Due-date come and gone? Looking to get labor started? Doctor mention the word 'induction' to you and now you are panicking that your body is "not doing anything"? Doctor telling you baby will grow too big if you go past your due date?
Beginning at 40 or 41 weeks, expect to undergo weekly, then twice-weekly, nonstress tests.
First of all take a deep breath. And another...
Your body is doing what it is supposed to be doing, growing a healthy baby. And I know you're probably really uncomfortable and very ready to meet your little one/s. As a birth doula and certified childbirth educator, I get asked all the time about "natural" ways to get labor started. So today we'll talk about non-pharmaceutical inductions.
In another blog post, I discuss Informed Consent. Remember, there are pros and cons to everything. It's important for you to be informed. And this is no different.
A lot of the things I discuss below are recommended by healthcare providers and many of the other methods need more testing in order to be proven affective but moms swear by them. Make sure to always discuss any natural induction you want to try with your healthcare provider first. If you decide to see an acupuncturist, herbalist, homeopathic doctor or massage therapist, make sure you go to a qualified expert and make sure they are knowledgable in pregnancy and labor aspects of their therapy.
Medical Reasons For Induction
Keep in mind that there are medical reasons for inductions such as cancer, hypertension, diabetes, kidney disease, a small-for-date baby, uterine infection, a decrease in the amount of amniotic fluid or an intrauterine death followed by a long wait for labor (don't freak, we are talking weeks, not days and chances are very low). If you are free from the above reasons for a medical induction keep reading.
What starts labor?
Recent research has suggested that labor actually begins when the baby’s lungs mature enough and secrete a protein called surfactant. Surfactant is essential for breathing outside the womb. The release of this protein signals a cascade of hormones in the mother telling the mother’s body to initiate labor. (Dr. Carole Mendelson, Dr. Jennifer Condon and Dr. Pancharatnam Jeyasuria, 2004). Also as the baby prepares and lowers in the mother’s body, it puts pressure on the cervix causing a release in the hormone, oxytocin. Oxytocin is a very important hormone for labor and delivery. It thins and dilates the cervix, causes contractions, and moves the baby down and out of the birth canal. It also releases breast milk and triggers nurturing and bonding feelings between mother and baby.
“There is a sort of chemical ‘combination lock’ that starts labor.
Everything has to be lined up just right to ‘unlock’ a good labor pattern. When we interfere with that, it can be as frustrating as using the wrong combination of numbers to open a locked safe.” — Midwife Gail Hart
Your due date is really just a guess date
Did you know that only about 5% of babies come on their due date?
No one knows exactly when your baby is going to tell your body that he/she is ready to be born. Try to trust in the wisdom of your body and the wisdom of the baby. No mater how many "natural" things you do to get labor started, if your baby is not ready, he/she is not ready...and labor won't start.
It's true that the normal range of maturity is between 38 and 40 weeks but did you know that your due date can be off by 2 weeks? That's because women's bodies don't follow exact mathematical timetables. It's based on a 28 day cycle and assuming that every women ovulates on day 14. You see, your estimated due date was calculated by identifying your first day of your last menstrual period, counting back 3 months and adding 7 days. BUT the length of menstrual cycles varies and so does the length of time a baby stays in the womb. Due dates are also determined by early 1st trimester ultrasounds.
The only pregnancies in which the approximate time of fertilization is known are In Vitro Fertilization (IVF) pregnancies. First time mothers giving birth on average deliver at 41+0 weeks or 287 days. Most moms go into labor anywhere from two weeks before or two weeks after their due date. So basically you can think of it as your due month rather than a due date. Be patient and take these extra days to spend time with those you love, nap, eat well and do things you love to do because as soon as the baby arrives, spontaneity will fly out the window and it will be all about the baby.
In 2013, however, ACOG redefined what it means for a woman to carry her baby to term, in an effort to prevent non-medically necessary inductions before 39 weeks.
- Babies born between 37 weeks and 38 weeks and six days are now considered "early term."
- Babies born between 39 weeks and 40 weeks and six days are considered "full term."
- Babies delivered between 41 weeks and 41 weeks and six days are considered "late term,"
- Babies born after 42 weeks or more are considered "post term."
Keep in mind that there are 6 ways to progress
A lot of women focus on the dilation and are devastated when their doctor or midwife says, "no dilation yet".
The cervix and baby need to do 6 things before the baby is born.
- The cervix needs to move from the back to the front (anterior position).
- The cervix needs to soften (ripens).
- The cervix needs to thin out (effaces).
- The cervix needs to dilate or open.
- The baby's head needs to mold, baby needs to rotate and tuck his/her chin.
- The baby needs to descend through the birth canal.
Just in case you're still wondering if you'll know if you're in labor or not...read this. Signs of Labor - What You Should Know If You're Pregnant
What to do?
