Saturday, September 25, 2010

Natural Methods of Labor Induction

As an alternative to the traditional hospital route for induction, many modern mom's are looking to the past for tried and true old-fashioned methods of induction. Natural ways to induce labor may be chosen for many reasons, such as avoiding invasive medical ways to induce labor or for maternal or fetal risks that have medical induction on your care provider's mind.

It's important to note that none of these methods for inducing labor at home will work if your cervix is not ripe. These methods may help ripen your cervix-making it soften, efface and dilate.

It is also extremely important for me to remind the reader that before any at home method of induction is tried mom should be at least 40 weeks and needs to discuss it with her care provider before she attempts it.

The methods I discuss are: Sex, Food, Nipple Stimulation, Castor Oil, and Acupressure. 


Sex is not necessarily associated with starting labor but may help to ripen the cervix. Semen is the highest source of prostaglandins. Prostaglandins cause the cervix to "ripen", or soften and prepare to open. Sex can help the cervix to dilate and efface by depositing these prostaglandins on the cervix.

Furthermore nipple stimulation may also have a role in that it is known to release oxytocin, the hormone that causes contractions.  In addition, orgasms produce oxytocin.   So, between these factors, there is a pretty good case for the stimulation of labor.

As an alternative to intercourse, you might consider collecting semen in a condom, a diaphragm or an Instead cup to hold the semen against the cervix. An Instead cup is designed for use during menstruation, but theoretically could be used in this manner.

Studies about the effectiveness of sex starting labor are very few. And it should be noted that nothing should enter the vagina once the bag of water has ruptured.  However unappealing sex might sound at 40+ weeks pregnant, it can for many be a better option than a pitocin induction at the hospital.


In every female circle their are women who swear to have the secret to starting labor. Which is often eating X Y or Z. Often times it's an extra spicy dish that they claim brought them face to face with their baby.

Unfortunately, the statistics are out on this one - there is simply not enough research to support that any foods are effective in inducing labor.

Many women have sworn the following are foods that will induce labor:
  •     Pineapple
  •     Spicy Foods
  •     Chinese Food
  •     Eggplant Parmesan
  •     Licorice

The most well-known of these would have to be spicy foods, like hot peppers or any other spicy Mexican dish. What the research is now showing is that these foods may be something to avoid prior to labor.

This is due to the fact that certain spicy foods release capsasins, which may be counterproductive in labor. When the baby descends down the birth path, the pressure exerted releases endorphins into the woman's body. These endorphins are a natural pain-killer. In effect, the capsasins counteract the endorphins and rob the mother of her natural ability to have a pain-free birth.

The Eggplant Parmesan was also in vogue for a time. While this dish may have been contributing to labor, it is probably not due to the eggplant but rather to the seasonings in the dish. Both basil and oregano are herbs contraindicated in pregnancy due to their potential ability to start labor.

Pineapple is not supposed to induce labor, but rather is thought to be a cervical ripening agent that stimulates prostaglandins, although this has not been proven.

Licorice, real licorice candy, the black kind, is thought to also stimulate the production of prostaglandins. This is due to the chemical, glycyrrhizin. Eating lots of licorice might also result in mild diarrhea, which causes intestinal contractions that may lead to sympathetic uterine contractions. This type of licorice can also be found in tablet form. Again, no definitive research suggests that licorice can induce labor.

When looking for foods that induce labor, only consume them if they are something you normally select. There's just not enough evidence to say they work for certain, and in some cases they may cause more harm than help. 

Nipple Stimulation

Using nipple stimulation to induce labor has been practiced by women for centuries. It is one of the most effective at-home induction methods there is. This stimulation brings about the release of oxytocin, which is the natural form of pitocin. Oxytocin causes contractions, which can lead into true labor. It's important to note that this will only happen if your body is already close to labor. As with all natural labor induction techniques, don't attempt this until you are over 40 weeks.

This practice is often recommended by midwives when a woman is long past due or when labor is stalled.  This can be done manually or with an electric breast pump.

When this is performed, the uterus sometimes becomes hyperstimulated, meaning that it gets too little rest between contractions, so use caution and consult your practitioner first.

Here is a guide to help you understand the process:
  1. Only massage one breast at a time.

  2. Grasping the areola, rub in a circular motion until a contraction begins. It's important to mimic the suckling action of a baby.

  3. Stop after the contraction begins.

  4. Wait 15 minutes, then repeat.
Stop using nipple stimulation  if the contractions are 3 minutes apart or lasting 1 minute or longer.

Castor Oil

The theory behind using castor oil to induce labor is that it causes intestinal cramping and diarrhea, which stimulate the uterus, thus producing prostaglandins, which then cause contractions.

Are there risks in using castor

There has been much debate over whether castor oil will cause the baby to pass meconium, or its first bowel movement.   If the meconium is aspirated, or inhaled into the lungs, it can lead to aspiration pneumonia, which can be fatal or lead to serious developmental delays.Meconium is deemed a signal of fetal distress. However, research has been conducted that has found no increased occurrence of meconium staining with this type of induction.

