Thursday, February 26, 2009

Natural Induction of Labor

As a general rule, I try not to post things that I talk about in class. Otherwise, why take my class, right? But repeatedly, the topic of induction gets brought up as a mom approaches or passes that magical 40 week mark. I have determined that when couples are in my class, they are thinking, "That won't happen to me. I'll be early." By the time they are due, often 2 months later, they need a refresher. This is worth repeating, as the induction rate is about 90%.

I know you are sick of hearing me say to trust your body to start labor on its own. But, TRUST YOUR BODY TO START LABOR ON ITS OWN. Now that that is out of the way, what if you really are trusting your body, but you have a threat of induction from your doctor or midwife? As I've said before, your baby has no idea that you have a calendar with his or her "due date" circled in red pen. That same date is also circled on your chart at your doctor or midwife's office. If you have been given a handful of dates, always go with the latest date to buy you more time. You might have to push for it, but it's worth it.

Make sure you are clear about the policy your doctor, midwife, or hospital have on induction. How long will they let you go? It used to be 2 weeks, standard. Lately, I've been hearing 10 days. It keeps getting shorter and shorter. Push for the 2 weeks. Evidence is on your side. Really, the time where there is an increase of stillborn births is closer to 43 weeks, so 42 has been considered safe for years. We have become dangerously comfortable with inductions though.

Near your 40 week mark, your provider will likely want to do a non-stress test to monitor if you are having contractions and to monitor the movement and heartbeat of the baby. There is a wide variance of how long they will require you to do this -- anywhere from 20 minutes to 2 hours. An ultrasound will also likely be done to check the size of the baby and fluid levels. Remember, ultrasound can be off by 2 pounds either way as far as the size of the baby goes. (That is another topic for another day, but we'll get to it.) Just know that in the vast majority of women, despite what the doctor would like you to believe, it is OK to have a big baby.

When all of these things have taken place at once, it is referred to as a biophysical profile. This may be done a few times before you actually start labor.

Ways to start labor include:

1) Nipple stimulation
-- It releases oxytocin, which is the natural form of pitocin. Studies have shown it to be just as effective in causing the uterus to contract as pitocin, with the advantages being that it is free and natural. Your body, and baby, will tolerate these natural contractions significantly better than artificially induced contractions. If nipple stimulation does not bring on contractions, your body is not ready. It is foolish to think that an induction is a good idea at this point. Your doctor does not know more about when your body is ready to give birth than you do.

2) Sex. Not just regular sex, but orgasmic sex. Orgasm causes the uterus to contract. When combined with nipple stimulation, this is very effective. Extra bonus -- prostaglandins, which help soften the cervix, are found in semen. So the more sex, the softer the cervix becomes. This is how 2 of my babies were "induced."

3) Breast pump. You might try this if you have a good pump on hand, like a Medella. Try it every hour or so for about 10 minutes. You don't need to crank it up either. If it's going to work, it'll work at a lower, less intense suction.

4) Castor Oil. Ina Mae Gaskin is a fan of using castor oil, but I would have to be really desperate to go this route, like 41.6 weeks. I did this with our first baby and it was like having the flu in early labor. Throwing up and diarrhea is not how I pictured this exciting time. The idea is that it stimulates the bowels, which stimulates the uterus.

5) Stripping Membranes.
Again, not a fan. It's not a part of the natural process, yet if I were in the 41st week, I would probably think about it. A lot of midwives like doing this and will often suggest it, in my opinion, too early. Sometimes it's even done during a vaginal exam without the knowledge or consent of the mother-to-be. She might find herself bleeding a couple hours later and panic. Sometimes it works, and sometimes it doesn't, just like with anything else.

6) Acupuncture or Reflexology.
It's no secret that pregnant women have pressure points throughout their body that can stimulate and cause contractions. That's why, when getting a massage or pedicure, you need to see someone who is trained to recognize these points and work around them. Your doula will likely be familiar with these pressure points and can work with you.

