Labor Stimulation Methods

Posted in Homebirth, Pregnancy

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There are a few reasons why natural methods of labor stimulation might be considered.

PROLONGED PREGNANCY: generally, labor stimulation is not considered until close to 42 weeks and a careful, individualized assessment of the calculated due date. Several factors are considered: the circumstances of the individual case, any medical indications for labor induction, political repercussions in the medical community of waiting for spontaneous labor to begin, and your informed choice.

PREMATURE RUPTURE OF MEMBRANES (PROM): when the bag of waters breaks before labor starts, the interval between rupture of membranes and onset of contractions can vary considerably. Most people will go into labor within 24 hours of the water breaking. Circumstances are assessed carefully on an individual basis. If you are GBS+ and/or 24+ hours have passed with no contractions, labor stimulation techniques may be appropriate.

Medical or obstetrical problems or complications that would generally require supervision of an OBGYN are not appropriate indications for labor stimulation. These include evidence of fetal compromise, preeclampsia/toxemia, placental abruption, etc. For these situations, medical labor induction or cesarean will be necessary.

The following common reasons for medical labor induction are not evidence based:

ASSESSING THE BODY’S READINESS FOR LABOR

The first assessment that needs to be considered is your body’s readiness to go into labor. If the membranes are intact, an internal exam can provide useful information. The more changes the cervix has already undergone, the easier it will be to get labor going. The Bishop score is the most commonly used method to rate the readiness of the cervix for labor, and gives points to five measurements of the internal exam, including: dilation (opening of the cervix), effacement (thinning of the cervix), station (descent of the fetal head), consistency of the cervix (firm or soft), and position of the cervix (facing back or facing front). A Bishop score of eight or more means the body is close to going into labor on its own, and natural simulation methods or medical labor induction are likely to be successful in achieving a vaginal birth. A typical prelabor assessment of the cervix with a Bishop score of six would look like this:

Bishop Score

CERVICAL RIPENING

Before labor, the cervix is firm and feels like the tip of a nose in consistency. When it has ripened, it feels more like the tip of a tongue. Ripening decreases the cervix’s resistance to thinning and opening. A major component of the ripening process is the presence of prostaglandins, hormones which cause physical changes leading to cervical ripening and uterine contractions. All of the following methods can help the cervix to ripen prior to labor, and may lead to initiation of contractions.

For all methods of labor stimulation, do not insert anything into the vagina if your membranes are ruptured (including fingers, sex toys, penis, capsules, suppositories, etc.)! This can increase the risk of infection.

NUTRITION AND HYDRATION

Stay well hydrated and nourished to prepare for labor.

EXERCISE

Walking, biking, swimming, yoga, and stretching are great ways to stay fit and ready for 
labor. They can also help with relaxation and mental preparation.

AFFIRMATION, RELAXATION, VISUALIZATION, AND MEDITATION

These are particularly effective if you think stress may be holding you back. Many pregnant people discuss feeling anxious or nervous about the impending labor and/or taking care of their newborn. Some people feel stressed by finishing up loose ends at work, family members coming to town, etc. Whatever it is that may be holding you back, acknowledge it and let it go! Visualize your body smoothly initiating labor and opening to release your baby. Talk to your baby and tell them that it’s time to be born and that everything is going to be okay.

BELLY MASSAGE

Massaging the uterus through the abdomen can focus more energy on the uterus as well as physically stimulate it. You can also consciously channel your energy to the uterus and baby through your touch. Cup your hand slightly and separate your curved fingers. Use your entire hand to firmly massage the abdomen in a large circle, using your open fingers and pads of your fingertips to gently grab and knead the uterus as you go. Don’t be afraid to use firm pressure, but do not use jerky, abrupt motions or jab the belly with your fingertips. Add clary sage and/or jasmine essential oil to the massage oil for additional labor stimulating benefits (do not try these essential oils before 38 weeks!)

DATES

Eat six dates daily until labor begins. One study showed eating six dates a day “significantly reduced the need for induction and augmentation of labour, and produced a more favourable, but non-significant, delivery outcome.” This was not a randomized controlled trial, and it was only ONE study, but since eating dates is unlikely to cause harm I include it here for educational purposes.

SPICY FOODS

Spicy food stimulates the bowel, which can trigger labor in some people. This is not scientifically substantiated but worth a try!

RED RASPBERRY LEAF TEA

Red Raspberry Leaf is a wonderful reproductive system tonic, strengthening and toning the muscles of the uterus and pelvic floor. Drink throughout pregnancy for its tonic effects, and double the dose in the last weeks of pregnancy to naturally stimulate labor.

Labor StimulationOTHER HERBS

The use of herbs to aid labor and childbirth causes fewer side effects in parent and baby than pharmaceutical drugs. The energies of herbs harmonize exceptionally well with the energies of childbirth.

BLUE COHOSH ROOT (Caulophyllum thalictroides) is also known as papoose root. Blue cohosh encourages the uterus to begin contracting and increases the force of contractions.

BLACK COHOSH ROOT (Cimicifuga Rracemosa) is a member of the buttercup family. It is also called snakeroot. Black cohosh does not increase contractions. It is an antispasmodic and is taken to coordinate uterine contractions and make them more effective and to help soften and ripen the cervix.

GINGER ROOT (Zingiber officinale) focuses energy in the pelvis and increases the energy available to the uterus.

Consult with your care provider or an experienced herbalist to see if taking herbs for labor stimulation is right for you.

HOMEOPATHIC REMEDIES

The two most common homeopathics used to stimulate labor are Caulophyllum and Cimicifgua. These are preparations of Blue and Black Cohosh (the Latin names are used in the homeopathic remedies). Another remedy sometimes used is Pulsatilla. Check with your midwife or an experienced homeopath about how and when to use them.

