18/04/2022
π€°Induction options: in hospital & at home
A common question βοΈοΈasked near the end of pregnancy is "how can I induce my birthing?" Maybe baby is getting up to 41w or 42w π, or medical care providersπ©ββοΈ are suggesting baby should come out early (often for unscientific reasons (1)).
First off, the only time induction should be considered, is if it is safer for baby to be *outside π€±πΎ, rather than *inside π€°π». If baby & mama are both healthy and happy, then continuing to let baby choose when they're ready is perhaps best. If there *is a legitimate reason for inducing, families can choose to either go to hospital π₯, or to first use some in-home techniques.
In a hospital, induction can mean:
π Chemically, with syntocinon (synthetic oxytocin). Chemical induction is more likely to be successful β
οΈ if mama's Bishop Score is 8 or more (2). It can be turned off / reduced once things are progressing , so mama's body can start producing its own oxytocin. This may feel important because while sytocinon π is great for getting the uterus moving, it does not properly fulfil other roles that oxytocin (the β€οΈ "love hormone") plays in childbirth, bonding and establishing breastfeeding π€±π½.
π Prostaglandin gel, used to artificially ripen the cervix: have it dilate (open π) and efface (thin).
π A Foley catheter π, which will mean spending 12-24h in hospital while it is inserted. This option is not often mentioned π€ to families, but it is generally available upon request π¨.
π A Stretch & Sweep βοΈ. Prior to any Stretch & Sweep, parents should confirm whether or not they consent β
οΈ to an amniotomy (having their waters broken π¦). If they π
πΌββοΈ do not consent, it's a good idea to have someone watch π the procedure, to ensure the care provider *only has a plain glove on (does not have an extra finger glove on), & doesnt pick up any equipment πͺ‘. These mean the care provider intends to break the waters without consent π.
If a family is looking to avoid hospital induction, there are multiple in-home techniques to consider π€. What will work best depends on the reason why your body & baby are choosing to stay as one:
π΅ If the 40 week date π is slightly wrong (conception happened later than calculated), or if baby is simply taking their time, then maybe baby's lungs π« haven't fully matured yet, & aren't releasing their signal that its birthing time (3). If this is the case, obviously it is in baby's best interest to stay put π€°πΎ. Patience is the best option here: some cakes need an extra 10 minutes in the oven π.
π΅ Baby might be still be "high", he hasn't engaged with mama's pelvis yet , & so mama's body is waiting for babyπ€°π». In this case, π§ββοΈSpinning Babies can be wonderful (4), and simple things like relaxing walks, crab walking up and down stairs, or slow hip circles on a fit ball π£ can help baby too.
π΅ The cervix mightn't have ripened ππ₯π₯₯. This is likely a symptom, not the cause for a continuing pregnancy: there's a reason mama's body doesn't think it's time to ripen (e.g. maybe baby πΆπΌ needs to drop lower). If wanting to help with cervical ripening, semen contains prostaglandins, or**sm π₯ releases oxytocin, & ni**le stimulation (5) is great at improving someone's Bishop Score , so maybe some bedroom play is a fun choice π? If looking for something else, evening primrose oil πΉ inserted vaginally is my personal recommendation (6). Acupuncture (5) & eating dates π (7) can also help - around 4 medjool or 10 smaller dates daily, from 37w.
π΅ Uterine sensations ("contractions") might be sporadic π¦or not progressing. This again is often a symptom (e.g. mama's emotional state, see below), and families should consider mama's Bishop Score & any previous π₯ C-section before attempting to influence the body's natural rhythm. Besides ni**le stimulation (which can have the wonderful side-effect of collected colostrum to freeze! π©π½βπΌ), there's an option to smell clary sage essential oil. Clary sage πΏ doesn't yet have medical evidence supporting it as a uterotonic (8), but it's traditionally used for this purpose with plenty of anecdotal evidence, it's relaxing π, cheap, & has minimal potential side effects.
π΅ Negative feelings like anxiety or fearπ¨ (or even excitement, which is a nervous energy) release hormones that can press the pause button βΈοΈ on a birth (9). When in Fight or Flight mode, the human body acts as if it's not safe to spend a few vulnerable hours birthing. Mama needs to release these feelings and return to a sense of peace π & trust - maybe through hypnosis or meditation π§π»ββοΈ, by writing a raw journal entry, or by talking it out with a friend π£ or professional. Some common issues to process are mama's relationship with family members or care providers, or aspects of birth or motherhood π€±πΌ.
Things I don't personally recommend are:
π οΈCastor oil. This creates gastro-like symptoms where people feel ill π€’ with diarrhoea π½ & associated dehydration (which can create issues with amniotic fluid, blood volume π©Έand mama's endurance for birth). Colloquially, it helps a person "p**p their baby out" π©, and it works quite well (7), but I personally consider this a last resort.
π Red raspberry leaf (tea π« or capsules). There's no evidence supporting red raspberry leaf for induction (10), & like many herbs it is diuretic π½. The Brewers Diet π₯ recommends eliminating herbal diuretics from your diet (11), so for me the moderate risk outweighs the potential benefit.
π Chiropractic care ππ½ββοΈ. This is something I know very little about, and can find little evidence π΅ββοΈ for or against, so I don't have an opinion to offer. As always, families should do what feels right for them π€°π».
π Spicy food πΆ. Again, there's no evidence for this, and if it *does work, it's likely similar to castor oil, in that spicy food eaten in excess can cause π©β¦ that burns. And if a baby comes into contact with it, it may sting baby too π₯. Eating spicy food within your comfort levels is fine, but please don't over-do it.
And there you have it! Hopefully with this information, your family will feel confident to make the induction choices that are right for you, and your birth will be a joyous one! β€οΈ
(1) https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/
(2) https://www.healthline.com/health/pregnancy/bishop-score
(3) https://www.sciencedaily.com/releases/2004/03/040323070708.htm #:~:text=In%20their%20study%2C%20UT%20Southwestern,normal%20breathing%20outside%20the%20womb
(4) https://www.spinningbabies.com/overdue-is-baby-engaged-yet/
(5) https://evidencebasedbirth.com/ebb-125-evidence-on-acupressure-acupuncture-and-breast-stimulation/
(6) https://evidencebasedbirth.com/evidence-on-evening-primrose-oil-epo/
(7) https://evidencebasedbirth.com/ebb-128-inducing-labor-with-castor-oil-and-dates/ #:~:text=Researchers%20have%20found%20beneficial%20effects,grams%20of%20date%20fruits%20daily
(8) https://www.aromatherapyforchildbirth.org/clary-sage-labour/
(9) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201/
(10) https://evidencebasedbirth.com/ebb-139-red-raspberry-leaf-tea/
(11) http://drbrewerpregnancydiet.com/id86.html