Natural Induction?

[Contented73]

Midwives, what do you do when you are trying to stimulate labor? Doulas, what sorts of things do you talk about with your clients?

I have two clients right now who really want to avoid a hospital induction (they both have induction dates set in the coming weeks). So, I'm going to give them a number of ideas, with the instruction that they discuss and clear any of them with their OB. By the way, has anyone ever heard of an OB willing to let a woman try castor oil?

The ideas I have are:
chiropractic (not sure technique)
accupuncture (again, not sure technique)
evening primrose oil
massage?
sex
castor oil
talking to baby!

can any one give me more info on these, or add to my list? Thanks!

[JanetF]

To avoid a hospital induction say no or have a homebirth. There is no right way to induce a baby that doesn't need to be induced. Induction, if it works, still results in a premature baby and a birth experience that is not of the woman and baby's making thus potentially jeopardising all those important hormones which set us up for parenting. There is no excuse for it without genuine medical need. Doing it yourself to avoid the hospital doing it is illogical and pointless when you could just say no and let a baby come when it should. Do you really think your clients are best served in this way?

[Contented73]

Originally Posted by JanetF

To avoid a hospital induction say no or have a homebirth. There is no right way to induce a baby that doesn't need to be induced. Induction, if it works, still results in a premature baby and a birth experience that is not of the woman and baby's making thus potentially jeopardising all those important hormones which set us up for parenting. There is no excuse for it without genuine medical need. Doing it yourself to avoid the hospital doing it is illogical and pointless when you could just say no and let a baby come when it should.

I couldn't agree with you more.

Unfortunately, these women are not going to say no, and there's nothing I can do to make them say no. These are women who are not even terribly interested in natural childbirth. They DEFINTELY are not interested, by any stretch of the imagination, in homebirth. I do gently encourage them to say no, but they have an OB breathing down their neck and playing the dead baby card.

As to whether or not they are well served by my suggestions, I like to think they are. If they can avoid a long drawn out hospital induction (ie, starvation, stress, drugs, no mobility, cold, uncomfortable bed, etc. etc.) then I'd like to think that yes, I've done *a little* to help them. Plus, I believe that the more natural methods of induction don't really work unless the body is pretty much ready anyway. Or, maybe something simple can help make their bodies slightly more favorable for their hospital induction, thus increasing their chances of having it be successful.

[happyartmama]

I'm in the same situation right now. Client will be 42 weeks tomorrow, has an appointment with OB (happens to be one of the more natural-minded ones), but last week they were at least talking about possible induction this coming week.

Just as OP described, this couple will not suddenly switch to a home birth, and no matter how many articles on dangers of induction and the arguments around post-dates I've read and also shared with them, the reality is that they're first-time parents who have that grain of fear "what IF something's wrong and we need to have this baby now".

I related the ideas about intercourse, nipple stim., castor oil, etc., but beyond that....?

I at least have in my experience (that I can relay to this couple if need be), an atypical use of pitocin. For many reasons, midwife discussed induction with a couple a few months ago and they started on a half (of standard) dose of pitocin to be upped only every 30-45 minutes (rather than the standard 15 minutes). This woman's labor progressed on pitocin in a way more akin to a naturally progressing labor than I would have thought possible using pitocin (cramping, slightly stronger but manageable, then really having to work at breathing and relaxation, then using movement and vocalizations, etc.)

End result was the pit was turned off after about 3 hours when the woman established her own strong labor pattern, and the couple was able to birth without an epidural, assisted delivery, or other things they didn't want.

Sorry to be so long, but I've encountered the OP's situation several times myself--I'm interested to see what other suggestions people have.

[Contented73]

Yeah, it's a funky situation we doulas get ourselves in, isn't it? We can be screaming inside with every ounce of our being for a mom to just refuse the stupid induction, but in the end she won't. She's just too afraid. Sometimes I think I would feel better if I just accepted clients who were having out-of-hospital births, but the reality is that there are so few of them, and many of them don't want/need doulas.

