most - other units approach this differently, as described in the opening post - If you physically CAN perform Amniotomy on a woman booked for induction, then you should.)