Category: Pregnancy

If your doctor or midwife has recommended labor induction, you may want to consider asking whether it would be appropriate for you to try some natural, non-medical methods of induction before moving on to medication. There are many ways to induce labor, but none of them have been proven consistently effective, and some aren’t safe to try at home. Any method you are interested in should be discussed with your doctor or midwife, prior to attempting. Never try do-it-yourself techniques unless you are full-term and have your doctor or midwife’s approval due to the increased risk of possible serious complications.

Sexual intercourse may not necessarily induce labor, but it may be helpful in preparing your body for labor. Semen contains a small amount of the hormone prostaglandin, which is used in the synthetic form of gel or a suppository to medically induce labor in the hospital many times. Prostaglandins help ripen the cervix, making it softer and thin out (efface). On the other hand, it’s questionable whether semen actually contains enough prostaglandins to have any real affect on the cervix. Also, having an orgasm may bring on a few contractions, because they produce the hormone oxytocin (which your body produces during labor to make your uterus contract). On a side note: don’t try intercourse to speed up labor, if your water has already broken.

Walking may not bring on labor, but it uses gravity to put pressure on your cervix and encourages your baby to descend down into your pelvis, which will lead to thinning and dilation. Exercise in general is good for you, as long as it’s not strenuous and you don’t over-do it. An added benefit is it may also help contract your uterus.

Nipple stimulation can sometimes start labor. Rolling or massaging the nipple and areola produces oxytocin, which in turn causes contractions. You can do this yourself or it can be done by your partner. You can even use a breast pump to stimulate your nipples. For this method if induction, it must be done over a period of time, for approximately 15-20 minutes each hour until contractions begin (if they begin). The problem with nipple stimulation is that the contractions can be very strong, much like contractions produced from Pitocin and therefore you run the risk of stressing your baby. This method should not be done without the supervision and/or knowledge of your doctor or midwife.

Castor oil is many times used as a strong laxative. By stimulating the bowels it may also cause uterine contractions, although it will more likely cause severe diarrhea, painful cramping and may possibly lead to your baby passing meconium before or during labor. Plus, the taste is very unpleasant. Enemas also tend to have the same effect, causing bowel contractions to stimulate the uterus.

There are a number of herbs which are thought to be useful for labor induction. Some of these include: black and blue cohosh, evening primrose oil, red raspberry leaf tea, cumin tea and goldenseal. The safeness and effectiveness of these herbs remains unproven, therefore they should not be taken without the recommendation and supervision of your doctor or midwife.

Acupressure , acupuncture, bumpy car rides, certain foods (such as spicy foods, eggplant parmesan and pineapple), visualization or self-hypnosis and relaxation or stress-relief techniques are all some other methods thought to possibly induce labor.

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The question of labor induction is really about weighing the benefits against the possible risks. If you’re having medical problems or your baby’s health is in danger, induction can begin labor at a crucial time. When the benefit is convenience, most doctors and midwives would advise against it. If done properly, and by a doctor or midwife who has carefully considered your situation, it can lead to the safe delivery of a healthy baby or allow timely treatment of a baby who needs medical assistance. Your doctor or midwife will recommend inducing your labor only when he or she believes that the risks to you and your baby of continuing the pregnancy are higher than the risks of waiting for labor to begin on its own. It’s important to clearly discuss these issues with your doctor or midwife. If the induction is being done for non-medical purposes then the benefits of induction may not outweigh the risks.

The most common risk you face if you’re induced is that the induction won’t work (after about 24 to 48 hours ) and you’ll need a cesarean. There is an increased risk of cesareans associated with labor inductions, particularly with first-time moms, whose risks increase by two to three times. Pitocin (synthetic form of the hormone oxytocin) use substantially heightens this risk of needing a c-section during labor. Due to the fact that Pitocin may make your contractions too strong, which can put stress on your uterus and on your baby, at which point your doctor or midwife may decide that a cesarean is necessary. There’s no sure way to know whether you’ll need to have a cesarean in the event that you’re induced. Discuss your concerns with your doctor or midwife, to identify any risk factors that could make a cesarean delivery more likely for you.

Such techniques as Pitocin and prostaglandin gel can occasionally hyper-stimulate your uterus (because of the stronger, more powerful contractions they tend to bring on), which can lead to possible uterine rupture and placental abruption, particularly if you’ve had a previous cesarean or uterine surgery. A recent study found that between 15 – 25% of women who received Pitocin, experienced uterine hyper-stimulation, the rates depending on the dosage amount given. In addition, the stronger, more painful contractions (which are also typically longer in duration) that these forms of induction may cause often leads to pain medication use that may not otherwise be needed. Epidural rates are much higher for women who’s labors were induced.

