Labour Induction

If you find your self past your due date by 1 week and 2 days, your care provider will probably start a conversation about medical inductions. Medical inductions may be necessary but are not with out risk and potential complications. Acupuncture may stimulate contractions, however, these contractions start slowly and increase with intensity and frequency allowing your body to produce natural endorphins to manage any discomfort. It should be noted that acupuncture itself cannot ‘induce’ labour in the same way medical intervention can.

Acupuncture treatment
Treatments to help stimulate labour are only administered with the recommendation of a midwife or OB. When indicated, specific acupuncture techniques are preformed after 40 weeks. It is recommended to have treatment every 2-3 days until baby is delivered. It is important to see a TCM Doctor or a registered Acupuncturist that is experienced in working with pregnancy.

What does it mean to induce labour?
Most labours begin naturally sometime between 39 and 41 weeks of pregnancy. A labour is “induced” when it is started by artificial means. Labour can also be augmented, or speeded up, if your labour started spontaneously but the contractions (rhythmic tightening of the muscles of the uterus) aren’t considered effective enough to bring you into full labour.

Why might labour be induced?
Although it’s usually best to let nature take its course, sometimes the birth process may need a little help. Labour is induced when the risks of prolonging your pregnancy are more serious than the risks of delivering your baby right away. You are more at risk if:

• You are overdue – your pregnancy has gone ten days to two weeks past an accurate due date.
• You have diabetes
• Your waters have broken and contractions haven’t started. There is a risk of infection the longer the waters have been broken. Research shows that 70% of mothers will have given birth within 24 hours and almost 90% within 72 hours of their waters breaking. So you could choose to wait for labour to begin, or you could choose to be induced. In either case, your midwife and doctor will observe you closely for any signs of infection.
• You are not having contractions but your waters have broken, and during your pregnancy, you tested positive (vaginal swab or urine test) for group B streptococcus. This is a case for immediate induction.
• You have a chronic or acute illness, such as pre-eclampsia or kidney disease, that threatens your well-being or the health of your baby.
• You have had a previous baby who was stillborn.

Circumstances in which you should not have labor induced:

• Tests indicate that your baby needs to be delivered immediately or can’t tolerate contractions.
• You have a placenta previa.
• Your baby is not in the headfirst position.
• You’ve had more than two c-sections or certain other kinds of uterine surgery, such as a myomectomy to remove fibroids.
• You’re having triplets (or more!)
• You have an active genital herpes infection.
• A loop of the umbilical cord has poked through your cervix. This is called a cord prolapse. The danger is that the cord would become compressed during labor and the baby’s oxygen supply would be cut off.

Inducing labor may be more risky, though not entirely ruled out, if:

• You’re having twins.
• You have too much amniotic fluid
• You’ve had one or two previous cesarean deliveries.
• You have heart disease or severe high blood pressure.

What are some of the ways labour may be induced?

• A membrane sweep in which the membranes that surround your baby are separated from your cervix. A midwife or doctor can carry out this procedure during an internal examination. It’s been shown to be effective in stimulating labour and is now offered routinely to women who are overdue before any other methods of induction. It can be uncomfortable if the neck of your womb is difficult to reach. You should be given a chance to ask questions or read information about the procedure before it’s carried out.
• Inserting a pessary or gel containing prostaglandin into the vagina to ripen the cervix (neck of the womb). Prostaglandin is a hormone-like substance, which helps stimulate uterine contractions. Often this procedure will start labour; at other times it is followed by Syntocinon (see below).
• Artificially rupturing the membranes (ARM) sometimes called “breaking the waters”. This procedure can be done during an internal examination. The doctor passes a long thin probe, which looks a little like a fine crochet hook, through your cervix and makes a small break in the membranes around your baby. This procedure is often effective when the neck of the womb feels soft and ready for labour to start.
• If labour does not start following the techniques above, or if your contractions are not very effective, Syntocinon – a synthetic form of the hormone oxytocin – may be used. It’s given through an intravenous “drip” – the hormone goes into your bloodstream through a tiny tube into a vein in your arm. Once contractions have begun, the rate of the drip can be adjusted so that contractions occur often enough to make your cervix dilate, without becoming too powerful. You may be offered an epidural for pain relief before or soon after the Syntocinon has been administered.

As induction is usually planned in advance, take some time to talk to your midwife or doctor. You have a choice about whether or not to have an induction and about what methods are used, although your midwife or doctor may suggest that one method is better than another, depending on how soft your cervix is. Think about what pain relief you would like if the induction makes your contractions very strong and difficult to cope with.

Some of the most common natural methods to induce labour:
NOTE: Yinstill does not endorse any of the following techniques unless specifically indicated for the case in question. Agreement with their primary care provider is also required.

• Lovemaking. Sexual intercourse is thought to work in two ways. It may trigger the release of a hormone called oxytocin – the ‘contraction’ hormone – and this may increase the frequency of Braxton-Hicks, or practice, contractions. Semen also contains substances called prostaglandins. These can help to ripen, or soften, the neck of the womb (cervix) ready for it to dilate when labour contractions start.
  If you think your waters may have broken, don’t make love as this may increase the risk of infection, but do seek advice from your midwife or your local maternity unit.

