Final answer:
The first step to induction of labor in a patient with a closed cervix is cervical ripening, a process that may involve the use of prostaglandins or mechanical methods to soften and thin the cervix prior to dilation. If necessary, synthetic oxytocin, such as Pitocin, can be used to maintain labor contractions.
Step-by-step explanation:
When labor is to be induced in a patient with a closed cervix, the initial step typically involves cervical ripening. This is a process of softening and thinning the cervix before it starts to dilate. Methods for cervical ripening include the use of prostaglandins, which are hormones that can be applied topically or taken orally, or mechanical methods such as a Foley bulb or laminaria tents. These methods aim to ensure the cervix is favorable for the labor process, and once ripening is achieved, the cervix starts to dilate. This first stage of labor can take varying lengths of time, greatly depending on individual circumstances and whether the mother has given birth before. If the labor does not progress into stage two, where the baby is expelled from the uterus, an IV infusion of synthetic oxytocin, like Pitocin, can be administered to restart and maintain labor contractions.