This information pamphlet is only relevant to women who have not previously undergone cesarean section or other big operations on the uterus.
Induction of labor
Approximately 25 % of all births in Denmark are induced. There are a lot of different reasons for inducing labor. The most common reason is that the due date is exceeded by 10-12 days. Other common reasons for inducing labor are:
pre-eclampsia, diabetes, hepatic events, twin pregnancy or if the baby is not growing as much as expected for the gestational age. There are pros and cons to everything. If you have been recommended induction of labor, it is because your physician has assessed this to be safer for you and your baby than continuing your pregnancy.
When inducing labor, we recommend that your contractions and the baby´s heart beat are monitored by CTG (see section on CTG). This means that it will be more difficult to be active and move around during labor. For the same reason, you cannot expect to deliver in water, once your labor has been induced.
When labor starts naturally, it is important to be patient. It can take a while before the contractions are effective. The same goes for labors thatare induced.
You will receive a phone call from the midwife on duty on ____ day the _____/_____.
During this conversation you will make an appointment for the induction. We strive to make the call between 11 AM and 1 PM. We kindly ask that you meet for examinations and inducing labor at Department 4022, entrance 4, 2nd floor on _____day the _____/_____at _____.
Your partner or another companion is welcome to join you.
At the appointment, you will:
- Receive information about the various ways to initiate the induction of labor.
- Have a CTG trace, monitoring the baby’s heart beat.
- Have an abdominal and vaginal examination. After this, we will decide the best way to induce your labor . It is important that you feel safe and well informed the entire time. You are therefore encouraged to ask questions along the way.
CTG (CardioTocoGrafy) is a device that registers the baby´s heart beat and the uterine contraction. Two elastic belts will be attached around your stomach. On one belt, an ultrasonic device counting the child’s pulse is attached. On the other belt, a device that measure muscle activity will show when you are having contractions.
How is labor induced?
Inducing labor with hormones – prostaglandin (Misoprostol/Angusta or Minprostin)
If your cervix is not shortened and still closed , we recommend induction by hormone tablets. These tablets contain the pharmaceutical drug misoprostol.
Misoprostol is originally developed and approved for other medical purposes, but it also stimulates the uterine muscle. There are other types of medicine that are approved for inducing labor, including Minprostin® suppositories. Obstetricians and midwives in Denmark however agree that misoprostol-tablets are a safer choice. According to scientific studies, fewer women
undergo acute cesarean section when using misoprostol.
This is why misoprostol tablets have been used in many years to induce labor, in Denmark and abroad.
All types of medicine used to induce labor can cause side effects: Some women experience a little diarrhea, nausea or headaches due to the
medicine. You can also experience a light fever, dizziness or skin rashes.
There is a very small risk (less than 1:10.000) that the uterus will react so strongly to the medicine, that it ruptures. This is why we monitor the
labor closely, once the contractions start. It is important to remember that most women do not experience side effects.
When inducing labor with hormones, it can either happen during admission at the maternity ward or at home. It depends on the reason for induction. If you are at home during part of the induction, you will receive a schedule showing
when you should take the medication.
It is important that you call the department if you feel unsafe or in doubt. Phone number: +45 35 45 40 22.
You should also call us:
- When your contractions start.
- If your water breaks.
- If you start bleeding.
Induction of labor by loosening or rupture of the membranes (Amniotomy)
If the midwife during the vaginal examination can feel that your cervix has dilated a little, she can loosen the membranes. In some cases this alone can lead to contractions and start labor. Often the loosening of membranes is followed by rupture of the membranes.
Some women fell that it hurts a little when the membranes are loosened, while others feel only a bit of discomfort during the procedure. You can bleed a little afterwards, which is normal.
When your cervix is shortened and the cervix is approximately 2-3 cm dilated, the labor can be induced by rupture of the membranes.
When the membranes break and some of the amniotic fluid begins to flow, the pressure in your uterus will change. This allows the baby´s head to move downwards and force the cervix to open. When the membranes have been ruptured, you will stay in the department. Often contractions will start spontaneously within a couple of hours after rupture of the membranes. If not, the induction of labor is continued by administering hormones intravenously to stimulate contractions.
There is a small possibility that the umbilical cord can be squeezed or that bleeding from the placenta occur, when the membranes are ruptured. This is why we monitor the baby’s heartbeat during the induction.
Inducing labor by balloon catheter
If it is not possible to rupture the membranes, a balloon catheter can be inserted through the cervix. A balloon catheter is very thin, made of rubber and can expand like a balloon on the end.
The catheter will be inserted through the cervix during a gynecological examination. The balloon is afterwards filled with water, in order to put pressure on the cervix. This will make the cervix dilate and make it possible to rupture the membranes.
The catheter will fall out by itself, once the cervix starts to dilate. If it has not fallen out within 12 to 18 hours, the midwife will remove it and immediately after rupture the membranes.
It can fell a bit uncomfortable to get the balloon catheter inserted. In very rare cases and if the baby’s head is not well engaged in the pelvic, the catheter can change the baby’s position in the womb.
If you do not wish induction of labor
If you do not wish to have your labor induced, we will help you with an alternative plan. Talk to the midwife and physician about your possibilities.
When you meet for induction of labor
We always strive to abide to the scheduled appointments. However, labor cannot be planned so you might experience some waiting time. In rare cases we have to postpone your induction to the day after. This will only be the case, if the physician assesses it safe for you and you baby to have the induction postponed.
We therefore recommend that you bring reading material, computer or such, and maybe something to eat. You will find water, tea and coffee in the department, and otherwise you can visit the café or 7-Eleven on the ground floor.
There is free wifi at Rigshospitalet
Covid-19 test before induction We ask you to have a test for Corona virus before induction of labor. The test can be made in Rigshospitalets clinic in Ryesgade 51-53. You can arrange the date with the doctor or the midwife when you get the date for induction.
The department is open round the clock and we are looking forward to see you.