• Nipple stimulation. This will release the hormone oxytocin and may help start labour. It’s only likely to be successful if your cervix is ‘ripe’ and ready to dilate; otherwise it seems to help with the ripening process. There is no agreement on how much nipple stimulation you need, or how often, to stimulate contractions.
• Walking. This is also a common suggestion. The explanation appears to be that the pressure of your baby’s head pressing down on the cervix from the inside stimulates the release of oxytocin, hopefully bringing on labour. If your baby has not ‘dropped’ or is still high in the pelvis, walking will also encourage your baby into a better position so that labour is more likely to start on its own.
• Castor oil. For decades, women have been using castor oil to help induce labor. In fact, many old school physicians and midwives swear by it. It can provide good results if you are already in early labor. It is believed to work by causing spasms in the intestines, which surround the uterus toward the end of pregnancy. These spasms, in turn, cause the uterus to cramp, which might result in labor.
  You can take 1 to 4 ounces of castor oil mixed with 6 ounces of orange juice to cut its oiliness. You’ll want to drink it quickly because of the unpleasant taste. Some practitioners suggest taking a single dose; others suggest repeated doses depending on your response. Keep in mind that castor oil usually will cause your bowels to empty within about three hours. With luck, soon after that, you will be in true labor.

• Spicy food Some people swear that it was that extra-hot enchilada from their favorite Mexican restaurant that brought them face to face with their new baby. Unfortunately, the statistics are out on this one. You could try it, but if you have a full stomach when you are in labor, you might vomit and see that enchilada again–in less-than-appetizing circumstances.
• Clary Sage Oil-This is an essential oil that can cause strong contractions. Mix 10-15 drops of the oil with a carrier oil such as Almond oil. Rub the oil on your hands and use some lotion (any kind) and just massage in. You can do it for as long as you’d like.
• Raspberry Leaf Tea – Raspberry leaf tea is not actually known for it’s labor inducing properties, but it is believed to be helpful in toning the uterus and helping with labor.
• Cinnamon stick tea – Take cinnamon sticks and boil them into a tea and drink. It actually tastes good so even if it doesn’t bring on labor it may help you to relax.
• Evening primrose oil – Evening primrose oil comes in small capsules similar to vitamin E. It is believed to help soften and ripen the cervix.
• Caulophyllum 200x: This homeopathic remedy is reported to be a good labor initiator. The dose can be repeated every half-hour for two hours.
• Labor Tincture (Susun Weed’s Wise Woman Herbal):
  1/2 ounce dried Black Cohosh root
  1/2 ounce dried Blue Cohosh root
  1/4 ounce dried Ginger
  1/4 ounce dried Birthroot
  1 cup (8 fluid ounces) 100 proof vodka
  Place dried herbs in a pint jar and add vodka. Label and cap. Let it all steep together for 6 weeks or longer. Decant tincture by running the mixture through a juice extractor or a salad spinner. If neither of these are available, pour the tincture and herbs onto a cotton cloth and wring by hand. Store decanted tincture in a cool, dark place in brown glass. Be sure to label it. The blue cohosh encourages the uterus to begin contractions and increases the force of the contraction. The black cohosh helps the uterus to contract in a coordinated and effective way, the ginger focuses the energy into the pelvic area and increases the energy available to the uterus. The birthroot (trillium) adds its influence on the uterus by speeding up the action of the cohoshes and joining with the ginger to energize the uterus. This tincture can be used to initiate labor, strengthen contractions, unstall and stimulate labor, deal with exhaustion during labor, expel the placenta and help to control postpartum hemorrhage.

• Blue Cohosh tincture: 3-8 drops in a glass of warm water or tea, is very effective in starting labor. Repeat every half-hour for several hours until contractions are regular. If labor is not underway in four hours, use a dropper full of the tincture under the tongue every hour for up to four more hours or until contractions are strong and consistent.

Are there risks associated with inducing labour?

• Medical methods of induction may not work straight away. You may need repeated treatments and it may be several days before you go into active labour.
• Artificial rupture of the membranes (ARM) is not always effective, and, once your waters have been broken, your baby could be at risk of infection so your midwife and doctor will want to keep a close eye on you. If they suspect that you have an infection, you will be offered antibiotics and a Syntocinon drip.
• Syntocinon can cause strong contractions and put your baby under stress, so continuous electronic monitoring is necessary. Some women also say that the contractions brought on by Syntocinon are more painful than natural ones, so you may choose to have an epidural for pain relief. You are therefore less likely to be able to move around freely during labour if you are attached to a fetal monitor and a drip for the epidural. However, some hospitals offer telemetry (where you aren’t attached to the monitor by wires) and mobile epidural, which may enable you to maintain some movement during labour as well as relieving the pain.
• You are more likely to need a forceps or ventouse delivery following an induction, or a caesarean. This may be due to complications in the pregnancy that led to the induction and/or it may be due to problems caused by the induction itself.
• There is also a very small risk that, if a Syntocinon drip is used to induce or augment labour, your uterus may be over stimulated. This would seriously reduce the oxygen supply to your baby and could, in a worst-case scenario, cause your uterus to rupture (tear). This is more likely if you are having a trial of labour following a previous caesarean section.