Induction of labor after cesarean section

This information pamphlet is only relevant for women who have previously undergone cesarean section or other big operations on the uterus.


This information pamphlet is only relevant for women who have previously undergone cesarean section or other big operations on the uterus. 

Illustration of a red baby carriage

Inducing 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 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 that are induced.

You will receive a phone call from the midwife on duty on _____day the _____/_____. During this conversation you will make an appointment for induction of labor. We strive to make the call between 11 AM and 1 PM.

We kindly ask that you meet for examinations and planning of the induction of labor at Department 4022, entrance 4, 2nd floor on _____day the _____/_____at _____.
Your partner or another companion is welcome to join you. 

At the appoint, you will:

  • Receive information about the various ways to initiat 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
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?

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 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. 
 

Picture of a baby sleeping on a stack of towels

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 bleedings 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, to put pressure on the cervix. This will make the cervix open 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 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 postpone the induction.
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.

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