Inductions
As we approach your due month, it is common for your medical provider to discuss various induction methods with you. Some of the reasons inductions are recommended is due to arising or existing medical concerns with you or the baby. Please note an induction can increase your chances of having a cesarean (or belly) birth as you’re asking your body to do something it may not be ready for.
Around 36-38 weeks of pregnancy, it is very common for medical providers to discuss various induction methods with you. Unfortunately, some medical providers don't mention what YOU can be doing at home to help the process along
NON-MEDICAL INDUCTION METHODS
Here are non-medical induction methods you can explore and discuss with your medical provider:
Intercourse/ Orgasm
Orgasms provide a surge of oxytocin through your bloodstream (explained in more detail below). Intercourse allows a high concentration of semen to sit on the cervix. Semen is high in prostaglandins, a naturally occurring hormone in both men and women that softens and prepares the cervix for dilation.
Nipple Stimulation and other Sexual Activities
any sexual activity that induces an orgasm is encouraged (unless your doctor is prohibiting this) because it floods your bloodstream with oxytocin, the hormone used to strengthen your contractions
Red Raspberry Leaf and Nettle tea - this uterine tonic promotes a boost of nutrients and encourages more efficient contractions. You may start with 1 cup a day, working up to three cups daily (this is more for efficiency and preparation than induction)
Eating Dates - dates have been known to encourage the production of estrogen and prostaglandins, which both aid in the preparation and dilation stages of labour. Dates are also high in fibre and contain antioxidant, antibacterial, anti-fungal, and anti-proliferative properties. Starting with 3, work up to eat 6 a day starting now if possible
Walking/Stairs/Lunges - while this will not initiate labour on its own, movement around the pelvis gives your baby more opportunities to find favourable positions to descend into the pelvis. Babies being head down in the womb is only part of the puzzle piece!
Forward Leaning Positions - alot of your baby's weight is in their torso and as we lean forward or to the side, our abdominal wall begins to act as a hammock for your baby. This is important because head down is only a piece of the puzzle. We also desire baby's to be facing our back as they enter the pelvis.
Birth Ball - similar to above, rocking, swaying, doing circular motions or figure eights while sitting on the birth ball create opportunities for your baby to get into an ideal position. After 37 weeks, you can bounce on your birth ball forming additional pressure on your cervix to encourage softening, ripening and dilation.
Evening primrose oil
Please discuss the appropriate dosage with your medical provider. Typically one 500-1000 mg capsule is recommended daily starting from the 38th week of pregnancy until birth.
Acupressure/
Acupuncture
Please contact a local professional to discuss if they are willing to do the procedure with the intention of inducing labour. Most will only offer their services after 38 weeks gestation.
Castor Oil - can be massaged into the abdomen from 38 weeks of pregnancy. There are mixed reviews about oral consumption of the oil as it causes abdominal contractions that may trigger uterine contractions due to the organs' close proximity.
Connecting with Other Health Professions like a pelvic floor physiotherapist or chiropractor - your body is undergoing a lot of changes, especially in these final weeks of pregnancy. Having additional care providers on your team ensures you are caring for your whole self, reducing the symptoms you may be experiencing and improving your labouring and recovery experience.
Here are MEDICAL INDUCTION METHODS that your midwife or obstetrician may consider depending on the state of your cervix. Attached is a table outlining how care providers assess your cervix. The benefits and risks of each method are not outlined, but if you need a refresher, we can always schedule a call to review them together.
MEMBRANE SWEEP, also known as STRETCH & SWEEP:
during a cervical exam, your care provider can "massage" your cervix, separating the amniotic sac from the cervix to encourage the release of prostaglandins, which soften the cervix.
WHEN SHOULD IT BE CONSIDERED: When there is time to wait for the spontaneous onset of labour because there are no urgent health concerns. Birther must be dilated enough for one finger to be inserted into the cervix (typically 1 cm). If the cervix is closed, a cervical massage may be administered instead.
CERVICAL GEL:
synthetic prostaglandin hormone, called dinoprostone or Cervidil is administered via a 12-hour slow-release pessary inserted behind the cervix. This hormone encourages the softening of the cervix. It can stimulate uterine contractions, though the pessary can be quickly removed if there are too many contractions (uterine hyperstimulation).