Anyway -- happyartmama, what do you tell them about castor oil? I don't think I would feel comfortable actually suggesting she take it, but I would like to give her an article that explained how it worked, how much to take, etc. That way she could come to her own conclusion and discuss with her OB. But at least she would have the actual guidelines for taking it.

[happyartmama]

Castor oil question: when I talk with clients about this option, I add (and I usually don't have to) that it should perhaps be the last natural induction method tried, basically as a last resort prior to an induction. Mainly because in some cases, women take it, have awful diarhea, and still no labor. Now they've spent ours in the bathroom with no expected outcome. So if they're scheduled to be induced let's say Tuesday morning, I suggest that they try the castor oil Monday morning so at least if it doesn't work it can be through her system and she can get a decent night's rest prior to the induction.

As you said though, I don't really *tell* them to do it, just suggest it as another option that they can research on the web for additional answers. The women I know who have tried it mixed 1-2 tablespoons in with orange juice concentrate (much better testing) and drank it that way.

I've recently found out from another more experienced doula that you don't have to ingest it. Similar positive labor-starting results have occurred from massaging the oil into the skin low in the groin/belly area and on the soles of the feet. It's absorbed through the skin. Kinda messy, and mom can still be running to the bathroom quite a bit, but at least no tasting is involved.

Hope that helps...I always get nervous when a client goes toward 42 weeks--not because of post dates, but because I know the pressure that will inevitably be starting for induction and all that that can mean. I listen to the client, gently remind her about averages and how some women need to be on that far end of dates to even *get* an average, but around here, home births are extremely rare, and the one remaining birth center is about an hour away. :

[attachedmamaof3]

Originally Posted by Contented73

Yeah, it's a funky situation we doulas get ourselves in, isn't it? We can be screaming inside with every ounce of our being for a mom to just refuse the stupid induction, but in the end she won't. She's just too afraid. Sometimes I think I would feel better if I just accepted clients who were having out-of-hospital births, but the reality is that there are so few of them, and many of them don't want/need doulas.

Anyway -- happyartmama, what do you tell them about castor oil? I don't think I would feel comfortable actually suggesting she take it, but I would like to give her an article that explained how it worked, how much to take, etc. That way she could come to her own conclusion and discuss with her OB. But at least she would have the actual guidelines for taking it.

I wouldn't do the castor oil. It is up in the air, but as it has a...laxative..effect on the mother, it can also be said it does the same for baby. IMO, meconium in the amniotic fluid is the last thing I'd want to be discussing with an OB.

[AmieV]

Now, I am not a midwife, but honestly, natural induction makes me almost as uncomfortable as medical induction. If we truly believe the baby needs more time, what is the difference in how we start to try to force it out?

I can say that when I am a doula I would certainly not be recommending things like castor oil. The most I would suggest is sex and the other gentler forms that really only work if things are progressing anyway. Recommending natural induction to me seems way out of the scope of how I want to practice as a doula and offering too much medical advice for my comfort level.

If it were the case of someone being postdates, I would discuss with them the results of any tests they'd had (u/s, etc) and if things were looking good, encourage them to read some of the information in Heart and Hands and Sheila Kitzinger's books about postdatism, so that they could have their fears assuaged and make their own decision about attending the induction or not.

The most I would probably say about natural induction is that there are methods out there and if they want to consider it they can research it on their own. I would also mention any attendant risks. I firmly believe in letting people make their own decisions, and I would feel awful if there was a bad outcome because of a natural induction I had recommended. So while I would certainly offer all the information I had at my disposal, I would not recommend, encourage, push, pressure for one decision over another. At the end of the day they have to live with the consequences of their decisions, not me, so they need to make them on their own.

