Midwives--Please help!!!

[BirthIsAwesome]

I have a doula client who had a no-pain-meds, pit induced, horrendously painful 12-hour labor for her first baby. She consented to the pit (being 42 weeks, didn't know any better) but was adamant to not take pain medication for the baby's sake.

Well she hired me 6 weeks ago and is more prepared. She wanted to stay at home as long as possible, no IV, intermittent monitoring, move around, have a natural beautiful labor etc... well she is now 41 weeks and is consenting to a pit induction on Thursday, if she doesn't go into labor beforehand. : She has asthma and is having a hard time breathing with baby's feet in her chest, plus she is very swollen and uncomfortable, and just wants the baby out. Baby (according to doctor palpation) is around 8 pounds, which sounds reasonable because her first baby was 8 lb. 6 oz. at 42 weeks.

She is 3 cm. dilated, 85% effaced, and +2 station. I hate induction, but in her case, she will be induced anyways if she doesn't go into labor. So I told her I would research and see if she can go to the health food store, buy some tinctures, and try an herbal induction. If she can go into labor on her own, she can labor at home as long as she wants and does not have to have continuous monitoring and an IV line, which in turn means that she can't use the shower or walk the halls or get into better positions than semisitting. I am so bummed out, but this is her last resort; she is determined to have the baby.

So midwives---will you please give me some advice. What are the tried-and-true methods of herb induction that will get her into labor?

[JunipersMom]

I havent found anything yet that works everytime.. I think the body and baby have to be ready too. But the old stand-bys are: nipple stimulation (breast pump works good), sex (and if she can orgasm), Castor oil (2 ounces mixed in a glass of orange juice), Evening Primrose oil (internally and rubbed on her cervix) and then there's the cohosh's ~ but personally I wouldnt use those unless she has some kind of monitoring..

[BirthIsAwesome]

I know--I'm scared of the cohoshes too. I told her all the other stuff (except castor oil) and I was wondering if there are any gentler herbs than the cohoshes that she could try. It is my personal opinion (my non-medical, as-a-doula, personal opinion!) that her body and baby are ready but that stress and fear are releasing adrenaline, which is blocking her oxytocin release. She has had some family issues and some tension and fear about this birth, because of her first experience (which tells you how much she wants the baby out---she's willing to go through that pit induction again).

And by the way, I will be lending her my fetoscope, so her husband can check FHT's, if she tries any herbal induction. And of course I'll be there, so if he can't hear them (rare), I will break the rules and listen. It's more important to me that I help her have an awesome birth than that I stay within the doula scope of practice (though I try to follow the rules as much as possible.) Any time I have a client who wants to stay at home as long as possible (like show up to push, since they are 10 minutes from the hospital) I have dad check FHT's through a contraction, hourly, after 12 hours of labor. Just makes me comfortable knowing that baby is not in distress.

Anyways...thanks for the response, JunipersMom.

[Jane]

If she were my midwifery client, and we were facing a thursday morning induction (it happens), I'd recommend a good night's sleep on tuesday and good rest on wednesday, followed by castor oil at 8 pm (cooked in a scrambled egg or with protein in a shake), and a repeat dose at 2 am if she's not having contractions at 2 am. If she's having contractions at 2 am - NO SECOND DOSE. I haven't seen acupuncture or herbs work.
I talk a lot about how walking can keep labor going, but can't start labor - so many mamas do 2 miles at the mall and it just make you tired!
I also haven't seen nipple stimulation work to start labor (a small sample size, though!) but I have used it to augment contractions - nipple stim until a contraction comes, then stop. Start again after the contraction.

[BirthIsAwesome]

Thanks apricot! I'll definitely tell her that as one of her options.

[momileigh]

I have seen breast pumping work to start labor many, many times. It has to be a double electric, and it has to be done regularly. I like 5 min. on, 10 min. off. Some midwives do 5 on 5 off, others 10 on 10 off. I've seldom seen it fail, especially if someone is something like 3/85/+2 ! BUT I would want FHTs checked at least every hour during this type of induction, just because it is so effective. Sometimes we combine breast pumping w/ homeopathic oxytocina, or B&B, and sometimes we alternate oxytocina and B&B. To be honest, I've never really noticed B&B being all that effective, so I don't know why they freak everyone out so much. I *know* all the books say, etc., but seriously, B&B given a dropperfull at a time... I just don't ever see it making such a huge difference that I would be worried.

[nashvillemidwife]

I will third the recommendation of castor oil. It's nasty but it gets the job done. I'm an herbalist and even I use herbs as a last resort.

[BirthIsAwesome]

Thanks ladies! She does not have access to a double electric pump, unfortunately. I think I'll suggest she try castor oil and then as soon as she gets some ctx, to try some intensive nipple stim (oral--hubby!). And she definitely will be monitoring FHT's with my fetoscope, if she decides to try the induction.