First thing's first... wait till 40 weeks! And keep in mind that there are no "natural" inductions because you're still trying to do something to get labor started. It's always a good idea to talk with your doctor or midwife about "natural" induction methods especially if you are considering herbal remedies or nipple stimulation beyond normal sex play.
Do what makes you feel relaxed, open and loved. Please don't get obsessed with trying to get labor started or trying to force it to happen because your baby might not be ready and he or she may even become stressed. Trust me, your baby feels everything you're feeling emotionally so relax.
8 Natural Labor Induction Methods
1.) Nipple Stimulation
Nipple stimulation can help ripen your cervix and/or start labor because it increases oxytocin production. Oxytocin is the love - bonding hormone and it is also responsible for contractions. You see, you get a spike in oxytocin when you look into someones eyes, get a yummy hug, during sex and when you have an orgasm. I love oxitocin!
Here is the concern about nipple stimulation and why you need to get the okay from your healthcare provider, it can cause prolonged contractions (more than 60 seconds), come to frequently (more than two in ten minutes), or are to intense and painful. Plus the baby may not tolerate it. You may not want to try this if baby is high risk or you are high risk.
So how do you do it? One popular method is to apply warm compresses to your breasts and alternately stimulate each breast manually or using a breast pump for 15 minutes each until contractions begin.
Another, gentler method is to get into a tub of comfortably warm water. Soak a dish towel or washcloth in the water, and drape it over the breasts. Roll one nipple in your fingers, through the towel, for up to 15 minutes, or as long as it takes to make a contraction happen. When the contraction begins, stop the stimulation. After it ends, wait about 5 minutes before stimulating the other nipple, and repeat the process for an hour. Then, take a break for 3 or 4 hours, and begin again. Stroking, nipple rolling and caressing should be light.
You can also try:
- Caressing and oral stimulation by your partner. Use this if it feels good and is effective or until contractions become strong.
- Try nursing a borrowed baby. Suckling by a three-twelve week old baby is the most effective form of nipple stimulation. Make sure they are not hungry because they will get frustrated. They should be a little fussy because babies usually just want to suck and not eat. Allow them to suck for 10 minutes per breast. Sit on a water proof pad because your amniotic sac may rupture.
Again, talk with your healthcare provider before trying this.
2.) SWEEPING MEMBRANES / STRETCH & SWEEP
The procedure may also be called a stretch and sweep, because if a sweep isn't possible, your healthcare provider may still try to stretch or massage your cervix. Sweeping the membranes involves your medical care provider inserting a finger into the internal cervical opening and separating the membranes from the uterus wall near your cervix. This increases prostaglandin production. Prostaglandin is responsible for contraction of the smooth muscle of the uterus and the biophysical changes associated with cervical ripening.
A membrane sweep increases the likelihood that labour will start within 48 hours. You have a better chance if your cervix is already preparing for labor. A sweep can be performed on women who are at term and have no other complications, for example, placenta praevia. (A placenta covering the cervical opening).
Sweeping the membranes may be uncomfortable and painful for some women and other women have said they didn’t feel much at all. Some spotting or bleeding may occur as a result and some find they have irregular contractions after a sweep, which may be uncomfortable and still not progress into labor. Increased risk of infection (bacterial) and unintentional ROM breaking of amniotic sac (water bag).
3.) SEXUAL INTERCOURSE
I know the thought of sex right now can be the last thing on your mind but did you know that semen contains prostaglandins, which help soften the cervix? And a good old orgasm can help you relax and releases oxytocin so it's a two for one. Plus you and your partner won't be able to have sex for like 6 weeks after the baby comes, so it might be nice to connect sexually. I'm sure your partner will appreciate it. And no, his penis won't hit the baby's head. (I have been asked this questions a lot!). It's important for the man to ejaculate inside the vagina. Just enjoy it and forget about trying to start labor. Once won't cut it either.
If you can't bare the thought of intercourse, oral or manual stimulation of the clitoris, even without orgasm, may also be effective in starting labor. Keep in mind that intercourse, manual stimulation, and oral-genital stimulation should be done as long as the amniotic sac (water bag ) is still intact. Because once the amniotic sac has ruptured nothing should enter the vagina because chance of infection for mother and baby increases. If the amniotic sac has ruptured, you can still do clitoral stimulation. Sex should be comfortable for you and your partner.
4.) NATURAL PROSTAGLANDINS - herbal
- Borage oil, evening primrose oil, flax seed oil, and black current oil.
All are thought to ripen and soften the cervix and increase the flexibility of the pelvic ligaments. You can take the capsules orally or put one or two in the vagina to melt. Use directly on the cervix only if the amniotic sac (water bag) is still intact. These will only prepare the cervix, but will not start labor. Please note that there is currently some question as to whether or not orally ingested evening primrose oil has a positive effect on softening your cervix. I encourage you to do your own research. And make sure to consult with your doctor or caregiver first.
