When you meet at the ward to start induction of labour, the midwife starts by
making sure that both you and your fetus are well.
This is done by initiating a so-called CTG where the fetal heart rate and the
contractions of the uterus are monitored for at least 20 minutes.

A vaginal examination will be performed by the midwife to assess cervical length, dilation, and the position of the head in your pelvis. Based on an overall
assessment, we plan the further course in collaboration with you.

When the time of birth draws closer, the cervix ”matures”, which means it gets softer. The cervix starts to open a little.

Induction of labour can be done in several ways:

• Maturation of the cervix with the hormone Misoprostol.
• Rupture of membranes - i.e. the amniotic sac is ruptured and the
  water breaks.
• Starting intravenous administration of medicine to stimulate contractions.
• Insertion of a balloon catheter.

If the cervix is immature and you have not previously had a Caesarean section, the recommendation is to induce labour by using the hormone Misoprostol. In this case it can take 2-3 days or maybe more before you are in active labour.

The purpose is to shorten cervical length and to start dilation to make it possible to rupture the amniotic sac.

When cervical maturation is achieved, it is possible to rupture the amniotic sac using a thin plastic tool to allow an amount of the amniotic fluid to be released. It may be slightly uncomfortable, but it will not hurt you or your baby because the membranes do not have nerves.

When the membranes are ruptures, the labour process has started.
We strive that you have delivered within 18 hours, because there is a small risk of infection when the water has broken.

If there are no spontaneous contractions some hours after rupture of membranes, you are offered intravenous medicine to stimulate contractions. The amount of medicine is gradually increased until the contractions are strong enough.

The fetal heart rate is monitored closely by CTG during induction of labour.

Facts about CTG

Two elastic belts are placed around your stomach to secure the two transducers registering the fetal heart rate and any contractions. The results of these registrations are shown as two curves on a screen.

If the cervix has started to dilate the fetal heart rate can also be monitored by attaching an electrode onto the fetal scalp.

The condition of the fetus is determined on the basis of these CTG curves.

There are several reasons for choosing to place a balloon catheter.

• If you have previously had a Caesarean section, labour cannot be induced by Misoprostol.
• If the midwife is unsuccessful rupturing the membranes despite treatment with Misoprostol for several days.
• If you do not wish to be treated with Misoprostol.

The balloon is a thin flexible catheter inserted through the cervix and then filled with water; the balloon expands and puts pressure on the cervix. This treatment is normally not painful.