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how to induce labor naturally February 18, 2010

Posted by guinever in : doula, labor, pregnancy , comments closed
creative common license http://farm4.static.flickr.com/3295/3059144058_f467d2261d.jpg

photo by emifaulk

The information I offer here is for informational purposes only and should not take the place of medical advice from your doctor or midwife. These are all well-known ways to encourage contractions to start.

eat spicy food to get those contractions started

Why it works: anything that gets your digestive system humming can also stimulate the uterus since they’re right next to each other. The spicier the better–mexican, thai, chinese. There’s even a famous Eggplant Parmigiana available at Scalini’s Italian Restaurant in Georgia that is “guaranteed” to bring forth a baby within 48 hours or mom-to-be will get a gift certificate for another meal.  Over 300 moms have had babies after eating the parmigiana.  You can make it at home following the  recipe posted at their website.  I’ve made it a couple times and it is super yummy, yet quite time consuming to make.

walk to encourage labor contractions to start

Why walking works:  Braxton hicks contractions usually start when you’re walking. The more you have, the more prepared your cervix will be when labor starts.  Walk often. Walk fast. If it’s too hot or cold to walk outside, and you don’t have a gym membership, go to the mall or other indoor building where you can walk safely and comfortably.

make love to help labor start

Why sex works: The prostaglandins in semen help to soften the cervix, the vital first step in the cervix getting ready for labor, before the cervix even starts dilating. Oxytocin, one of the hormones that is involved in labor, is released during a woman’s orgasm.

nipple stimulation to start contractions

Why it works: the same reason as above; oxytocin is released. You can either use a breastpump or have your partner do it.  This can be tedious; it must be done for hours to induce labor. However, doing it for just a few minutes can be beneficial if combined with other techniques. Alternately, you can get in a deep tub of water and let the water stimulate your nipples.

acupressure points

If you can’t get to a professional massage therapist, you can find the points at home. . You’ll know you have the point right when you find a tender spot that hurts. Apply pressure for about a minute at a time. Apply as much pressure as is comfortable. It might sting a little.

induction massage

Go to your favorite massage therapist or find one who specializes in pregnancy and induction massage. It will feel good. Your therapist will help you to relax as well as stimulate the uterine points. It’s best to think about going into labor during the massage. If your body is ready for labor, an induction massage might just work for you.

Read things to consider before doing a labor induction at the hospital.

coming soon: inducing labor with herbs, homeopathics, castor oil, and primrose

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think twice, no think three times before being induced for labor April 11, 2009

Posted by guinever in : birth, labor, pregnancy , comments closed

bag-of-pitocinMy pregnant readers often ask if I think they should be induced.  After reading each scenario, my usual thought is, “No.”  But that is a decision to be made by a woman after discussing it with her medical care provider. If you’re interested in natural labor induction methods, go here.

Read “Don’t let this happen to you”  part 1 and part 2 written by a labor nurse all about a birth that started with an unnecessary induction.

Questions to consider before saying yes to induction:

  1. Will my health be compromised if I continue my pregnancy?
  2. Will the baby’s health be compromised if I just wait for labor to start on its own?
  3. What will happen if I don’t induce today, tomorrow or next week?
  4. Why does the doctor want to induce? Is it for his/her convenience or is it for the health of me and my baby?

Consider this:  50% of inductions in first-time mothers result in a cesarean birth. Yikes!  That’s half. The over-all cesarean rate in the U.S. is currently 31% according to the CDC (Center for Disease Control and Prevention.)

The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States.

Not all inductions are bad or unwarranted. If you have a medical condition such as very high blood pressure, diabetes (not gestational diabetes), pre-eclampsia, an induction is desirable. An induction should be considered only when mother or baby is in danger if the pregnancy continues.

Common non-medical reasons for induction

  1. Doctor is going on vacation
  2. Doctor wants to do all his deliveries during the day and not get called in the middle of the night. He wants to control the timing of your labor.
  3. Doctor gets paid more for a surgical birth than for a vaginal birth.
  4. It’s the last week of December and the couple wants to be able to claim the new baby as a deduction on their taxes.
  5. Couple’s parents are in town for the birth and so they “need” to induce before they go back home.
  6. Mom wants to plan her birth so she can time her maternity leave for work.

So why do many inductions end in surgery?

It’s because the body just isn’t ready for birth. The cervix isn’t ready to dilate. If you’re nearing your due date and you or  your doctor wants to induce, please consider the bishop score which takes into account baby’s position, and the dilation and effacement of the cervix. You can take this short 5 question quiz based on the Bishop score to see if being induced might work for you.