SEXUAL ACTIVITY

Oxytocin is released during arousal and orgasm and might lead to uterine contractions. Kissing, hugging, petting, clitoral stimulation, and using a vibrator are all effective and pleasurable ways to promote oxytocin release, help you feel loved and supported, and open up the cervical sphincter. If you enjoy penis-in-vagina (PIV) intercourse, sex can also help stimulate labor due to the prostaglandins in semen. Prostaglandins are hormones which cause physical changes leading to cervical ripening and uterine contractions. If your bag of waters is broken, do not put anything into the vagina. This includes fingers, sex toys, or a penis.

BREAST AND NIPPLE STIMULATION

Stimulating the breast causes oxytocin release and subsequent contractions. Grasp the whole breast with one hand in a C-shaped position. Gently, but firmly, massage and knead the breast down towards the areola and nipple. Roll the nipple in your fingers firmly and then start over again from the top of the breast. The time it takes for labor to get rolling varies tremendously among people, with some going into labor quickly and others taking up to several hours to establish an effective labor pattern. Start with 1-2 hour sessions several times daily. You can use a manual or electric breast pump or your partner or a nursing baby can suckle to accomplish the same thing.

CHIROPRACTIC ADJUSTMENT

A chiropractic adjustment can be helpful in releasing tension in the lower back, opening the pelvic joints and ligaments, and helping a posterior baby to rotate to anterior. All of these can help labor to begin. Find a chiropractor here.

ACUPUNCTURE

Certain points on the feet, legs, hands, and back may stimulate cervical ripening, fetal rotation, and labor contractions. Find an acupuncturist that has experience working with pregnant people and feels comfortable helping you stimulate labor. Find an acupuncturist near you through the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

ACUPRESSURE

The following acupressure points are excellent for cervical effacement and ripening, encouraging descent and rotation of the fetal head, and stimulating contractions (do not try them before 38 weeks!) For all the points, apply steady pressure (unless otherwise indicated) for 10 minutes, then rotate with other points.

Legs and Feet:

Upper Back and Hand:

Lower Back:

SWEEPING OR STRIPPING THE MEMBRANES

Stripping the membranes is more of a medical procedure than a natural method. It is done at your provider’s office and involves doing a vaginal exam. If the cervix is dilated at least 1-2 cm, your provider will insert two fingers and slide them around just inside the cervical opening to lift the bag of waters away from the uterine wall. This cervical manipulation can cause release of prostaglandins leading to cervical effacement and ripening. One out of eight people will go into labor within two days. Disadvantages are that it’s uncomfortable and invasive, your provider could possibly rupture the bag of waters accidentally, and frequently it leads to very uncomfortable cramping that doesn’t progress into labor.

CASTOR OIL

Castor oil ontains prostaglandin precursors, causes intestinal mucosa to release prostaglandins, and stimulates the bowels, which begin to contract and cause diarrhea about 1-2 hours after ingestion. The bowel activity is believed to stimulate the uterus by sympathetic response. The usual dosage is two tablespoons initially with apple, grape, or cranberry juice, followed by another tablespoon 30 minutes later, and a final tablespoon one hour after that. You can also mix castor oil into smoothies or ice cream shakes using the same dosing protocol. Castor oil is generally reserved as a last resort because it is a very unpleasant way to go into labor. It may cause severe diarrhea that can lead to dehydration, so make sure you are well hydrated before trying this method.

EVENING PRIMROSE OIL

Evening primrose oil contains prostaglandins which may help to ripen the cervix. The oil can be applied vaginally or taken orally. Many midwives and parents swear by this method, but some studies have shown an increased incidence of early rupture of membranes and longer labors. For these reasons, it should be a last resort. Consult with your care provider about whether evening primrose oil is right for you.

*****  If you are not a client of BirthRoot Midwifery, please consult with your midwife or doctor before trying any of the above labor stimulation techniques!!!
If you are a client of BirthRoot Midwifery, talk with Sandra about these methods before trying them to see which ones will work best in your situation. ******

FETAL SURVEILLANCE

Your care provider might offer you extra fetal surveillance and monitoring while you are waiting for labor to start. These tests are to see how your pregnancy is going and to check the health of you and your baby . A non-stress test and/or biophysical profile might be offered 1-2 times weekly while you are waiting to assess for problems or complications that would indicate a need for medical labor induction.

Non-Stress Test (NST): performed using an electronic fetal monitor either at your provider’s office or in the hospital. In order to get a positive result, or what’s called a reactive NST, there must be at least two accelerations, or increases, of the fetal heart rate within a 20-minute period. A reactive NST is considered to be an excellent indicator of fetal well-being in the 3rd trimester because a fetus must receive adequate oxygen and other nutrients through the placenta and be neurologically healthy in order to have accelerations of their heart rate.

Biophysical Profile (BPP): ultrasound that looks at four parameters to determine fetal well being: fetal tone, gross body movement, breathing movements, and amniotic fluid volume. Each parameter can get a score of 0 or 2 with 8/8 being reflective of a healthy baby. The BPP is often combined with the NST to give a combined total score of 10. In that scenario 8/10 or 10/10 are considered to reflect healthy babies without evidence of compromise. Equivocal (ambiguous) scores would be 6/8 or 8/10. This can happen if the baby is sleeping during the test or if you are dehydrated. The best thing to do is go home, drink lots of fluids, rest, and eat really well. You can ask your provider to repeat the test in another day or two to see what happens.  A negative score would be less than or equal to 4/8 or 6/10. This reflects a compromised baby, and you should discuss medical labor induction with your care provider.