R Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Morgan, did you your absolutamente best 对, Pupula. Yes. Thank you. That's fine. Let me just get the don't wander if you can 되는 you can't, 10. Having her � her leg. Don't and children when you pass 42 weeks of pregnancy and therefore it is recommended to give birth before 42 plus 0 among all uncomplicated pregnant women. The start-up will typically be between 41 plus 3 and 41 plus 6. Some others are in a state of pregnancy that makes the start-up recommended earlier. It can be that you have passed 40 years or you have had a BMI before your pregnancy at over 35. It can also be that you have diabetes in pregnancy, that you are pregnant with twins, that you have a pregnancy-related liver clot, blood pressure rise in pregnancy or pregnancy poisoning. There can also be other considerations to take when we plan the start-up. In these cases, we will often make some individual assessments of when the best time for the start-up is. If you are in doubt about why you are recommended for the start-up, you should ask your midwife or doctor. When you enter the birth control, we will offer you a midwife consultation, just as you know it from your own midwife. This means that we will feel your stomach, check your blood pressure and urine and hear how you are doing in general. In addition, we will run a baby heart rate test. It is a bit like when you have experienced with your midwife that you are listening with a doptone, so this is just a little over a little longer time and gives us a better insight into how the baby is doing. It takes about 20 to 25 minutes. In addition, we will make sure that the baby is still with the head down. We do this by putting a small mini scanner on your stomach. It looks mostly like a small mobile phone and can't do much else than give you an answer on whether the baby is with the head or the nubis down. Then we talk more about what kind of plan you are considering for the last part of the pregnancy. And to assess the best, we offer you to examine you internally to examine how long your uterus is and to open your uterine mouth if possible. It can also be that we offer you a hindrance solution. I will explain a little more about what it is. It is important for us that you already before you come to this visit have made some considerations about what you could think and what you imagine about the last part of the pregnancy. And then of course we guide you individually and according to the examinations we make. In general, one can say that the procedures can be of very different types. Some take a short time and others take longer time. So for the first time you should have a really good amount of patience and expect that the pregnancy can last several days. In general, it can be said that the more you bleed and the shorter and the more open the uterus is, the easier it is to start the pregnancy. The more patient the body is simply to get started with the pregnancy. A pregnancy will also often be a combination of different methods of pregnancy and I will probably go through them a little later. In general, it will be so that in connection with the beginning of the pregnancy, you spend more time in the hospital than if the pregnancy had started by itself. And therefore, the pregnancy can feel longer. Depending on what cause there is for the beginning, most of us will experience that we will overwork the baby to some extent during the pregnancy. It is not always that it should be all the time. We have such a heart rate curve on, but it will be to a greater extent than if the pregnancy had started by itself. Therefore, it is not always that you can experience that it is possible to get into a pregnancy under the pregnancy. In some cases, you can do it during the period of the pregnancy, but probably not during the entire pregnancy. Therefore, it will also be so that you cannot recommend pregnancy at our birth clinic. There are single exceptions and you should just ask your midwife about them. It will also be so that there is a greater probability that you will use a V-stimulating drop in connection with the pregnancy. So that is the recommendation. And it is so that we cannot recommend that your pregnancy goes longer than 42 weeks. But it is also a suggestion. And if you do not want to follow our recommendation, we offer a little extended control program. And we do this to make sure that both you and the baby are doing well. The most important thing is that you still notice your baby as you usually do throughout the period. Moreover, when you are about 41 years old plus 6, we will offer you a scan of the baby. And we do this to assess how big the baby is. Because we know that if the baby becomes very big, it can cause some complications in the pregnancy. Moreover, we will also measure the amount of breast milk that can help us assess that the baby still has it well. We will also offer you some extended uterine control where we run a heart rate curve to make sure that the baby still has it well. In general, it will be so that we do this 2-3 times a week as long as the pregnancy has not started, we will offer you some extra controls. We also check your blood pressure and your urine to make sure that you do not develop pregnancy. In this slide, I have taken the starting point in that you do not want to start after your date of birth. If you are recommended to start for other reasons and do not want to start, we will make an individual control program that suits you. In the following, we will talk a little about how we start a pregnancy. When we are going to evaluate how your pregnancy starts, it is important to evaluate the pregnancy as a whole. Are you the first child or have you been born earlier? Have you previously had a uterine cut and thus have a stomach that we should consider? We want to investigate internally to examine your uterus and your uterine mouth. The longer the uterus is, the more it affects the way we start the pregnancy. The uterine throat, especially the one you see in the picture here, will be 3-4 cm long and be fixed in its structure and closed, and this makes it to hold on to the pregnancy. In the last part of the pregnancy, the hormones will make it soft, shorten and pull away a little, and the uterine mouth may also start to open a few centimeters and become ready for the birth. The way it is is up to you to decide which way you would recommend the pregnancy to start. The methods we have for starting the pregnancy are, for example, the hand solution. We can use a medical start-up. Then you can prick holes in the forearms. Some of you may have heard that we take the water. Then you can use a V-stimulating drop and something called a balloon catheter, and we will go through that now. A hand solution is not a regular start-up method. It is more like a tool that can push the natural processes the body is starting with. To make a hand solution, the uterine mouth is required to be strong enough to get a finger up on the baby's head, and then you move your finger around between the forearms and the lower part of the uterine mouth. When you do that, you create a natural release of prostaglandins, which is a hormone that stimulates the birth process. The effect of the hand solution is scientifically investigated and shows that when you make a hand solution, it increases the