Nurse Titration of Oxytocin for Post-Dates Labor Induction Across Body Mass Index Categories

This dissertation consists of an integrative literature and a retrospective cohort study. In the literature review, I aimed to describe nurses’ oxytocin administration practices, related nursing interventions, and labor outcomes for overweight and obese women who received oxytocin infusion during the intrapartum period. In the original research study, I aimed to determine whether intrapartum nurses administer oxytocin infusion differently among normal weight, overweight, and obese women, and whether any differences in administration were related to differences in labor outcomes. For the literature review, I used the scoping methodology for guidance in study selection, data abstraction, and data interpretation. Five studies met inclusion criteria. Two studies were retrospective and observational, and three studies were secondary analyses. Oxytocin administration variables reported included duration of oxytocin infusion, maximum rate of infusion, and total oxytocin infused in labor. The main labor outcomes reported were length of labor and method of delivery. Oxytocin-related nursing interventions (fetal heart rate and contraction monitoring) were reported in four out of five studies but were not measured in any. Authors of these five studies reported that more oxytocin is administered with increasing BMI, but length of labor becomes longer with increasing BMI and cesarean delivery rates increase with increasing BMI. For the retrospective cohort study, electronic medical records were accessed for women who delivered between January 1, 2013 and June 30, 2013 and received oxytocin infusion for post-dates labor induction. After charts were screened for inclusion and exclusion criteria, 280 women’s charts were included in the study. These women were grouped according to BMI at labor admission: normal weight (BMI < 25.0), overweight (BMI 25.0 to 29.9), and obese (BMI >30.0). Oxytocin administration variables (e.g., total oxytocin infused, highest infusion rate, length of infusion), and labor outcomes (length of labor and method of delivery) were compared across BMI groups while controlling for maternal characteristics, labor interventions, and provider type. Obese women received more total oxytocin than overweight women, length of labor increased with increasing BMI group, and cesarean delivery rate increased with increasing BMI group.