Evidence shows that older mothers are more likely to be medically induced. Once a cascade of induction and intervention has been embarked upon, there is also a higher chance that birth may result in an instrumental delivery or cesarean. This is because medical intervention speeds up the natural process of labour which may cause foetal distress, leading to further intervention to protect the baby’s well being.
There are a number of things you can do to encourage induction naturally, and so hopefully avoiding a cascade of medical intervention. It is also a good idea to get the all clear from your doctor or midwife before trying any of the below, especially if you have a pre-existing medical condition. Unless specified otherwise you shouldn’t try any of the following until you are past your due date.
If none of the below work, they will at least help prime your body for labour by helping to ripen the cervix and stimulate the uterus. And not to forget, that your baby will arrive when he or she is ready…
1. Creative Imagery: As there is such a strong link between mind and body, daily relaxation and visualisation may help to achieve on set of labour. You could imagine the following as often as you like:
Breathe deeply into relaxation. Imagine your cervix is a beautiful flower ripening and opening. Now visualise your baby moving down the birth canal. Imagine your perineum opening again like the gentle, unfolding petals of a flower.
2. Acupuncture: This is the insertion of very fine needles into specific points of the body. The needles stimulate the body’s energetic function which then acts upon the physical organ(s). It is recommended that a pregnant woman has acupuncture at least three days past her due date. It helps to speed up the body’s natural processes by ripening and dilating the cervix and stimulating uterine contractions. Research shows that acupuncture for induction generally works within 6-48 hours of treatment. Generally one or two treatments is all that is required to get labour going. Acupuncture can also help turn a breech position and can be used for this any time from 32 weeks. Success rates are high, but if the baby has not turned by 39 weeks treatment is often ineffective.
3. Acupressure: This uses the fingers to apply gentle to firm pressure on key healing points, effecting the body’s energy flow. Acupressure uses the same points as acupuncture and helps to dilate the cervix and stimulate contractions. You can apply treatment yourself. Debra Betts, nurse and acupuncturist, has published an excellent free booklet which you can download here , detailing all the acupressure points for inducing labour, pain relief during and post labour, and for promoting efficient breastfeeding.
4. Reflexology: This is a type of massage which applies pressure to specific points on the hands and feet. The hands and feet are divided into reflex areas or zone systems that have a direct connection with the different parts of the body. Reflexology to induce labour is best performed by a qualified practitioner after your due date.
A particularly powerful point for bringing on labour is the ‘thumb point’. It influences the pituitary gland, which releases oxytocin, the hormone in charge of uterine contractions. Apply firm pressure on the center of the thumb for at least three minutes. Then, switch to your other thumb. If you feel a contraction release the pressure and then reapply when it ceases.
5. Labour Massage: The massage therapist will work on the acupressure points which promote labour and may also those aromatherapy oils (see below) which assist with induction. If nothing else, the massage will ease any tension and prepare a calm space for labour.
6. Homeopathy: Homeopathy is an effective system of healing which assists the natural tendency of the body to heal itself. Remedies such as pulsatilla and caulophyllum are often used to stimulate labour, strengthen contractions and help the cervix to dilate. If you decide to use homeopathic remedies then consult a professional practitioner.
7. Aromatherapy: Aromatherapy should be used with caution during pregnancy as it can cause adverse reactions like headaches, nausea and allergic reactions. However, there are some types of aromatherapy that are safe to use at home to induce labor once your due date has passed. The oils can either be massaged into the skin using a carrier base oil (eg almond oil), diffused in a burner, or a couple of drops applied to a relaxing bath.
- Lavender: Helps to relax and calm the body. Being tension free will facilitate the onset of contractions. It can help create a tranquil atmosphere during labour and makes a calming spritzer when mixed with water and sprayed on the face and body.
- Clary sage: This oil should not be used during pregnancy. To stimulate contractions massage a few drops into the abdomen using a carrier oil such as almond. When contractions have begun it may help ease the pain as it is said to be an antispasmodic.
- Basilica and Oregano: These should not be used during pregnancy as it helps to stimulate the uterus and aid contractions. Therefore they are fine to use after your due date and a few drops can be massaged into the abdomen using a carrier oil.
- Jasmine: Helps to stimulate the uterus and ‘warm the womb’. Again, should not be applied until after your due date.
8. Sex: As you are probably more than aware, sex can be enjoyed throughout pregnancy. Not only is sex a great way to relax but semen contains prostaglandins which helps to soften and ripen the cervix. The female orgasm produces oxytocin, the labour hormone.
9. Nipple Stimulation: This releases the labour hormone, oxytocin. Roll the nipples between the fingers including the entire aeola, the dark area around the nipples, for 2-5 minutes, rest for 2-3 minutes and then repeat the precess for about 20 minutes. It is a useful method for bringing on stronger contractions as it mimics the suckling of a newborn. If its too fiddly with fingers you can also use a breast pump for 10-20 minutes and repeat every 60 to 90 minutes. Stop when strong regular contractions are established.
