Induction of Labour

Immediately before induction, the midwife will examine you and your baby:

• The midwife will assess the baby’s size and position in the uterus by examining your abdomen.
• A vaginal examination will be performed to assess whether your cervix is open enough to break the water, or whether the cervix needs to be ripened first.
• A cardiotocography trace (CTG) will be recorded to monitor your baby’s heartbeat and any contractions.

Induction of labour takes place at Akut Klinik for Gravide at Regionshospitalet Gødstrup.

You will find Akut Klinik for Gravide in Wing A, Level 2.

Artificial rupture of the membranes.  (Amniotomy)

If your cervix is sufficiently open, the midwife will rupture the membranes.

During a vaginal examination, the midwife uses a small plastic instrument (an amnihook) to make a small hole in the membranes. This procedure is usually quick and painless, but some women may find it uncomfortable, especially if the cervix is difficult to reach. If needed, you may use nitrous oxide (gas and air) for pain relief.

Following artificial rupture of the membranes:

• Contractions may start on their own within the next few hours, it happens for approximately 25%
• Together with you, we will assess whether you can return home while waiting for contractions to begin, or whether you should remain in the department.
• If contractions have not started within 1–4 hours, we recommend starting an oxytocin drip.

Possible Side Effects

If the baby’s head is not firmly engaged in the pelvis, the umbilical cord may, in very rare cases, slip down in front of the baby’s head immediately following the artificial rupture of the membranes. This can affect the baby’s heartrate and requires an emergency caesarean section.

Oxytocin Drip

If contractions do not start following artificial rupture of the membranes, or if they are not effective enough to dilate the cervix further, you will be offered an oxytocin drip.

The drip contains the hormone oxytocin, which stimulates the uterus to produce contractions. Initially, these may be mild ripening contractions, followed by stronger labour contractions.

An oxytocin induction may involve several phases:

• The dose will gradually be increased.
• There may be breaks from the drip to allow your body and uterus to rest.
• The midwife adjusts the drip depending on how the induction progresses.

While you are receiving oxytocin, your baby’s heart rate and your contractions are continuously monitored using CTG.

Possible Side Effects

Possible side effects of oxytocin include:

• Nausea and vomiting
• Headache
• Palpitations

The medication may sometimes cause very frequent contractions with short pauses between them. This can affect the baby’s heartrate. If this happens, we will reduce or stop the drip.

If your cervix is not yet ripe and remains closed, we recommend cervical ripening with either a balloon catheter or tablets.

Balloon Catheter

If it is not possible to rupture the membranes because the cervix is not ready, labour can often be induced using a balloon catheter.

A balloon catheter is a thin rubber tube with a small inflatable balloon at the tip. It is inserted through the cervix during a vaginal or gynecological examination. The balloon is then filled with fluids to help the cervix open.

The catheter remains in place until the cervix has ripened sufficiently for artificial rupture of the membranes.

• Together we will assess whether you can stay at home while the catheter is working or whether you should be admitted to the department.
• If the catheter falls out or if your water breaks, you must contact the labour ward.
• If it does not fall out by itself, we will remove it after 12–24 hours. In most cases, it will then be possible to rupture the membranes .

Possible Side Effects

Side effects may include discomfort, pain, and/or Braxton Hicks contractions.

There is a very small risk of overstimulation of the uterus, although this risk is significantly lower than with medical methods.

Previous Caesarean Section

If you have previously had a caesarean section and your cervix needs ripening before breaking the water, a balloon catheter will be the first choice for induction.

If you have had a previous caesarean section, you will always be admitted to the department during induction.

Induction with Tablets

If it is not possible to use a balloon catheter, you will be offered induction with tablets to ripen the cervix.

You will not be offered tablets if you have previously had a caesarean section.

The tablets are called Angusta® and contain the hormone misoprostol. They must be taken according to the schedule provided and explained by the midwife.

• Together we will assess whether you can stay at home during this part of the induction or need to be admitted.
• Once the cervix has opened sufficiently, we will rupture the membranes. In most cases, no further tablets are needed after this.

Possible Side Effects

Possible side effects of the tablets include:

• Diarrhoea
• Nausea and vomiting
• Bleeding
• Fever

There is a small risk that the medication may cause too many contractions, which can affect the baby’s heart rate. This can be treated with medication to reduce contractions.