Induction?
The following article discusses induction and getting labor going with a Spinning Babies approach.
Spinning Babies doesn't recommend induction of labor, whether by natural means or with medications. Its not the place of this website to make medical decisions.
Why Induce?
Inducing labor can be beneficial when a pregnant woman is sick with uncontrollable high blood pressure or the baby is clearly showing signs that the placenta is not functioning well.
Induction can be viewed as a way to avoid infection if the amniotic fluid membrane (sac, or "waters") has broken.
Though studies don't support it, there is a widely held belief that induction might prevent shoulder dystocia if early induction prevents the baby getting over 8 lbs. 13 oz.
It is popular to induce labor rather than let the pregnancy go beyond 42 weeks. The concern is the placenta may not continue to function well. A test called a "Biophysical" exam can be done to check fetal movement, amniotic fluid level, blood flow and other characteristics using an ultrasound machine to assess fetal well-being. The test can be repeated as needed. This test isn't perfect. Some providers induce even with good test results.
The Biophysical and other maternal and fetal assessment tests seek to determine whether the pregnant woman or fetus are so sick that their chance of death out weighs the side effects and risks of induction. If they are that sick, then induction becomes a tool for their well-being.
Induction is tempting when a mother is hoping to give birth with a midwife or family practice doctor but the midwife or family practice doctor can't or won't help her after 42 weeks gestation. Don't assume they can't help you, discuss your options with each individual midwife or doctor. This "rule" varies among practitioner. Another situation favoring induction is when the mother has a date for a cesarean scheduled.
Induction is tempting for social reasons such as having a doctor that you know, having a baby while a husband, partner or other special person is in town (perhaps on leave) or to avoid having a baby on a final exam or during another family event or before insurance coverage changes, etc. Some women are so uncomfortable in late pregnancy that they are actually suffering. Induction can become very attractive.
Read the discussion in FAQs about whether or not to induce because a baby is thought to be large.
Why Not Induce?
The March of Dimes is on a campaign to reduce inductions to only those most medically necessary and not to induce before 39 weeks. Even a 35-36 week gestation baby, just 1-2 weeks earlier than what is considered term at 37 weeks, has a 1% higher chance of dying in the first year of life than a full term baby. Sometimes doctors and parents alike think (are sure!) the baby is due on a date that turns out to be earlier than the baby really was due and suddenly all are suffering over the challenges of a "late premature" infant.
Induction is associated with several other interventions. The more interventions the less mother-infant skin-to-skin time is likely as the baby may be more likely to need resuscitation.
Epidural anesthesia can be avoided with induction, but it is certainly a common expectation for a woman to have both as a set.
Finishing the labor with a sudden cesarean is more likely during a labor that is induced with medications. One problem is that the strong contractions from induced labor can pile up and block baby's recovery time between contractions. Natural labor is sometimes super strong and contractions can be close together, too, but aren't as likely to reduce baby's oxygen levels as much.
Natural inductions can sometimes come on stronger than is safe, but more likely, natural inductions may not be strong enough to advance labor all the way through to birth.Women can get exhausted mentally and/or physically.
Sometimes the fuss over either type of induction wears a woman out mentally. She expects a baby soon after the induction starts. Its not uncommon for an induction to take three days. Most of that time will be in early labor though. The IV Pitocin, prostoglandin on a string, or herbal drops can be stopped if a woman needs to rest, they aren't effective or they are too overpowering. (Cytotec can't be stopped and that's another problem with that popular inducing agent.)
A calm doula is a good addition to any induction. She should know the psychology of comfort, encouragement and patience to be with a woman from before the induction is begun all the way through to the birth. Two doulas allow each other to tag team for potentially long inductions (first babies, inductions before 41 weeks, inductions when baby is not yet engaged in the pelvis).
A mother writes,
What I want is to wait until 42 weeks providing all is well at my
biophysical exams. She has me going twice a week and so far all
results have been good.
I didn't do the glucose test since I don't believe that was anything
other then her trying to frighten me about the size of the baby.
I am feeling lots of irregular contractions, lost my mucus plug, feel
intense pelvic pressure, doing acupuncture, primrose oil, walking
three miles a day and to my husbands delight daily sex. I have a
bottle of castor oil as a last resort but am trying to focus my
energy on things happening in their own time. I know I am up against
a 42 week deadline and I am willing to induce at that point if that
is what is best.