7182_pitocinHere’s an all too common labor scenario:  Mom can’t handle the high doses of pitocin so her blood pressure goes up. This affects the baby. Mom gets the epidural because she can’t handle the contractions on pitocin. The epidural makes the labor slow down, so the pitocin is increased. Afterall,  she can’t feel the contractions anymore. Baby increasingly gets worse and worse until a cesarean is needed to save the baby. Mom is worn out and can’t take care of her baby who is having trouble breastfeeding because he’s so lethargic from the drugs that crossed over the placenta.

induction 101

If your cervix is really soft, you might get to skip this first step and just go to the hospital in the morning. But if your cervix is hard like the tip of your nose, you’ll be asked to come in at night and you’ll be given a prostaglandin on your cervix for the purpose of softening it. Some women are able to sleep through the night. Other women feel contractions and are uncomfortable enough that a good night’s sleep is impossible. By morning, your cervix should be nice and soft and ready for the next step in the induction. How long does it take the cervix to dilate 5 centimeters?  But first, let’s answer the following question:

what’s a prostaglandin?

cervidil_10825_5_big_Naturally occurring prostaglandins are in semen. Therefore, you can have all the prostaglandins you could ever need and want in the comfort of your own home. The best way to soften your cervix is to have sex with your husband several times during the last month of your pregnancy.

There are two chemical prostaglandins approved by the FDA for the purpose of inducing labor. They’re the pge2 type and they’re cervidil which is similar to a tampon that is inserted and then can be pulled out and prepadil which is a gel that is rubbed onto the cervix.

But there’s another prostaglandin that’s a lot cheaper than the two mentioned above.  It is not approved by the FDA for labor.  It’s called cytotec and it is used in the treatment and prevention of stomach ulcers. But because it is a prostaglandin and it’s cheap, doctors started experimenting with it to see if it would work during labor.  To quote a labor nurse,

Cytotec turns the cervix to mush. It works really well.

Another name for cytotec is misoprostol. Here’s the FDA fact sheet on misoprostol. Cytotec should not be used during labor; it can over-stimulate the uterus at the least and cause death of mother and child at the worst.

so what happens if you say no to induction?

Wait. Be patient. It’s hard sometimes; I know. Be aware of baby’s movements. Continue your pre-natal visits to monitor the baby’s health and your health. If everything is ok, be confident in your body’s ability to birth your baby. Your body has grown and nourished your baby for nine months and still can. Labor will start. No one was pregnant forever.

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Katherine’s birth story: cervadil induction, natural birth January 21, 2008

Posted by guinever in : birth, birth stories, birth story, health, labor, midwifery , comments closed

Thanks to Katherine for submitting her birth story. In her words, she was committed to an un-medicated, un-managed, natural birth, but was also birthing at a big university teaching hospital, albeit with a team of very cool midwives. She and her husband took a Bradley® class, followed the Brewer diet, did yoga once a week, and walked 2-5 miles per day.

41 weeks along in my pregnancy

On Thursday, my 1-week postdates checkup, I had borderline low amniotic fluid levels (which increase the chance for a “cord accident” and are an indirect marker of potential placental insufficiency, which can both be serious complications) with 1 cm dilation and 50% effacement, so the midwives wanted to induce me the next day. As I suspected, they “don’t do inductions on the weekend,” but I didn’t want my son to be born based on the hospital’s scheduling practices. I got them to agree to give me an extra day to research and think and see if labor would start on its own.

inaAfter reading in Ina May’s Guide to Childbirth that low amniotic fluid was a reason that Ina and the other midwives who work with her would transfer to the hospital, I decided it might be serious, and I’d better see what I could do to get labor started. I got acupuncture twice, did nipple stimulation, sucked my thumb to stimulate an acupressure point on the roof of my mouth that helps get contractions going and helps them be stronger once they do start, visualized and told my cervix to efface and dilate because the baby needed to come out.

an induction with cervidil

By Friday night when I went in for what I was hoping was just a check, I was still 1 cm, but 75% effaced and having small contractions every 10-15 minutes. I was thinking I’d be told, “Yes, you’re in early labor. Go home.” No such luck. The midwife and nurse weren’t convinced I was in early labor and told me that I needed to start a cervical ripener in preparation for a pitocin induction the next morning. The midwife inserted cervidil at about 8:30 p.m. I was still pressing the acupressure point in my mouth and chanting in my head for my cervix to efface and dilate. By 10:30 p.m., the nurse had decided that maybe it was real labor after all. I remember the nurse kept asking me to rate the pain of contractions on a pain scale, and I went from, “Oh, maybe a 1.5″ to “That was…mmmm, a 3.” to “Um, 4?” The nurse said at one point, “Are you sure that was only a 4?” and I told her that I was trying to save the bigger numbers for later. My husband said I never went higher than a 5, although some of the contractions were pretty painful. For the most part,

I would say that labor wasn’t so much painful as it was all-consuming. It’s like being in the ocean and being carried up and down in huge waves. If you give in, accept it, and ride out each contraction, it’s not so bad. But if you tried to avoid it, I am sure it would be more painful.