10. Evening primrose oil: This is an excellent source of prostaglandins which helps to soften and thin the cervix for dilation. In capsule form, the oil can be taken orally or inserted vaginally. It can be taken orally as soon as 34 weeks, and can be applied directly to the cervix at full term (37 weeks). The general recommendation is two 500mg capsules per day until week 38, and then you can increase to 3-4 per day. The entire capsule can be inserted vaginally; bedtime is best as it will dissolve whilst resting. You can also applying directly with your fingers onto the cervix.
11. Raspberry Leaf Tea: A uterine tonic, it helps to tone and focus the braxton hicks contractions which exercise and strengthen the uterus for labour. I have come across many mixed messages on when to take it. My midwife told me that from 34 weeks is fine. Taken after birth, it also helps breast milk production. If you don’t like the taste, you can also take it in tablet form.
12. Herbal Teas: Black cohosh and blue cohosh must be used with absolute caution particularly blue cohosh which has been linked to complications at birth for the baby. If you decide to use herbal teas, please consult a naturopath for the correct dose. It is probably far safer to take the homeopathic version of each tea;
- Black cohosh – cimicifuga
- Blue cohosh – caulophyllum
13. Foods: Fresh pineapple contains the enzyme bromelain which may help to soften the cervix. However, you would probably need to eat a large amount for it to have any effect and it could cause a tummy upset in the process. Still, eating alot of pineapple can stimulate the stomach which helps to stimulate the uterus into action. Curry may also help to stimulate the tummy and in turn the uterus.
14. Exercise: Any exercise which helps the baby’s head to press down on the cervix and helps release oxytocin, the labour hormone, is bound to be beneficial. Try pregnancy yoga, walking and bouncing on a birth ball. Maintaining a good posture in an upright chair will also help to keep the baby in the optimum birth position (back to tummy). There appears to be a link between slouching on sofas and babies lying in less advantageous positions for example, lying on an angle or back to back.
The ripeness of the cervix effects how successful induction will be; the riper it is, the more chance of achieving labour. So using any of the above suggestions for naturally inducing labour may help if further assistance is required. Medical induction of labour will be offered when pregnancy is overdue at around 41 to 42 weeks in this order;
1. Membrane or cervical sweep: This is routinely offered to women when they are overdue and if this is your first baby, offered from 40 weeks. You will most likely be offered up to three sweeps. Your midwife or doctor will insert their fingers inside you and gently separate the membranes that surround your baby from your cervix. Depending on how ripe and easy to reach your cervix is, this can be an uncomfortable procedure. You can ask your carer to go slowly and inform you of what she is about to do at every stage. This may help your body to relax and yield to the process.
2. Prostaglandin: This is a hormone which ripens the cervix and stimulates contractions. It’s inserted into your vagina in either tablet, pessary or gel form by your midwife or doctor. Only one dose of the pessary is required as it releases the prostaglandin over 24 hours. A second dose of the tablet or gel might be required if labour hasn’t started after six hours.
3. Artificial rupturing of the membranes: Also referred to as ‘breaking the waters’, this is used to help speed up labour if it isn’t deemed as ‘progressing fast enough’. The procedure will mostly likely take place during an internal examination. Your midwife or doctor will make a small puncture in the membrane using either an amniohook (looks like a long crochet hook) or an amnicot (a latex rubber finger glove with a small hook on the end of the finger). Once your waters have broken there is greater risk of infection. You may want to try other methods of speeding up labour like visualising, different positions, nipple stimulation, walking, acupressure (see above).
4. Syntocinon: This is the synthetic form of the labour hormone oxytocin. It is administered through an intravenous drip inserted into your lower arm. The amounts of the hormone entering your blood stream can be adjusted depending upon the frequency and strength of contractions. Syntocinon is offered if labour hasn’t started following a cervical sweep, prostaglandin or if contractions are ‘ineffective’. It assists the progression of labour by creating regular, strong contractions to that the cervix dilates. However the sudden onset of strong contractions may put the baby under stress so you will be continuously monitored during this procedure.
Your healthcare provider may push for an earlier induction if you are over 35. It is in your interest to work cooperatively with your midwife and/or obstetrician. However, in the absence of any complications (e.g. pre-eclampsia, diabetes, waters broken but contractions haven’t started within 24 hours, risk of cord prolapse due to malpresentation etc) don’t feel pressured into going along with any intervention you are not happy with. You can use the following guidelines to help assess your decision about induction or intervention during the birth;
B – What are the Benefits?
R – What are the Risks?
A – What are the Alternatives?
I – What are your Instincts?
N – What if we do Nothing?