The more powerful contractions brought on by certain methods of induction can limit blood flow and oxygen supply to the baby, leading to drops in the baby’s heart rate. You’ll need to have continuous electronic monitoring during an induced labor to assess both the frequency and length of your contractions as well as your baby’s heart rate, because of these risks, which may restrict mobility. Also, induced labors are often longer (as well as require longer hospital stays typically), require stricter bed rest and may require an internal monitor, which further restricts mobility. Labor inductions many times also mean administration of IV fluids.

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There are several different ways to induce labor. The methods your doctor or midwife uses will ultimately depend on the condition of your cervix. Your doctor or midwife will check to see if your cervix is getting soft, thinning out and opening up (effacing and dilating). If your cervix hasn’t yet, then it’s considered “unripe” and not ready for labor. In that case, your doctor or midwife may insert medicine containing the hormone prostaglandin close to your cervix to help it along before the induction. Quite often, your doctor or midwife may break your water soon afterwards to jump-start labor. Many times oxytocin will be given through an IV to start contractions and help them to get stronger and regular. Hospitalization and close fetal monitoring are mandatory during a labor induction. Inductions are often done overnight for women whose cervix isn’t ready to go into natural labor, while other times when a woman’s body is ready to go into labor, induction may not take long at all.

Stripping (or “sweeping”) the membranes is one induction procedure that is often done in your doctor’s office and then you are sent home. This is basically an aggressive pelvic exam where your doctor or midwife manually separates your amniotic sac from the lowest part of your uterus (or cervix), by inserting a gloved finger and “sweeping” it in a circular motion around the inside of your cervix. Stripping the membranes is supposed to stimulate the release of prostaglandin hormones to bring on contractions. It is believed that labor starts as a result of this procedure typically within a few days, although it may need to be repeated before labor develops and no one knows if this is just coincidence or the result of the stripping. Many times this procedure is uncomfortable and sometimes brings on cramping and spotting.

Many times during an induction, your doctor or midwife may help your cervix to become soft and pliable to move things along. This is often done by having a prostaglandin medication (gel or suppository) placed in or near your cervix, often more than once. Dinoprostone (Cervidil or Prepidil ) is a common prostaglandin gel used to soften the cervix. Cervidil is typically given in the form of a removable vaginal insert, with a retrieval cord and resembles a tampon. Prepidil is typically given in the form of a gel, sometimes smeared on the cervix. Some doctors use Misoprostol (Cytotec) to induce labor, however it’s a controversial method and is more riskier than Prepidil and Cervidil, due to the increased possibility of uterine hyper-stimulation and uterine rupture, as well as fetal distress. So far the FDA has not approved Cytotec for use to induce labor, only for treatment of ulcers. Cytotec is typically given in the form of a tablet inserted vaginally near the cervix or a pill ingested orally.

Another common technique for labor induction is rupturing the amniotic sac or “breaking your water” (amniotomy). If your cervix is very ripe and ready for labor, this alone might get your contractions going. Your doctor or midwife uses a small hook instrument (that resembles a crochet hook) to make a hole in the amniotic sac, during a pelvic exam and it’s not generally uncomfortable. This causes the amniotic fluid to begin leaking out, which usually brings on contractions within hours. Once your water has broken, most doctors and midwives will want you to deliver within the next 12 to 24 hours because the risk of infection for you and your baby increases over time. Breaking your water should only be done if your cervix is starting to dilate and your baby’s head is firmly engaged in your pelvis, which reduces the risk of cord compression or cord prolapse, leading to decreased or stopped blood flow to your baby.

If prostaglandin medication and/or having your water broke doesn’t get labor well on it’s way, your doctor or midwife may decide to give you oxytocin (Pitocin) intravenously (through an IV) to produce uterine contractions. Pitocin is a synthetic form of oxytocin, which is a hormone that your body produces naturally during labor to make your uterus contract. The amount of Pitocin used depends on how your body accepts it and the levels are generally slowly increased until the contractions reach the desired strength and frequency, about every 15-30 minutes. A low-dose that allows at least 30-45 minutes between dose increases is best. If you start contracting well enough on your own, the medication may be decreased or shut off, which is less painful for you and easier on your baby. Many women (80% who’ve had Pitocin) say that it causes more intense, more painful contractions that last longer and many times have double peaks.

