Cervical Ripening/ Induction Agents[88]

Midwives without specialized practice certification may only administer a cervical ripening pharmacologic agent in preparation for labour, inducing labour and/or as a continuation of cervical ripening with a physician order. As with any induction method where a physician has prescribed the inducing pharmacological agent, the midwife may continue to be involved in care as the condition warrants.

A midwife with specialized practice certification may, on her own responsibility, initiate induction of labour in hospital with a cervical ripening agent under the following conditions:

  • Pregnancy ≥41 weeks gestation with normal results from tests of fetal well-being, where indications for consultation or transfer of care to a physician are not present other than the required consultation at 42 completed weeks[89] and there is consent to labour induction.
  • The reasons for initiating an induction must be compelling, convincing, consented to, and documented.

The cervical ripening is recommended if the Bishop score is <6.

Factor:Score:
0123
Dilation (cm)01-23-4≥5
Effacement (%)
Thickness / Length (cm)
0-30
>3
40-50
1-3
60-70
<1
≥80
ConsistencyFirmMediumSoft
PositionPosteriorMidAnterior
StationSpines -3 or aboveSpines -2Spines -1 or 0Spines +1 or lower

Please refer to the CMBC Framework for Certification for Induction and Augmentation of Labour in Hospital in conjunction with local hospital protocols.

88. Several cervical ripening methods can be applied to increase the success of a vaginal delivery with an unfavourable cervix which includes both mechanical and pharmacologic options. Mechanical options such as a balloon device may be applied on the registrant’s own responsibility. Please refer to the CMBC Guideline for Cervical Ripening with a Balloon Device.
89. While a physician consultation is required at 42 weeks, this does not preclude a midwife with this specialized certification initiating an induction on request.

Dinoprostone Insert / Prostaglandin E2 (Cervidil®)