- Herbal Tinctures
Black and Blue Cohosh. It's believed that both methods are effective in stimulating the uterus. BUT you must consult with your healthcare provider before using this method because Cohashes can raise blood pressure and should not be used without a qualified Herbalist.
- Castor Oil ( You MUST speak with your healthcare provider before trying this.)
Castor oil is made from the castor bean seed and has been used historically since the ancient Egyptians for treatments on skin and hair, and used as a laxative. It has been used for generations to induce labor. Although the induction mechanisms are not known, the oil causes diarrhea by contracting the smooth muscles of the intestines which triggers uterine contractions.
Possible risks - Castor oil causes diarrhea and intestinal cramping for several hours which can lead to dehydration. It may irritate hemorrhoids. And it tastes terrible. FYI - the abdominal distress can continue throughout labor but some women swear that castor oil caused them to go into labor. Remember, it is extremely important to stay hydrated, especially if there is diarrhea. Drink lots of water and coconut water.
5.) JUST RELAX And Take Care of You
Anxiety can delay the onset of labor. Being relaxed, feeling safe and supported all help open the cervix. Fill the tub with comfortably warm water, turn the lights off, light some candles and play your favorite relaxing music. This will do you good no matter what.
- Try Visualizations
While you’re relaxing in the tub or lying comfortably in bed, imagine your uterus contracting as well as the process of labor and the joy of holding your baby in your arms. Imagine what it feels like, who's there, what are they wearing, what sounds do you hear, what music are you playing etc. Even if labor doesn't get started, this is a fantastic practice to do everyday leading up to labor.
This will feel good whether it starts labor or not. Have your partner warm some lotion or oil in their palms, begin massage of the inner thighs working in an oval motion covering the area from the knees to the groin. Be sure to tell your partner when the contractions start so massage can be stopped to prevent overstimulation and contractions that are too strong. Who knows, it might lead to sex.
Get a Few Acupuncture and/or Acupressure Treatments and /or Massages
How does acupuncture work? Acupuncturists use tiny needles on certain parts of the body to stimulate labor. Don't worry, they don't go in deep but the good news is that many women have found it to work after several treatments. Acupuncture unblocks energy flow lines and blocked energy is thought to impair the onset of labor.
One small study at the University of North Carolina found that women who got acupuncture were more likely to go into labor without a medical "push." The study included 56 women who were 39.5 to 41 weeks pregnant. (Forty weeks is full term.) Half of the women got three acupuncture sessions, while the other half did not. 70% of the women who got acupuncture went into labor on their own, compared to 50% who received standard care. The women who got acupuncture were also less likely to deliver by cesarean section -- 39% compared to 17%.
Acupressure - It is believed that there are certain points on the body especially by the insides of your ankles that can stimulate labor. The three main acupressure points for encouraging labor are: the roof of your mouth just behind the ridge behind the teeth; four finger widths above the inner ankle; and between the thumb and forefinger. Check out the video below to get tips on how to do acupressure.
Massage - Massage is a great way to relieve tension and relax but make sure your massage therapist specializes in pregnancy massage. Well trained massage therapists know to avoid these labor inducing areas on a pregnant woman until their due date.
- Get some Chiropractic Adjustments
Keep in mind that this doesn't stimulate labor but it can keep your spine, pelvis and sacrum in line, which will help you feel more comfortable and help the baby get into a better position. Also, chiropractic adjustments are great for breech and OP babies. (OP - when your baby's spine is turned towards your spine which can lead to a longer labor as well as back labor). Make sure your chiropractor specializes in prenatal care.
6.) Eating & Drinking To Get Labor Started - (Wives Tales)
- The Maternity Salad
Here in Los Angeles women swear by the Maternity Salad at Caioti Pizza Cafe in Studio City. This salad is piled high with romaine, watercress, walnuts and gorgonzola cheese. According to local folklore, it's the restaurant's special balsamic vinaigrette that jump-starts contractions. And now that Caoiti bottles their dressing, you can call them and buy it. 1-818-761-3588. They ship Tuesdays and Thursdays.
- Eat Pineapple
If you can tolerate it without getting heartburn, eating lots of pineapple is said to begin labor.
- Spicy Food
Again, only use this if it won't give you heartburn.
- Drink Spiced Tea or Cumin Tea
Spiced Tea - Make a cup of tea containing cinnamon, cloves and ginger. Yum! Drink one small glass every hour for no more than 6 hours. If this does not trigger labor, stop for 24 hours then try one more time. Do not attempt more than twice.
Cumin Tea - Place one teaspoon of cumin seeds in one cup of boiling water, allow to steep for 5 minutes, then drink. Do not drink more than one cup per day. Traditionally, a raw cube of potato is added to the tea, but the reason for this is not known.