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For most pregnant women, labor starts spontaneously and there is no need to interfere with the natural progression of events, from the first contraction to birth. If labor doesn’t start on it’s own naturally and you and your doctor or midwife decide it’s not a good idea to wait any longer, they may use certain interventions (techniques and/or medications) to “induce” your labor to start artificially. These interventions cause uterine contractions to begin or your cervix to ripen and dilate, so you can deliver your baby vaginally.

When induction of labor is being considered, your doctor or midwife should fully discuss your options with you before any decision is reached. This should include explaining the procedures and care that will be involved and whether there are any risks to you or your baby. During the induction of labor, your contractions, your blood pressure, how well your cervix is dilating, as well as your baby’s heart rate will be monitored carefully.

Labor induction is an increasingly common procedure, with over 20% of births being induced (or about 1 in 5). This is a large increase from 1989, when only about 8% of all live births were induced (or close to 1 in 10). Inductions for non-medical (often convenience) purposes are the main reason for this rate increase. The pressure to schedule births for reasons of convenience (women, as well as their doctors) has resulted in growing numbers of “elective inductions”. Ideally, labor is induced when the risks of prolonging the pregnancy are more serious than the risks of delivering the baby right away.

The most common reason for induction is when a pregnancy has gone 2 or more weeks past the estimated due date, which is often called “post-term gestation” or “post-date pregnancy”. Most studies have shown that it’s safer, in these instances, to deliver the baby at this time instead of waiting for labor to begin on its own, due to increased risks including possible uterine infection, decreasing amniotic fluid, stillbirth, aspiration of meconium, ossification of baby’s skull (making molding of the head during birth difficult or impossible) a very large baby (called “macrosomia”) and heightened chances of needing a cesarean.

Your doctor or midwife may also recommend induction if your pregnancy is complicated by a health condition that presents a risk to you or your baby, including high blood pressure, diabetes, severe preeclampsia, kidney or lung disease and serious infection.

There are a number of other reasons that induction may be offered or recommended: if you have placenta abruption, the placenta is not functioning properly, you have a small pelvis (and delivering a large baby vaginally may be impossible), your baby isn’t growing properly (IUGR), your baby’s heart rate has abnormal patterns, there’s too little fluid around your baby, your water breaks and your labor doesn’t start (often called “PROM”, which poses a risk of infection), you develop a uterine infection (“chorioamnionitis”) or you’ve had a previous full-term stillbirth. Induction under these circumstances may be your best option.

Other possible (non-medical) reasons for labor induction include: prior history of rapid labor (which heightens risk of an unplanned home birth), living a long distance from a hospital, your doctor or midwife will be unavailable for an extended period of time; possibly on vacation near your due date and you’d rather not take the chance of getting the on-call doctor, as well as special family circumstances (such as partner going on military leave, etc).

Back to Labor Stages

During the third part of the longest stage of labor, your cervix dilates fully to 10 centimeters, usually quickly. Your contractions are powerful and effective at this point, making this phase relatively short. They may be 2-3 minutes apart and last for up to a minute and a half, although sometimes they become so close and last so long that they feel as though they never completely disappear. When this happens, you may barely have time for a breath before another contraction starts coming on. It’s still not too late to ask for certain pain medications, although it is for some. Ask your doctor, midwife or nurse what options are still available and safe, if you decide you need pain relief.

Transition

Physically, you may feel exhausted and down-right worn out, especially if you’ve been in labor for a long time. You may feel a lot of lower back and rectal pressure, as your baby’s head applies pressure on the perineum and rectal area. This pressure may cause you to have a strong urge to push, which you need to tell the nurse, because you may very well be fully-dilated and ready for your baby to come out. Hold back, though until you’re told that you are in fact fully-dilated, because pushing before it’s time can cause you to tear or swell, making delivery more difficult. Try panting or blowing through contractions to keep from pushing.

Bleeding from your vagina may become heavier as more capillaries in your cervix rupture and your legs may tremble uncontrollably, feel cold and crampy at this point. You may feel shaky and shiver all over now, which is normal. You may experience nausea, as well as vomiting and chills one minute, but sweat the next (hot flashes).

Women typically go through several emotions during this phase and it’s not uncommon to have mood swings, since this is the most emotionally challenging part of labor. You may experience increased irritability and feel overwhelmed, as well as panicked, crying easily. Lots of encouragement is needed now from the support person or partner. Thankfully, this phase of labor is usually very brief.

Keep changing positions frequently, if you are able. Continue doing your breathing exercises and concentrate on getting through one contraction at a time. Distraction at this point, such as t.v. or the radio may be irritating as you try to concentrate. Soothing music may be a relaxing alternative. A cool washcloth on your forehead may be helpful, as well as continuing to suck on ice chips or sipping on water.

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