7) Walking.
Normally I wouldn't list this as one of the methods of starting labor, but I feel that if I don't mention it, someone will think that I just didn't know about it! I laugh when I see women at the mall, obviously very pregnant, out for a power walk, trying to start labor. Walking will not start labor. It will help to keep it going and there are many benefits to walking in early labor but it will not start it. Don't tire yourself out with this method unless you feel up to it.

I do not believe in the artificial induction of labor unless there is a true medical reason to do so. We have gotten so far away from normality when it comes to labor starting on its own. Nurses are shocked when my students show up in labor to the hospital to give birth. I should mention that I have had a couple of students who went past 42 weeks, approaching 43 weeks, who never started labor on their own. Legally, their doctors wouldn't let them continue with the pregnancy and induced labor. It wouldn't be fair if I didn't mention that it does occur once in a blue moon (Dr. Bradley had 2 women remain pregnant for a year before giving birth!), but it is definitely an exception, not the rule.

There are medical ways of starting labor, but I'm not even going there. A woman is twice as likely to have a C-section when she is induced. Think about that for a moment. Why would that be? Simply because her uterus was forced to contract when it wasn't ready. But it's almost always too late to turn around. The parents are expecting a baby out of the ordeal, no matter how he or she gets here. The mother's bag of waters is likely broken. The doctor is just in too deep at that point and has to just get the baby out. Fetal distress in an induced labor is caused from one of two things: either the baby couldn't handle the pitocin contractions or he or she couldn't handle the drugs the mother had to take in order to deal with the pitocin contractions.

Pitocin is evil. Sex, combined with nipple stimulation, is the best way to go. Which would you rather choose?! It's a no-brainer. It's like I always say -- The same thing that got you into this will be the same thing that gets you out.


Autumn said...

What's really frustrating is being a mom who births at home, is very "crunchy", married to a chiro and yet the minute I hit 38 wks I'm thinking "where's the baby??!" Sex and EPO become my new best friends. I end up not enjoying the end of my pregnancies. Today I am 39wks 1day and I actually have a peace that I may not birth this baby for another week or more. We'll see how long that lasts ;)

BTW, do you know Dr. Eva Troha (chiro)?

Donna Ryan said...

I don't know that chiro? Is she in the DFW area?

Good luck with the end of your pregnancy. Enjoy every last minute of being pregnant. What I wouldn't give to be in your shoes and have the opportunity to give birth again!

Autumn said...

Eva Troha's practice is called Cornerstone Family Chiropractic. It's in the Arlington/Mansfield area. She was going to get her doula cert. but realized with a busy practice and 2 small children now wasn't the best time. She has had both of her children at home and is a great source for natural health advice. If you ever have clients struggle with breastmilk supply, she is a GREAT resource.

Christina Pond said...

Being someone who went 42 weeks, with a for sure on that "due date" I can honestly say sex and nipple stimulation really work!

Donna Ryan said...

I had a friend/student in Albuquerque who was due about 2 weeks before me on our last baby. She wasn't sure about her dates though. She was using a midwifery group at a local hospital, same one she'd used with baby #1. As her "due date" got closer, the midwives were really pushing her date and talking induction. She just didn't feel right about it though. She sought out our Licensed Midwife, Barbara Pepper (the greatest midwife ever!), and ended up seeing her for the last month of her pregnancy. She gave birth, at home, almost a month after the CNMs and hospital would have induced her.

james and andre'a said...

Hi There,

My brother and sister-in-law are in your ward (Ben and Tawny Kelly). They told me about your blog and I'm so glad I looked at it! I took the Bradley course with my first one (born at 42 weeks gestation, 9.14 pounds) and was blessed to have him naturally.

When we were facing an induction date, my midwife advised me to use Evening Primrose Oil gelcaps vaginally. They helped soften the cervix and started labor. It took 5 to get things going! Have you ever heard of that one?