7.) BE ACTIVE - (wives tales)
Be a Kid Again and Swing
Go to a local park or playground and swing on those nice big swings. What a great way to start labor! But hold on tight, you don't want to fall off. It's an old wive's tale...but it just might work! And it'll put a smile on your face!
Taking long walks (30 minutes to several hours) is so great before and during labor because it helps your pelvis move and allows your baby to get into a better position for birth and encourage contractions to start or strengthen. Here is a variation, try walking along a curb, one foot up on the curb and the other one in the gutter, then turn around and go the other way. Sounds strange but it can really work. Also walk up and down stairs.
- Bumpy car ride
Here's a wives tale. The combination of movement and relaxation (someone else should be driving) can help the baby get into the right position for birth. It's a good idea to have something on the car seat to protect it in case your bag of waters releases.
I had to share this video with you.... This mom was told that if she danced to Thriller it would start her labor. My hats go off to her. Wonder if it worked? I can tell you it for sure helped her open her hips and the baby loved the jiggling. Hip circling is one of the best things to do during labor. Thank you Bonnie Northsea for posting this!
8.) Homeopathic Remedies
Homeopathy is a form of holistic medicine that has been used since the 1700s, beginning in Europe. It is safe, gentle, and is one of the most common forms of alternative medicine practiced today worldwide. It can be used during delivery, while many herbs and medications are contraindicated. It is also safe in the event of surgery, as in a cesarean section. Take each homeopathic medicine daily. Take 3 pellets under the tongue, separated by at least 30 minutes apart.
• Arnica 12C or 30C
• Caulophyllum 12C or 30C
• Cimicifuga 12C or 30C
• Gelsemium 12C or 30C
• Pulsatilla 12C or 30C
The mind body connection
It’s important to know that our emotions and thoughts play a big part when it comes to labor. Did you know that animals won’t go into labor if they feel scared or threatened in any way? It’s true. Fear can even cause their labor to stop all together.
When we are scared or fearful of something, our body releases a hormone called adrenaline, or what’s also known as the fight or flight hormone. Adrenaline is known to inhibit oxytocin, which stimulates contractions and keeps labor going.
When I have a client who is coming up on her due date or has passed her due date, I will have her go through 3 different exercises:
1.) Make a list of all the things you feel you need to get done before the baby is born. Decide which are most important and which are less important. The most important things get done first. If you can get to the less important, great. If not, no worries.
2.) Dig deep and ask yourself what fears, concerns, expectations, thoughts and memories you have regarding childbirth and parenting. Talk about any of those fears or concerns you have. Let go of other people’s baggage or birth stories if you need to. You can even write them all down on a piece of paper and when you decide to let it go, burn that piece of paper. Release that energy.
3.) Sit quietly, sip on red raspberry leaf tea, and have a heart to heart with your baby. Ask your baby what they need, listen and feel what they tell you. Tell them that you will do everything to help them have a safe and healthy birth. Tell them that you are ready to look into their eyes, but it has to be truthful from mother to child. Send them well-wishes and love. Do and say what feels right to you.
I have personally seen all three of these exercises work.
Just keep in mind that:
- These methods may not work unless your baby is ready!
- So be patient.
- Labor will start on its own time.
- Enjoy this time to do things that make you feel good, because if you feel good...your baby will benefit too!
The Bishop Score is a pre-labor scoring system that helps in predicting whether induction of labor will be required. It has also been used to assess the odds of spontaneous preterm delivery. You have great chances of a successful induction if your Bishop’s Score is greater than 9. Be sure to ask your caregiver for your Bishop Score. If you do end up needing to be induced by medical measures then you need to know about the Bishop Score. In Tips for Weeks 33 - 37: Hang In There!!! You're Almost There!! I talk more about the Bishop Score.
You should be all packed and ready to go to the hospital or birth center by now. But just in case here is a reminder of what to pack. Gearing Up for Labor? What You Should Pack And Bring To The Hospital…
Check out three of my most popular blogs on how to help you get ready:
- What Every Pregnant Woman Should Know About Eating And Drinking During Labor.
- Real Labor Tips for Dads From A Doula - Childbirth Educator
- How Making A Baby Plan Can Help Make Your Relationship Strong
Make sure to watch Baby Behavior 101 - Understanding Your Baby's Sleep and Cues. This is so helpful especially once the baby arrives.
You may want to consider creating a postpartum wellness kit for yourself. Here is what you'll need.
I'm wishing you a wonderful, loving and powerful birth experience!
Moskowitz, Richard, MD. Homeopathic Medicines for Pregnancy and Childbirth. 1993.
CAPPA Childbirth Education Certification Course
Aviva Romm, MD