[Stacymama]

Not a midwife, but there is nipple stimulation, acupressure points to start labor, taking orally evening primrose and inserting it vaginally, putting some on dh/so's penis before sex to help soften cervix. Thumb sucking (putting pressure on the palate)
I am not crazy about castor oil either, or stripping membranes.....just seems evasive still to me.
But, still better then hospital induction. They can always not show up to the scheduled induction, giving themselves at least a few more days.
Baby's come when they are ready.

[happyartmama]

This thread emphasizes, for me anyway, the somewhat difficult line many of us walk as doulas. I agree with AmieV that couples MUST make their own decisions and take on that responsibility. On the other hand, I also believe that one of the roles of a doula is to be a resource person, to offer knowledge (and sources of that knowledge) for the couple to absorb, follow up on their own, etc. If our role is to offer that type of unbiased information in the labor room, I see it as a natural extension to try to do so prior to labor.

I try to keep my tone and information at the level of "here's what I've found, here's where you can look for additional information, and ultimately this is your decision" type approach. ThenI get couples who follow with, "But if this were you, what would you do. What would you recommend?" And I'm back to the discussion about this being THEIR birth and THEIR decision.

[Contented73]

okay, castor oil aside - what about chiropractic or acupuncuture or accupressure? I've often heard these mentioned, but I don't really know how they help get a mom in labor. Has anyone heard of specific techniques that supposedly help? Anyone know of any articles I could look at?

[Eli's_mommy]

I know it all seems like a bad idea, but I think that if they're GOING to be induced medically soon, it seems better to try a natural induction (even though that wouldn't be my first choice).

I wonder if she could talk to her Dr. about having her membranes stripped as a first resort rather than being completely medically induced and going home and doing nipple stimulation. Hmmm.

Good luck!

[herbsgirl]

Unfortunatley, I have been scheduled for an induction with all 3 of my children. But the last time I decided I wanted to try and get things started on my own before I arrived at the hospital. I was having fairly regular contractions when I got to the hospital and they hooked me to the moniter. So consequently, the doctor did not have to give me as much "help".

I started about 3 days before scheduled induction and used Labor Balm, spread it on my belly. I kept on using it until I started to have contractions. Then I used it every hour, slathering it on my belly. The night before the induction, I topped the labor balm off with castor oil and root beer cocktail. By 5 am or so the next morning, I felt like I was in early labor.

So the doctor did not have to do as much Induction help, because I had did those things. My labor was the most natural labor contractions I have ever had!!

http://www.babybellyboutique.com/LaborBalm.htm

I used a whole 4 oz of Labor Balm on my belly. My doctor and I both felt more comfortable using the Labor Balm instead of the Blue cohosh internally.

[memiles]

As a doula, I don't feel it's my place to be recommending specific induction methods to my clients. As some of the OP's said, it's such a fine line to walk. I'm so clear with my clients from the interview on that I don't do anything clinical, and suggesting how to put mom into labor just seems clinical to me. I'd also hate to be the one who suggested the method that makes mom miserable but doesn't work (as I've seen happen with so many of these methods).

My solution for this issue is giving families the resources to find the information for themselves. A simple google search will lead them to many, many websites that outline the information we discuss here. Heck, I've told clients to come to MDC (mostly because I think they will get a dose of "let the baby come in it's own time" that's not coming from my mouth ). Many books list the various methods as well. It's not like the secrets of natural iduction are hidden within our minds, kwim? I tell clients that there is a wealth of information available online on natural ways to encorage labor, and that they need to make the decisions about their benefits and safety. If they ask about a specific method, I will run through the risks, benefits, and any observations I've had about moms who have tried it, but I'll just never feel comfortable saying "you should try castor oil".

I'm not above suggesting a good orgasm or two, though. :

Most importantly, I don't give my clients suggestions because I honestly believe that natural inductions don't work any better than medical induction. If they are able to put themselves into labor at home, they were going to go into labor anyway. I tried them for a full week with my first dd, and they did nothing but make me miserable, sore, cranky, and more worried that my baby wasn't going to come. When a baby is not ready to come, no ammount of sex, castor oil, nipple stimulation, or even pitocin is going to get them to come-hence the huge increase is surgical births after failed inductions.

