You have gone past you due date
You will receive a call, when you are 9 days past your due date. The midwife will give you an appointment to the Admission Unit (Fødemodtagelsen 346) at Hvidovre Hospital when you are between 10 and 12 days overdue. At this appointment you will be assessed by a midwife and a plan will be made for the induction. But we may not induce your labour on this day.
How ripe is the cervix?
At the Admission Unit a midwife will perform a vaginal examination to determine the best method by which to induce labour. She will examine the length, consistency and the dilatation of the cervix.
The baby's heart rate will be monitored with a CTG monitor before you are given any pills. This is to ensure the baby's wellbeing prior to any intervention.
Why induce labour when the pregnancy is overdue?
Several studies have shown that there is an increased risk of complications for mother and baby if the length of pregnancy goes past 42 weeks (your due date is at 40 weeks).
For these reasons women in Denmark are recommended induction of labour in order to give birth no later than 42+0 weeks gestation.
Induction of labour is a plan offered to you. This means you are free to refuse induction of labour after you have been given the information. If for example you refuse induction when you have gone past you due date we offer the following check-ups:
- Ultrasound scan to check the baby's weight and the amount of amniotic fluid
Hormones to induce labour
We do not know exactly what starts labour, but we do know that some hormones (prostaglandins and oxytocin) are involved. They soften the cervix and stimulate contractions. How much or how little hormone is necessary is different in every woman.
Step 1 - Pills
When do you have to have pills?
If the midwife has examined you vaginally and determined that the cervix has not shortened significantly, is closed or only slightly open, you will be given pills orally to induce labour.
You will be given the pill to take. It contains a prostaglandin, the hormone misoprostol (Angusta).
If you and your baby are well you will be sent home with pills to take every second hour, if you don't have any contractions. You will be given an appointment to come back the next day.
Days 2 and 3:
Same assessment and monitoring as on day one. If the cervix has shortened considerably or has started to open, the midwife may decide that it is appropriate to break the waters.
At home you need to await the effects of the pills. You may eat and walk around, remember to rest. Some women do not feel any effects of the pills whilst others start to feel backache, period-like pain or even contractions. Even if you do not feel anything, it does not mean that the pills are not working
Step 2 - Breaking the water
When can the water be broken?
When the midwife examines you and determines that the cervix is almost or completely gone and your cervix is at least 2-3 cm open, it is time to break the membranes.
The membranes surround and contain the baby and the water (amniotic fluid) inside the uterus.
Protected by the midwife's fingers, a plastic device is inserted into the vagina. Through the cervix a small hole is made in the membranes. You may feel a small trickle or a big gush of fluid. When the water has been broken it will keep running out until your baby has been born, as more water will be produced throughout labour. We will provide you with sanitary pads during your stay in hospital.
As there are no nerves in the membranes it is not painful to have them broken. However, as the water is broken the midwife may need to keep her fingers inside the vagina until the baby's head is pressed firmly down against the cervix. This may take a few minutes and can be uncomfortable.
As the water is broken and some of the amniotic fluid runs out, the pressure inside the uterus changes. This may stimulate the uterus to start contracting. It is a good idea to be upright, go for a walk or just walk around in the hospital if you are able to. Moving your pelvis will cause more water to run out and create better contact between the baby's head and the cervix. Moving around in itself may also stimulate contractions.
Step 3 - Oxytocin drip
When do you get a oxytocin drip?
If you have not started getting contractions after the water has been broken or if the contractions are not strong enough to dilate your cervix.
Occasionally the pills have not been able to open your cervix enough for the water to be broken. In these cases, a oxytocin drip may be started before the water is broken.
The oxytocin drip is administered directly into the blood. For this reason, the midwife will place a thin, soft plastic tube into your hand or arm.
The bag of saltwater and oxytocin is connected to a drip counter which means the midwife knows exactly how much hormone you are getting. The midwife will increase the drip slowly so the contractions will increase in strength and frequency as it would if you went into labour naturally. The contractions will eventually become efficient and powerful enough to make your cervix dilate. The midwife will ensure that there are interval in between the contractions for you and your baby's sake.
Another option is to have a balloon catheter inserted. If on day 3 the neck of the womb has not shortened considerable and you cervix has not opened much, a soft rubber tube can be inserted into the cervix. Two small balloons, one situated inside the uterus and the other just outside the neck of the womb, are filled with water. The balloons, connected with the rubber tube, put pressure on the neck of the womb and the cervix causing them to ripen. You may walk and move around as you wish unless you have been advised differently. The balloon catheter will stay inside you uterus for 12 hours after which it is removed and you water will be broken. You may feel some discomfort having the rubber tube inserted.
Induction of labour can be a long process, lasting several days, so remember to be patient.
If we are very busy it may be necessary to postpone your induction. The decision to do so will be based on a medical assessment.
About the CTG
When you are given pills, the water is broken or you have an IV oxytocin drip, we want to monitor your baby's heart rate with the CTG monitor. C stands for cardio (heart), T stands for toco (contractions) and G stands for graphy (recording). The monitor can register you baby's heartbeat and your contractions and record it on a piece of paper. By looking at this the midwife can assess your baby's wellbeing and the frequency and duration of your contractions. The monitor cannot tell us how strong or painful your contractions are, only you can.
If the delivery ward is very busy on the day of your induction, you may have to wait for several hours.
We recommend you have a big breakfast before coming into hospital, you need the energy.
Pregnancy papers ("vandrejournal"), food & drink, book/magazine, toiletries, slippers/comfortable shoes, comfortable clothes.