likelihood of you going into labor by yourself. You can experience, in connection with the hand solution, that it is an uncomfortable examination and that you get some strong menstrual-like pain in connection with this. Some will also experience that you get some contractions that you think are worse, but that go away again. You may have applied for the hand solution already during your last uterine visit or when you have been in the last uterine and medical check-ups. If you have any questions about this, you should ask. In Denmark, we have used the misoprostol product Angusta for more than 10 years to start the birth process. The active ingredient in Angusta is misoprostol, which is a hormone, a prostaglandin, that helps to dilate and shorten the uterine mouth, which stimulates the baby's head. If the uterine mouth is long and tight, it is an advantage to make it thinner and shorter. You will therefore be offered Angusta if the uterine mouth is long and preserved, and especially as a first-time birth, it can be an advantage that the uterine mouth is thin and that we use some time to thin it before we move on to other methods of start-up. How quickly you react to the medicine is very different and can last up to several days. The pills should be taken and taken with two hours interval until the baby starts to breathe and you must take at most 8 tablets per day. It is very important that you take Angusta after our given guidelines and you will be very well guided by the midwife who starts you up. If you are initiated with Angusta, you will get a schedule at home with information on how the medicine should be taken. There can be side effects from the medicine and some women will experience nausea, diarrhea, headache and dizziness. Some will also experience green foxtail and increased bleeding after the birth. Green foxtail means that the baby has had some discharge at some point in time in the water and it means that we keep an extra eye on the baby during the whole birth. In very, very rare cases, you can be overstimulated with Angusta so that the midwife can miss it. Now we are talking about numbers that are so rare that it is less than 1 in 10,000 women who experience this and we therefore consider Angusta to be a very safe preparation when we start our birth. It is important that you take the medicine according to the scheme you have been given. If you start to get a fever, you can call the midwife before taking the next tablet. Then you can, in cooperation with the midwife you are talking to, agree on whether to take the next pill, wait to take the next tablet or possibly come to the midwife for a checkup. All this ensures that you do not get too many fevers and that everything goes as it should. If you experience too many fevers in connection with Angusta, then we have some medicine that works muscle relaxants that we can give to just to get the baby to relax again. When you get the water, you poke holes in the foxtail so that the foxtail water can see. This can be the next step in the process of starting the process if you have already taken Angusta for a day or two, but it can also be the first method if the body already has the method in mind that it is what we consider the best way to start the birth. You use a thin plastic tool, it looks like a needle, which we use to poke holes in the foxtail. With the foxtail water going and the baby's head getting a little more pressure directly down on the lumbar mouth, you typically experience some fevers. After the water has gone, we typically wait for two to four hours before we do more. During this period, you can take a walk, move around a little, get something to eat and drink, and then wait and see if there are any fevers. So as long as you don't get fevers during this period, we recommend that the birth is stimulated further with a V-stimulating drop. The side effects you can experience in connection with us poking holes in the foxtail are a little extra unpleasant in connection with the examination. It can be that we have to pull a little more in your lumbar mouth, but even if you have poked holes in the foxtail, it doesn't hurt. There are no nerves in the foxtail and therefore it does not hurt you or the baby. A V-stimulating drop consists of salt water and a sytocin. Sytocin is a artificially produced hormone that mimics what the body produces to produce fevers. This is what we might have heard as oxytocin. A V-stimulating drop is used after the foxtail water has gone and is often used if you do not get fevers after the water has been taken or gone by itself. The drop is added to a small plastic tube that you put in your hand and then a pump is added. The pump allows you to control how much medicine you get. A V-stimulating drop starts at a low dose and then it increases gradually until you have fevers that are hypo and strong enough. You always have a heart rate curve, i.e. a CTG heart rate curve, on the baby when a V-stimulating drop is used. You can experience a fever, a headache, a headache and a slight increased bleeding after birth. Therefore, you can experience that the V-stimulating drop continues for a little while after birth. If you experience that you get too many V's from the V-stimulating drop, you can screw it down or close it completely. And in the last instance, we can also give some V-healing medicine if you get too many V's. A balloon catheter is a more mechanical way to moisten the uterus. You put a thin plastic catheter up through the uterus. You fill it with salt water and in this way you blow two small balloons up. As you can see in the picture on the slide, one balloon will lie up against the baby's head and the other balloon will lie inside the uterus. This way, you moisten the uterus while you are giving birth to a natural release of prostaglandin, the hormone that stimulates the birth process. The balloon catheter is often used as a lead in the birth process. Often, if you have used Angusta for a few days and nothing has really happened, you will tend to use a balloon catheter. It can also be that you have a C-section in the uterus and that the post-treatment with our doctor is the method you use to get it started. In most cases, you will remove the catheter after 12-18 hours. This is done by sucking the water out of the balloon and then the catheter slides out as a bar. The baptitrexation is to do what you have then Sometimes you will start to get pain while the catheter is in place and the catheter may fall out of its place. We usually remove the catheter 12-18 hours after the procedure is completed and then we can prick holes in the forearms afterwards. Some will experience discomfort and a little menstrual pain while the balloon catheter is placed and some will need pain relief. If you were born with a C-section earlier, we have slightly fewer methods for the initiation of the birth. We have this because there is a consideration for the arm in your uterus. It is recommended primarily to start the birth by pricking holes in the forearms. But if you are not brave enough to do so, a balloon catheter will be considered after you have just been in dialogue with our doctor. This is because the probability of the organ being damaged in the uterus increases from about 0.5% to 0.5% and therefore you will always consider which method to use in consultation with the doctor.