I did a lot of ‘vocalizing’, i.e. moaning like a zombie or mooing like a cow, and that helped dissipate the intensity of the contraction and kept me breathing. Or, I would be quiet, but trace the outline of a cabinet door with my eyes or stare at a speck on the floor as a distraction from the contraction. My husband talked me through a lot of contractions too, putting up with me saying, “No touch!” or “No talk!” for some of them. He called our doula to come be with us sometime in the dead of night, but I don’t really remember when…

laboring in the tub, floating like Ophelia

The Cervidil fell out (it’s on a little string like a tampon and is supposed to stay in for 12 hours) at about 2:30 a.m., and the midwife found that I was 6 cm dilated. My first question was, “Do you have to put it back in?” to which the midwife and nurse both started laughing, “No, you’re in labor and progressing well.” My next question was, “So, this means I can go in the tub now?” Thankfully, I was able to have the rest of my labor in the deep whirlpool tub they had in the bathroom, floating like Ophelia and dozing between contractions,then flipping onto my hands and knees for mooing and pelvic rocks when one was starting.

pushing

After some indeterminate time (being in labor is really an altered state of consciousness, and I had no idea about time except when I looked at the clock and marvelled that it was so late at night), my doula recognized that I was getting pushy and asked for the midwife to come in. I had noticed that the contractions felt different, like I was being wrung like a dishrag from the inside out, but I didn’t recognize it as transition. I thought some part of my BRAIN would say, “Wow, I really have the urge to push.” But in a homuncular version of a laboring woman, the head is about the size of a cherry tomato, and the abdomen is the size of a VW bus — there is nothing intellectual about birthing a baby.

The midwife listened to one contraction (think yodeler being strangled, and that’s the noise I was making) and told me to get out of the tub NOW (they are not certified to do water births at the hospital). She checked me and said I was fully dilated except a little lip of cervix that she pushed back.

I pushed in a number of different positions for about 2 1/2 hours, changing when it seemed right to squat or kneel or lunge, made more primal noises, but did the final pushing on my hands and knees, smelling coffee and marvelling that I could see daylight through the venetian blinds. My son came into the world easily and gently with some minimal guidance and lots of encouragement from the midwife, nurses, my husband, and my doula.

analyzing my birth

I feel really lucky that my labor was not too fast, and not too long either, and that I never felt the need for drugs. I am glad I had a midwife who literally sat on the couch drinking a cup of coffee until it was time to catch the baby. And she told me just what I needed to hear, “

You’re doing a great job working with your body. Remember that half of pushing is molding the baby’s head, so even if it doesn’t feel like anything is happening, you’re doing a tremendous amount of work with every contraction.”

I am also lucky that after pushing, I came away with a minor skin tear, but no terrible damage to my anatomy. I think pushing for 2 1/2 hours gave the tissues a lot of time to stretch, and the midwife was really good at telling me to push and hold, push and hold, so the baby came down really slowly.

I managed (somewhat awkwardly) to flip from my hands and knees to sitting up, passing my leg over the umbilical cord and having the baby handed to me, wet and warm, by the midwife. The first thing he did was poop all over me, but I didn’t even notice until later. I was just amazed that he was finally HERE, that he was so big (8 1/2 lbs, 21″ long), but so little, and that he’d just come out of my body, that I’D DONE IT! I’d had the un-medicated, unhurried, relaxed, un-traumatic birth that I had hoped and prepared for!

After the cord stopped pulsing, the midwife clamped it and asked my husband if he wanted to cut the cord. At first, he declined, afraid that he might hurt me or the baby, but the doula, nurse, and midwife all said, “C’mon, neither of them can feel it. Just do it,” so he did. Severing the umbilical cord strikes me as kind of a funny ritual, like the human equivalent of a ribbon cutting ceremony at a library or a new shopping mall. I think new fathers are encouraged to do it so they can feel like they really had their hands in the birth process in some active way. I kind of wished that they had waited longer, but I was in a bit of a daze and not really capable of speaking up at that point. I felt kind of loopy, almost like I was stoned.

After my placenta came out (I’m pretty sure the midwife asked if she could give it a little tug to help it along, and at that point, I figured she knew best what to do), the medical staff got down to business. I had a little 1st degree tear that the midwife stitched up while the nurse helped me try to get my nipples perky so the baby could latch on. The stimuli from the stitching and this motherly but energetic L&D nurse trying to help me was a bit much, but the babe latched on like a champ and the repairs were done soon enough.

Aside from the family practice doctor coming in to check the baby over and take his height and weight, some hard pushes from the L&D nurse on my uterus to make sure it was involuting (shrinking) and checks that I wasn’t bleeding profusely, they left me and my husband and our baby son in relative peace, free to stare at each other and be totally amazed that in just nine months, a being who didn’t exist had come into being inside my body and made his way into the world.

postscript

As it turned out, the amniotic sac didn’t burst until three contractions before my son came into the world, there was plenty of fluid, and the placenta was perfect. I could have waited for labor to start spontaneously… In the final reckoning, though, with all the negotiating between my desires and hospital “standards of care,” I am glad that I got to give my son what I consider the best birth we could possibly have had, given the setting and the small, but real, possibility that we could have ended up with a true complication.

Thank you, Katherine for submitting your birth story for other women to read.

You can submit your birth story too; please click here for guidelines.

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