The mother, however, can be at risk of dehydration due to the resulting diarrhea. This tires the mother and less able to endure through physical activity. It could also potentially endanger her milk supply. Also, if effective diarrhea can make labor a less pleasant experience. I recommend using extreme caution when taking castor oil, and of course consult your practitioner first.

How do I take it?

The usual dose is 2 tablespoons.  However, I strongly advise against taking it straight-you may not get it down. It's pretty nasty stuff. If you do pursue using castor oil for labor induction, take it in the morning after a good night's sleep. If taken at night, you most likely will not sleep due to the resulting diarrhea.

Here are some recipes to make it more palatable:
  •     Put it in 3-4 oz. of root beer, shake vigorously, and then gulp it down.
  •     Add a couple of scoops of ice cream to the castor oil and orange juice.
  •     Scramble it with 3 eggs.
  •     Drink the oil straight followed immediately by hot apple juice
As an alternative to using castor oil to induce labor, you may use evening primrose oil to naturally ripen the cervix. It is an excellent source of prostaglandins. It comes in a softgel that can be taken orally or inserted vaginally before bed. Oral use can start as early as 34 weeks and cervical application at full term.The recommended dose is two 500mg capsules per day. At full term you can add two capsules vaginally before bed, at which time the entire capsules will dissolve.


Using acupressure to induce labor is one of the most pleasant methods of natural labor induction. It is similar to using reflexology to induce labor or even going to the chiropractor for an adjustment.

To use acupressure as a method to induce labor, there are two pressure points that can be stimulated to produce contractions.

They are located:
  •     In the webbing of your thumb and index finger.
  •     Four finger-widths above the inside of your ankle bone.
To stimulate the first pressure point, pinch the webbing of your hand and rub in a circular motion for 30-60 seconds at a time, taking a 1-2 minute break in between contractions.

For the latter point, press firmly on the spot. It should feel sore if you've found the right spot. Press and rub in a circular motion until you have a contraction. When the contraction is done begin again.

Both pressure points can also be very helpful in progressing a long and slow labor.

Monday, September 20, 2010

All about Induction Part 3 - Pitocin

By far the most commonly used drug on the maternity floor, Pitocin is a drug used to start labor contractions or increase their intensity. I doubt many women in America have deliver a baby in the last decade who haven't at least heard the word. Pitocin, for better or worse has become a part of childbirth in American hospitals. 

What is Pitocin?

Pitocin is a synthetic oxytocin.  Oxytocin is a hormone that a woman's body naturally produces that cause contractions to begin.  When oxytocin isn't doing the job to get labor going, for whatever reason, then hospitals frequently use pitocin to get this process started.  This medical intervention is usually used in order to get labor started and to speed up the labor process.

When a woman's body makes oxytocin, it is secreted in bursts.  This creates a natural flow.  When pitocin is administered in a hospital, the woman has to be placed on an intravenous pump that gives her a steady flow of pitocin.  These contractions are quantitatively and qualitatively different than the ones she would experience on her own.

Benefits of Pitocin

  • Pitocin does tend to make labor shorter. This is a huge bonus for many women exhausted by labor.
  • Using synthetic oxytocin to stimulate labor if the membranes have been ruptured has cut down on infection rates.
  • Contractions can be "controlled" by adjusting the dose of medication.
  • Can be vital in helping stop excessive bleeding post birth, and can assist with placenta delivery. 

Drawbacks to Pitocin

Risks of Pitocin:
Contractions tend to be more painful and the mother is more likely to request pain medication or an epidural
Pitocin needs to be given by IV and the mother/baby will have to be constantly monitored, which makes it much hard to move around
Increases the chance of having a ruptured uterus
Increases the chance of the baby being in a bad position for delivery
Baby is more likely to have a depressed fetal heart rate pattern
More likely to need a cesarean
Increases risk of fetal distress, because there is less oxygen availableThe choice to utilize pitocin is a personal, and often controversial one. It is not a decision to be taken lightly, as it does carry significant risks, however it can also help women avoid infection and C-Sections. Be sure to talk openly with your care-provider before your birth about how and when he or she typically uses pitocin. If it is suggested as an option during labor, feel free to ask about alternatives so you can explore all of your options and make the best possible education decision.

*The information expressed here are my own views and are not intended to be substituted for medical advice. 

Tuesday, September 14, 2010



What is Cervidil?

Cervidil is the trademark name that Forest Laboratories, Inc. uses for prostaglandin E2 vaginal insert. It is a small rectangular pouch with a retrieval cord that looks similar to a tampon. It is inserted into the vagina.

Prostaglandin is one of the chemicals that play a part in ripening the cervix. A ripe cervix is soft and stretchy, ready to respond to uterine contractions. When given vaginally, cervidil may help to ripen the cervix.

Why choose Cervidil?

Cervidil is used to "ripen" the cervix when it is agreed that your baby is safer to be born than to remain in the uterus. Cervidil is the first step in a two part induction process when the cervix is not ready to respond to contractions.

Cervidil may increase the activity of non-productive contractions when no other labor stimulation agent has been used.

Cervidil allows the mother to use the medication for the prescribed amount of time an then remove it. In some cases a mother may be able to go home after administration to wait for labor to start. More often she will be admitted and the Cervidil will be administered overnight.