Your emails are a source of great comfort and wisdom and I thank you
again for taking the time to help me sort through this journey and
make informed decisions.
This is the same mother in an email nine days later:
Labor started on it's own Friday night. Water broke at home, went to hospital Saturday morning with light contractions and walked around central park until they were 2-3 minutes apart. About 4 hours of labor at the hospital and our beautiful baby boy was born, 7 lbs. 14 0z. 21 inches. He did come out facing sideways looking straight at his father, but whatever way he was facing mattered little in the end, we were just happy to hold him. He nursed soon after birth and hasn't stopped since. Many thanks for all your support and kind thoughts.
Here is a link to the Coalition for Improving Maternity Care's Induction Fact Sheet listing the risks of Induction. Click on the highlighted words if you want to download a free pdf. file (the free Adobe Reader software needs to have been downloaded first on your computer to read this pdf. file).
If the baby or mom isn't sick, why risk it?
If your child were one of 100 school kids on a field trip told to run across a freeway knowing that one of the children would get hit by a car, wouldn't you keep your child home that day?
Induction is a a decision for mothers to make with their midwives and physicians based on needs not desire; on health, not size.
The risk of not inducing should be equal or higher than the risk of inducing.
One risk of inducing is disturbance of the mother-child relationship at the beginning. Hormones are important and induction by Pitocin doesn't release maternal hormones to prepare the brain for loving a dependent baby. Induced women may need extra support during and after birth.
Skilled doula support in a hospital induction can raise a mother's natural love hormone, oxytocin. She does this by calm presence, a soft and calming speaking voice, touch and rubbing, and helping the partner be close and comforting by modeling. She will help the environment be more conducive to laboring, dark and quiet, while encouraging the staff to talk slowly and give a bit more freedom for movement and position changes, if that's appropriate. Doula care was shown to shorten induced labors in a pilot study done at two local hospitals in which I was a doula coordinator years ago.
If you are a woman who will be induced, increase your social support now and later. Be good to yourself and be good to your family.
Your mothering experience is worth it!
How to Induce
Induction of labor can be started by natural means when the natural substance supports something that the mother needs. Medications are generally more effective, but will require medical supervision and usually a hospital stay with monitoring for mother and baby to reduce the risk of overdose (contractions that are too strong and too close for good oxygenation between contractions, or rupture of the uterus).
Pitocin (oxytocin, which is the natural blood chemical from our brains, or Syntocin another brand name, but in the UK and Down Under) is given with IV fluids through a catheter in the arm or hand. "Prostaglandins" are artificial hormones. The gel is put on the cervix to ripen it and sometimes labor can start just from a few applications of gel. Another form is by a very inexpensive pill called Cytotec, which though often
effective is associated with a high rate of rupture of the uterus,
amniotic fluid forced into the mother's lungs with resulting shock,
and/or maternal death.)
There are a variety of natural means to induce. Special foods, walking, lovemaking, nipple stimulation, castor oil, herbs, homeopathy, body work, moxibustion and acupuncture.
One natural way that makes me uncomfortable is breaking the water, also called rupturing the membranes. A plastic hook is inserted through the cervix to snag the membranes and make a leak or a gush. Obviously, if the mother's water breaks first, without contractions starting on their own, this method isn't an option.
The rule of thumb about rupturing the amniotic sac is, if labor is slow, breaking the water slows labor more; if labor is (or would be) fast, breaking the water may speed it up.
If a first baby is OP or ROT, please do everything else first! Babies born in the sac seem the most alert and peaceful. They've had an internal water birth! The intact sac is useful to put a thin cushion of fluid between their head and their mother's pelvis with the contraction making a thin stream of water between them and assisting rotation. That's my opinion.
I'll leave it to you to find an experienced practitioner when you get into herbs and homeopathy. Natural ways can also have side effects. But typically what I observe is that women take too little. But again, too much is not too good either. There is a way of blending homopathy and herbs that seems more effective than either alone. Acupuncture seems effective, more so when done by a very experienced Chinese-trained acupuncturist. I prefer natural methods, but take self induction very seriously. Be mindful.
