In some cases, labor may need to be induced, in which case the body is helped in various ways to make the cervix soft and ready to open with the help of labor.

Causes of induction of labor

Perhaps you are wondering how a birth is induced if it does not start naturally? Labor can be induced for several reasons. For example, there may be reasons such as pre-eclampsia and gestational diabetes but also overweight and long waters. In healthcare, we call induction of labor.

The choice of delivery method depends on the maturity of your cervix, but also on whether there are any individual risk factors such as a previous caesarean section. The midwife or doctor will perform a vaginal examination to assess the direction and consistency of your cervix, how far the head has descended into the pelvic canal, how much of your cervix remains, but also whether the cervix has opened slightly. It may be that the fetal head is not fixed, or that your amniotic fluid has already passed. Depending on the results of the examination, there are different methods of delivery.

Commissioning methods:

- Medication using prostaglandins (can be taken by mouth or vaginally)
- Widening of the cervix with the help of a balloon catheter
- Pierce the amniotic membranes (amniotomy) and then pain-stimulating drip if necessary

If your cervix is very immature, labor is usually started with prostaglandin medication to help the cervix mature. The medication can be given repeatedly, and the midwife will assess whether you have contractions between doses and run a CTG to see that the fetus is doing well in your belly.

In order to bring in a balloon catheter You need to be open enough to insert the catheter (about 1-2 cm), but even here you may have to start medication because it does not feel mature enough. The midwife will then come and pull the balloon at regular intervals to make sure it is tight and pressing optimally on the cervix. The idea is that it should generate a similar effect on the cervix as the pressure from the fetal head would have done (but now may not be far enough down). When the balloon falls out, you are open about 3-4 cm and the induction is usually followed by the midwife then *piercing the membranes*. After a while, the midwife will examine you to evaluate the effect of the water release. If you have not gone into labor or opened spontaneously, you may be given a pain-stimulating drip. You may not go through all the steps described above, but it will depend on how your cervix reacts to each procedure and whether or not your amniotic membranes are intact. In some cases, you will open so quickly from the medication that the balloon catheter step will be redundant. Remember that these are always individual assessments and regional guidelines may differ.

One tip is to be prepared for the fact that a start-up can take time, sometimes a long time over several days. Therefore, try to bring things with you that can help you pass the time. Don't forget that the time you spend in the hospital before you are in active phase, you would otherwise likely have spent at home.

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