Induction of Labour - no previously Caesarean Section

You must give consent to induction of labour after reading the following information.

Induction of labour is normally scheduled between 8.00 am and 4.00 pm (08.00-16.00) in the Obstretric Outpatient Clinic (Akut Klinik for Gravide).

Before inducing labour the midwife will examine whether you and your baby are well enough to start the procedure:

• The midwife will examine your abdomen to estimate the size and the position of your baby
• Your blood pressure will be measured
• The baby's heart rate will be monitored by CTG (cardiotocography) which also registers any uterine contractions
• A vaginal examination will be done to estimate the length, position, consistency, and dilation of the cervix

Day 1
If the midwife considers that the cervix is unripe, you will be treated with Misoprostol tablets to ripen the cervix. Usually you will receive a tablet containing 25 micrograms of Misoprostol. 
The first tablet should be taken after the first examination. If your induction does not require admission, you will be given the pills you need for the rest of the day and you can go home. At home you should take one pill every two hours. You will be given a new appointment for the following day. 
If you have contractions, pain or bleeding or if your waters break you must not take any further medication. Contact the Labour Ward instead. 

Day 2 and 3
If your cervix is still "unripe" you will recieve another course of Misoprostol tablets following the same procedure and with the same dosage as the first day. If your cervix has ripened and dilated then we will perform artificial rupture of the membranes (read about ARM below). 
If your cervix still is "unripe" and you have not had contractions after three days, the midwife will reassess the situation to determine the next step in the induction. Depending on the reason for induction we may offer induction using a balloon catheter (read about balloon catheter below) or continue with the Misoprostol treatment for another day. 

In some cases we will offer a Caesarean section if labour not occur. 

In general
Some women react quickly to prostaglandin and give birth quickly while others need treatment for a longer period. There is no way of knowing in advance how you will react to the treatment. You should contact the Labour Ward if you experience contractions, pain or bleeding, or if your waters break during induction with Misoprostol before you take the next tablet. 

If and when your cervix is shortened and the orificium has opened 2-3 cm it is possible to rupture the membranes. 
If spontaneous contractions do not occur 1-3 hours after this procedure, it is possible to stimulate contractions with Misoprostol or an intravenous infusion of oxycontin (see below). 

If it is not possible to rupture the membranes then a balloon catheter can be placed.
This is a silicone catheter with two small balloons at the end. It is inserted  through the cervix while you lie on your back with your legs in stirrups. One balloon is placed in the uterus and the other balloon in the vagina. The balloons are then slowly filled with water so that they expand and compress the cervix. The procedure is usually performed in the afternoon or evening, and you will normally be admitted overnight. If you have contractions, the catheter falls out, or your waters break please contact the staff on the Ward. If the catheter has not fallen out within 12-18 hours it will be removed and usually it will be possible to perform artificial rupture of the membranes.

You will be offered an oxytocin drip if you have not had contractions following artificial rupture of the membranes or if your contractions are not effective enough to dilate the cervix.
The oxytocin drip will enduce or increase the effectiveness of your contractions. The midwife will regulate the drip depending on how labour progress.
While you are being treated with oxytocin the baby's heart rate and your contractions will be monitored by CTG. Usually you will give birth within 24 hours.
If contractions do not occur after 6-8 hours of treatment, the infusion can be stopped so you can rest. The infusion will be resumed later in the day or the following morning.

Induction of labour is offered when your doctor and midwife think it is better for your baby to be born soon rather than continuing with your pregnancy. 
The greatest disadvantage of induction of labour is that it can take longer than spontaneous delivery. Even though side effects can occur during induction of labour most women do not experience complications.

Misoprostol
Misoprostol was originally developed to treat other conditions not related to pregnancy and labour, but as it also stimulates uterine contractions Misoprostol tablets have been used to induce labour in Denmark and other countries for many years.
There is a very small risk that prostaglandins may course your uterus to be overstimulated. This means that you may develope very intense, frequent, or long-lasting contractions, which could be stressfull for your baby. If your womb does start to hyperstimulate, you can be given medication to stop or slow down your contractions, so it is important that you contact the Labour Ward when you feel the contractions starting.
There is an extremely small risk that your uterus will react so strongly towards the prostaglandin that the uterus may rupture. If this happens then an emergency Caesarean section must be performed.

Artificial rupture of membranes
Before rupturing the membranes a vaginal examination will be performed to ensure that the procedure can be performed safely. There is a small risk that the umbilical cord can be compressed after the membranes have been ruptured or that the baby's head will be descend with a little more difficulty, which may prolong labour. 

Balloon Catheter 
The use of a balloon catheter may increase the risk of infection in the uterus. There is also a small risk that the baby's head will descend with a little more difficulty. 
The balloon catheter can often give period-like cramps which can be relieved by removing some of the water from the balloons. 

Intravenous infusion of oxytocin 
There is a risk for overstimulation of the uterus where contractions are too frequent or are prolonged, so the contractions and the baby's heart rate will be monitored continuously by CTG.
There is an extremely small risk that very powerful uterine contractions can cause the uterus to rupture. If this happens, an emergency Caesarean section will be performed.