That said, I think that a natural induction can be worth a try before a medical induction when the healthy mother is motivated to try it and she is open about it with her birth team.
The Spinning Babies point of view on Induction
Fetal positioning is at times a cause for delay in the start of labor.
When doulas and midwives have asked my advice about natural induction methods they are often surprised to hear me turn away from herbal tinctures (though they can work) and focus on the baby's position and station. I want to know if the baby is engaged. That's more important than anything else.
Getting baby engaged often starts labor once a woman is overdue when baby Hasn't been engaged.
A few studies have shown that over due babies are more often posterior; a few studies did not find that. A few studies have shown that when the water breaks before contractions start in, the baby is often posterior. When water breaks earlier than term in pregnancy, an infection may be present, even if the mother doesn't feel sick. When the water breaks before labor starts for a full-term baby, it may be worth trying out the Spinning Babies approach to labor progress. Again, I don't recommend breaking the water to advance labor or cervical dilation. I don't care how much the cervix is dilated.
Help the baby into position and the rest will happen by itself.
Exceptions
The exception may come with hypertension in pregnancy. If a woman's metabolism is "sloshy" due to the cause behind the fluid retention, slight rise in blood pressure and the subtle malnutrition that goes with that picture, her body may not pick up on the baby's signals that he or she is ready for birth and the signal to start labor may be missed by her body. This is my 'lay' explanation for what I see when labor onset is missed and babies are indeed overdue.
Emotional reasons for labor onset to be delayed are usually immense stressors and not normal stress. But an "airing out" day is a good thing too. Sometimes its just that there is more time to ponder the "reasons" why baby may not be coming that women who give birth earlier in gestation don't have time to ponder. Every situation is different, but generally, we providers should be more reluctant to find fault with the woman's head - at least not before investigating the baby's head!
Goals:
Head flexion (baby's chin to chest)
Optimal Fetal Position (LOT, LOA, OA)
Head engagement (baby's head has dipped well into the pelvis)
Then,
Physical activities to bring the crown of baby's head onto the cervix
Here are ways to meet these goals:
Sifting with the woven Rebozo (Mexican scarf) to relax the broad ligament and help the woman relax that which she can not consciously relax at will.
When a birthing woman is lying down on her back, propped up in bed or on the couch, do an diaphragmatic release (abdominal release). Its a myofascial technique that a birth partner can do or another person who does myofascial release.
Do a forward leaning inversion for 30 seconds. Once labor contractions are regular, its OK to repeat this type of inversion for 1-3 contractions in a row.
Reposition the baby towards the cervix.
Sitting upright with a straight back during contractions when you rest and walking when you are awake.
Also, standing and leaning forward during a contraction and straightening up between.
Keeping your knees soft so the fascia around your pelvis is flexible, not taunt.
Sitting on the birth ball with feet solidly on the floor and hips fluid and making circles for 20 minutes. Have a helper near by and have a railing of some sort to hang on to or a person behind you to rest back on between contractions if you get tired.
Rapid circles on the birthing ball seem more helpful in bring the baby down into the pelvis than slow circles. Use happy music to keep the pace. Be mindful of your own body and needs, don't hurt yourself.
If you know that the baby is facing forward (posterior presentation) or you have back labor in any case, there is a simple technique that works wonders.
When you can anticipate a contraction coming (contractions have to be somewhat regular) begin an Abdominal Lift, also called a Belly Lift, and hold it during the contraction.
Let go of your belly in between contractions. Do a Belly Lift ten-times in a row if your labor has the pattern described on the Abdominal Lift description on this website.
Labor starts, but is slow
Whether labor starts spontaneously with these techniques or an induction is now underway, use the above techniques again as needed. If after that the baby is still high, try the following.
If the first baby seems to be in a good position but not engaged, use Walcher's Position to open the pelvic brim.
If a mother has had a good labor progress in previous births, you can take a chance at Walcher's even with a posterior positioned baby. The baby may engage OP and rotate later or fit all the way through in an OP position. Not all OP babies fit, though, so if the mother has had a cesarean for a previous OP birth, this is a first baby, the baby is large, or the mother has an android pelvis, I would do more to get the baby into an anterior position first (LOT is included in the anterior positions).