WHEN SHOULD IT BE CONSIDERED: if the cervix is still firm whether there are active contractions or not. If your water breaks or you've had previous uterine surgery, like a c-section, this method should not be used.
PLEASE NOTE: Once inserted, the birther and baby are monitored for 30-60 minutes and sent home with instructions to return in 12 hours to be re-assessed.
FOLEY CATHETER OR BALLOON:
a single or double balloon catheter is inserted into the cervical opening. Once in, the balloon is inflated with saline solution. It is used to apply pressure to the cervix to encourage dilation without causing uterine hyperstimulation. Once inserted, the birther and baby are monitored for 30-60 minutes and sent home with instructions to return in 12 hours to be re-assessed. Once dilated to 3 cm, the catheter balloon can fall out and the induction process may continue with either Artificial Rupture of Membrane (your care provider breaking your water), Pitocin, or natural augmentation tools.
WHEN SHOULD IT BE CONSIDERED: When there is time to wait for the spontaneous onset of labour, but there are more health benefits to birther and/or baby to initiate the process than risks. The Bishop Score of birther is lower than 8. Cervix is still firm whether there are active contractions or not. Has a history of adverse reactions to synthetic prostaglandins or attempting a VBAC.
PLEASE NOTE: It is common for care providers to apply cervical gel and the foley balloon at the same time. And Birther must be dilated enough for one finger to be inserted into the cervix (typically 1 cm).
When compared to using cervical gel, the overall outcome was relatively the same. The benefit lies with the reduction of side effects when using the foley balloon on it's own.
ARTIFICIAL RUPTURE OF MEMBRANE (AROM), also known as BREAKING OR RELEASING YOUR WATER:
When a health care provider intentionally punctures the amniotic membrane/sac to release the amniotic fluid. By releasing those hormones the body may absorb them and there is less of a cushion between the baby’s head and the cervix.
WHEN SHOULD IT BE CONSIDERED: After other induction methods have been introduced. If the birther is 4 cm, contractions have been irregular and the baby is well positioned (head down, facing the birther’s spine and engaged in pelvis).
ADDITIONAL THINGS TO CONSIDER:
Commitment to birth: Once the amniotic sac is open, most health care providers want the baby to be born within 18-24 hours to reduce the risk of infection.
The onset of labour is unpredictable so after AROM alone, labour may not commence
Studies have found increased maternal satisfaction with the process & duration of labour when AROM was immediately followed by intravenous synthetic oxytocin administration (which has it’s own risks to consider).
PITOCIN:
Synthetic oxytocin Pitocin is administered via an Intravenous line (IV) in the hand or arm. The amount of the drug is usually increased every 30-60 minutes until the health care provider’s desired frequency and duration of contraction is achieved.
WHEN SHOULD IT BE CONSIDERED: After the cervix is soft, thinning/effaced (50-100%) and at least 4 cm dilated with irregular or weak contractions.
PLEASE NOTE: You may always ask to speak with the health care provider and request they turn it down, stop increasing it or turn it off completely. There is benefit to allowing your uterine muscle to rest before demanding that it continue to work. Although this is not favoured by care providers, it is your right to know and it is your right to revoke/withdraw your consent to the amount of drug being given.
MISOPROSTOL:
a synthetic prostaglandin, called Cytotec, is administered orally or vaginally. While the American Gynecologic/Obstetric Association has deemed this a safe method to start uterine contractions, Health Canada has not. The optimal dose, route of administration and dose interval are yet to be decided.
WHEN SHOULD IT BE CONSIDERED: Greater than 35 weeks gestation and intact membranes (if administering vaginally).
Again, we are here to go over this again with you, so please don't be hesitant to reach out. Truth is, this is why we start reaching out weekly at this point because we know nerves, jitters and last minute prep tends to get in the way. We've got you covered!
Talk to you soon xo
If you would like to listen/read more on these methods, Evidence Based Birth has several podcasts with transcripts detailing the studies they have reviewed and breaking down what this really means for you:
