🩸 Induction, Oxytocin & Cesarean Birth
When to stop the oxytocin, what tachysystole does to the placenta, and the care that follows a cesarean.
💉 Oxytocin — and when to stop it
Oxytocin makes the uterus contract. The uterus must RELAX between contractions to perfuse the placenta.
Too many contractions, too long, or no rest between them starves the baby of oxygen.
🚨 Stop the infusion if
- Contractions more often than every 2 minutes
- Contractions lasting longer than 90 seconds
- Resting tone does not return between contractions
- Any late decelerations or non-reassuring pattern
- Suspected uterine rupture
Then: left side, oxygen 8–10 L, increase the maintenance IV, notify the provider.
Oxytocin is a high-alert medication. It always runs as a secondary infusion on a pump, so it can be stopped instantly without losing IV access.
🧠 Ripening before induction
An unfavorable cervix is ripened first — prostaglandin gel or a mechanical balloon — because inducing an unripe cervix usually fails and ends in cesarean.
The Bishop score rates dilation, effacement, station, consistency and position. A higher score means induction is more likely to succeed.
💧 Amniotomy (AROM)
Deliberate rupture of membranes to speed labor.
- Check fetal heart rate immediately before and after
- Note TACO: time, amount, color, odor
- The head must be engaged first — otherwise the cord can prolapse
- Temperature every 2 hours afterwards — infection risk rises once the barrier is gone
🩸 Cesarean birth
Why it happens
- Failure to progress — the commonest reason
- Fetal distress
- Malpresentation — breech, transverse
- Placenta previa; cord prolapse; active herpes lesions
- Previous classical cesarean
🩺 Before
- Consent; IV access; bloods including type and crossmatch
- Indwelling catheter — keeps the bladder out of the surgical field
- Antacid to reduce aspiration risk
- Wedge under the right hip to tilt the uterus off the vena cava
- Antibiotic prophylaxis
✅ After — it is abdominal surgery AND postpartum
You are assessing two things at once:
| Postpartum | Post-surgical |
|---|---|
| Fundus — firm, midline (palpate gently) | Incision — REEDA |
| Lochia — still occurs after cesarean | Pain control, often PCA |
| Breasts, bonding, feeding support | Early ambulation — prevents DVT and ileus |
| Bladder function after catheter removal | Incentive spirometry, turn, deep breathe |
Lochia still happens after a cesarean — the placental site still has to heal. Students often forget to assess it.
🚨 Report after cesarean
- Boggy uterus or heavy lochia
- Incision redness, separation, drainage, or a fever after 24 h
- Calf pain, sudden dyspnea or chest pain — DVT or PE
- Absent bowel sounds with distension — ileus
- Urine output under 30 mL/hr
🎯 NCLEX traps
- Contractions closer than 2 min or longer than 90 s → stop oxytocin
- Oxytocin always runs as a secondary line on a pump
- FHR before and after amniotomy; head must be engaged
- Assess lochia and fundus after a cesarean too
- Early ambulation is the key post-cesarean intervention