How effective is Cervidil?

Because prostaglandin E2 helps to make the connective tissue of the cervix more pliable while also stimulating contractions, it is more effective than synthetic oxytocin at inducing labor. The rates were similar for women giving birth within 12 hours, but more women had given birth within 24 hours with prostaglandin and the difference is even more pronounced at 48 hours. In addition, the rate of instrumental vaginal delivery is lower with women induced with prostaglandin E2.

This data sheet on Cervidil offers information from research trials about its efficacy.

Risks of using Cervidil

Risks for Mother

* Gastrointestinal effects such as nausea, vomiting and diarrhea.

* Small risk of uterine hyper stimulation.

* Requires continuous monitoring of baby's heart rate which decreases mobility.

* Another form of prostaglandin E2, Prepidil, cannot be removed if hyper stimulation occurs.

Risks for Baby

* Uterine hyper stimulation can cause abnormal fetal heart rate.

My Opinion

It's no secret that I am not a big fan of unnecessary induction. I really believe that most babies will come the exact time they are meant to and in most cases I lean towards trusting nature over science. With that said in times where induction is necessary Cervidil is a good option to get things going. I have often seen in used in conjunction with Pitocin (stay tuned for my Pitocin post). Typical administration is to inject the Cervidil and if contractions haven't started or increased to productive in 12 hours, add Pitocin. I always encourage Mom's to talk with there care providers and indpendlty research all of your options before labor and delivery begin.

Prostaglandin also occurs naturally in Seamen, and will be discussed further in my natural induction methods post.

Goer, Henci. The Thinking Woman's Guide to a Better Birth. 1999. New York: The Berkley Publishing Group.
Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.

Tuesday, September 7, 2010

The Bishop Score - How you can decrease your chance of having a C-Section

This is my first post in a series about induction.

What is a Bishop's Score and How Does it Relate to Inducing Labor?

It amazes me how many inductions are scheduled with out any mention of the bishop score. This is system which places numeric value on factors such as effacement, dilation, cervical position, station, etc. to provide a guideline to determine how effect an induction would be in resulting in a vaginal delivery. Obtaining a bishop score is painless, and takes virtually no time, since your physician or midwife is likely doing vaginal exams anyway. It is my opinion that before any elective induction is schedule the bishop score should be discussed. Read below to find out how they are determined and check out the C-Section rates for the various scores.

A Bishop's Score refers to a group of measurements used to determine whether a woman may have a successful vaginal delivery and whether labor ought to be induced. Bishop's Score is based on station, dilation, effacement, position and consistency.

Station is a term used to describe the descent of the baby into the pelvis. An imaginary line is drawn between the two bones in the pelvis (known as ischial spines). This is the "zero" line, and when the baby reaches this line it is considered to be in "zero station." When the baby is above this imaginary line it is in a minus station. When the baby is below, it is in a "plus" station. Stations are measured from -5 at the pelvic inlet to +4 at the pelvic outlet.

Dilation is measured in centimeters, from 0 to 10. Your cervix is fully open and you should be able to push when it is dilated to 10 centimeters. Occasionally, a physician will measure dilation in "fingers." Dilation often begins days or weeks before labor actually begins. At first, the progress may be very slow. Some women may be dilated 2 to 3 centimeters long before labor. Once active labor begins, you will begin to dilate more quickly.

Effacement refers to the softening and thinning of the cervix. You won't feel this happening; it may only be measure with a vaginal exam. Effacement is measured in percent. When your cervix is normal, it is considered to be 0% effaced. When you're 50% effaced, your cervix is half its original thickness. When your cervix is 100% effaced it is completely thinned out and you are ready for vaginal delivery.

Position refers to the positioning of the cervix. If the cervix faces front (anterior) it is more favorable, while posterior is less favorable.

Consistency of the cervix is measured on a scale of firmness from firm to soft. The softer the cervix is, the better the chance of vaginal delivery.

The Bishops Score generally follows this scale:

Score Dilatation Effacement Station Position Consistency

0 closed 0 – 30% -3 posterior firm
1 1-2 cm 40 -50% -2 mid-position moderately firm
2 3-4 cm 60 -70% -1,0 anterior soft
3 5+ cm 80+% +1,+2

A point is added to the score for each of the following:
Each prior vaginal delivery

A point is subtracted from the score for:
Postdates pregnancy
Premature or prolonged rupture of membranes

cesarean rates: first time mothers women with past vaginal deliveries

scores of 0 – 3: 45% 7.7%
scores of 4 - 6: 10% 3.9%
scores of 7 - 10: 1.4% .9%

Induction is generally attempted when a mother has a favorable Bishop's score. A mother may be given misoprostol, cytotec or prostaglandin gel to help ripen the cervix and improve the score. A score of five or less is said to be "unfavorable." If induction is indicated, the mother would be a candidate for a cervical ripening agent. These are usually introduced one or two nights before the planned induction. A score of eight or nine would indicate that the cervix was very ripe and induction would have a high probability of being successful.

Your physician can assist you in understanding and interpreting your own Bishop's Score.