During a routine visit with my midwife five days before my due date, I was told I had sudden, through-the-roof high blood pressure. At first I didn’t believe it—I felt fine and was on my way to lunch with a friend. I made my midwife take it four times before we agreed there was a problem. Instead of a leisurely lunch with my pal, I was told to collect my overnight bag and my husband and rush to the hospital to be induced.
It turns out I had pre-eclampsia (also known as gestational hypertension), a condition characterized by high blood pressure and sudden or excessive swelling caused by a malfunctioning placenta. Induction may also be required if your waters break but labour doesn’t start, or, the most common case, if you go past your due date. (If you’re overdue, the timing of induction will depend on your age, health issues—like high blood pressure and diabetes—and the standard practices at your hospital.)
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“We don’t generally do inductions to make a delivery date more convenient,” says George Carson, an obstetrician in Regina. But women who live in rural areas without a hospital nearby may be offered a scheduled induction to ensure baby’s safe arrival. “I’ve also done them for women whose partners were in the military and being stationed overseas, but that’s an extenuating circumstance. We’re interfering with a natural process, so we have to balance all the risks and benefits to determine that the mother or baby—or both—would be better off with the baby delivered.”
That’s because triggering labour comes with its own set of complications. Women who are induced have higher rates of intervention during delivery, including requiring a vacuum, forceps or even a C-section. Doctors don’t know if this is due to the induction process, or the underlying issues that cause an induction to be necessary, but either way, the decision isn’t taken lightly. (The induction rate in Canada is around 20 percent, which means about one in five women are induced.)
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If you do have to be induced, your practitioner will first assess your cervix. (Due to your now higher-risk delivery, if you have a midwife, your care will usually be transferred to an OB/GYN, but many hospitals will allow your midwife to continue to assist with labour and delivery.) If your cervix hasn’t started to shorten or soften, you may be given prostaglandin, a hormone applied directly to the cervix in the form of a gel. Alternatively, some hospitals use a Foley catheter, a balloon-like device that’s inserted into your vagina and inflated to stretch your cervix. The next step is an IV drip of Pitocin, a synthetic version of the hormone oxytocin, which will stimulate contractions.
It’s a fairly straightforward process, but most moms who’ve been induced will tell you it isn’t easy. Many experience a more painful delivery because the induction process quickly initiates stronger and more regular contractions, compared to natural labour where they have the chance to ramp up slowly.
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“It took two rounds of gel, then a Pitocin drip that went on forever,” says Toronto mom Nicole Manek, who was induced a week past her due date with her son, Leon. “And then I didn’t deliver until two days after we started—and it was a C-section.”
My daughter, Matilda, arrived 21 hours after I was admitted, with the help of an episiotomy and forceps. It wasn’t quite the careful delivery plan I’d crafted with my midwife, but for me, an induction was definitely required.
“A natural, spontaneous labour is always what we want, but sometimes induction is necessary,” says Carson. If it means safely delivering your baby (and possibly protecting your health, too) you can’t really argue with that.
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A version of this article appeared in our October 2014 issue with the headline “A little push,” p.67.