Induction of Labour with a previous Caesarean Section

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

Before inducing labour the midwife will examine whether you or 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

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 Oxytocin (see below). 

If it is not possible to rupture the membranes then a balloon catheter can be placed.

A balloon catheter 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 progresses.

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.

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 however a small risk that the umbilical cord can be compressed after the membranes have been ruptured or that the baby's head will 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.