[Contented73]

Megan, I guess I fall slightly on the other side of the line than you. I actually agree with everything you said. No, I never recommend anything or tell them to do anything. No, induction doesn't really work if baby and mom aren't ready.

However, they are hiring me so that I can provide some information to them - in all areas of pregancy, birth, baby care, breastfeeding, etc. They *want* me to be a resource so that they don't have to start from scratch. For example, I have a reference sheet that I give them about breech babies. It lists ten different things that they can think about or try to get the baby to turn. I always, always say "research this more on your own, I'm not recommending that you do any of this, all things can have unintended consequences, and most importantly, discuss with your care provider"

I don't see induction methods as being in a different category than any other info I give them. I'm always exceedingly careful with my language when I write things up for my clients. I try to imagine their doctor reading what I wrote, and how that doctor would respond. Basically, I try not to say or do things that sounds quacky or irresponsible. Anyway, what I'm envisioning here is a simple worksheet with eight or so ideas for them to explore; a jumping off point for them to do their own research. Maybe it wouldn't even include a mention of castor oil....still undecided about that.

Thanks everyone for all the insightful comments here. It's a very good conversation!

[1stimestar]

I hear from so many doulas that if baby and mom aren't ready, natural inductions wont work. What they may do however is give mom unproductive contractions wearing her out, putting her on a time clock, make her think her body doesn't work right, etc. There are as many cons to "natural" or at home labor induction attempts as there are with hospital inductions. I make sure to tell my clients that. I also tell them one way to tell if their inductions are medically necessary. If the doctor schedules it for Wed. at 6:00 am at their Monday appointment, then it is obviously not an emergency. If the doctor sends them directly to the hospital from their appointment tell them the baby needs to be born right now, then it is more likely a necessary induction. For those who do not feel comfortable going against their dr. right to their face, there is always the excuse that they can't get a babysitter until the following week for other children or their car broke down, or their mom is coming to town that day or they can call the day of and say they are sick with flu like symptoms.

[SublimeBirthGirl]

I'd give them the motherfriendly induction fact sheet, remind them that babies decide when to be born, and let it go. This is why I don't doula anymore! I can't take it. Teaching is hard enough sometimes.

[Eli's_mommy]

Originally Posted by memiles

I'm not above suggesting a good orgasm or two, though. :

[birthgreeter]

As a midwife...home birth or birth center births (I don't do hospital births) first I talk a lot about how the baby needs more time and is not ready. Most of my clients are always willing to just wait and be patient.

We also talk about what may be holding them back...do they have some stress in their life? Do they have some anxiety about the birth or some other thing in their life? How is the relationship with their partner? has something happened in the last few days or weeks that needs to be settled?
I had a client once who with her home birth, (not first baby but first home birth) had an issue in her personal life that she did not tell me about at first, but once it was 'settled' she went into labor, had a wonderful home birth. she was almost 3 weeks overdue when she delivered.
another mom...not my client, but I was covering for another mw while she was on a vacation...this mom always goes 3 wks over, and when I took over her care....I found out she was downing a bottle a day of blue cohosh...I talked to her about why this was not a good thing. she finally listened to me after 2 days of my 'nagging' her. (she had been on it for 5 days total!!!) after being off of it and 'giving in' to the fact that she has always went over due before, she went into labor on her own, and delivered a healthy baby...her first water birth-remained happy with 'her choice' of finally being patient.
after all that is said and done....still Sometimes -- they want to 'induce' in what they feel is a natural way...
sex...nipple stimulation...EPO...castor oil are things we may discuss.
I never use any ' medical-meds'... (IMO) they are not safe to use at home...
but which ever they choose...we cover ALL of the side effects. Once we do, most choose to just wait. Between a hospital induction and a 'natural' induction...I would choose a 'natural' one any day. Important-they need to make a informed choice.