Q: Any ideas, advice or recommendations on how to naturally induce labour? I am a midwife with a high percentage of first time mums overdue; they get fed up, and I have run out of tips.
-Anon.
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According to the medical literature, human gestation ranges from 36 to 44 weeks. That is a two-month range, not the EDC plus or minus 2 weeks. The mean length of time plus or minus one standard deviation gives the 38-42 weeks range, with 40 weeks the average, or mean.
The mean has come to mean the right answer. Phooey! Here is an analogy: Few people actually have a 98.6 F temperature; that is an average. Some actually feel unwell if their temperature is 98.6 because their own body temperature is lower. Everyone has his or her own range. So it is with due dates.
Where I live, over 50% of births involve Pitocin, usually to induce, often because the practitioner wants the birth to be Monday through Friday, daylight hours. Sometimes it happens because the mother is complaining about the heaviness and pressure of late pregnancy and the provider takes that complaining seriously and tries to fix it. Sometimes it happens because the mother has dilated (even as far as 5 cm) or effaced a lot but isn't having contractions; the practitioner fears the baby will fall out (mothers wish that would happen!) and brings her in and induces. There is no respect for natural process. Even a birth center where I teach transfers 20% of women to the hospital most commonly because the women "need" Pitocin. How could the human race have survived if 20% of women couldn't give birth without drugs?
I hate the whole idea of "due date." It is only a guess that creates expectation. The woman often circles that date on her calendar so she won't schedule any other appointments for that day. Better to teach women that the misery of late pregnancy is a natural motivation to want to go into labor, which is a natural progression from the joy of showing the sweet little belly that occurs in the early months. Teach them how to pay attention to their babies to know if things are OK in there. Babies will still play and respond inside even at the very end.
Practitioners may want to see her every week, to listen to a heartbeat or check a blood pressure, to tell her how well she looks, to listen to her complain and suggest a warm bath and other comfort measures, and to communicate to her that pregnancy is a time of waiting.
As a cranio-sacral therapy practitioner, I appreciate the power of intention and belief. When the healthcare provider gets worried about the length of gestation, that worry communicates to the woman, who may delay the start of labor longer because her adrenalin level can go up. Worry and beliefs are contagious. And we all know that adrenalin is the enemy of oxytocin!
So let's organize to keep pregnant ladies happy. Watch them with love and for heaven's sake, let the baby come when it wants.
-Nikki Lee
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I think we shouldn't even consider doing anything to induce before 42 weeks unless there are definite concerns about the health of the baby. A mom is not post dates until she is past 42 weeks. Until then she is merely "due," not overdue.
I know some advocate induction near the due date because they think it will avoid problems with big babies, but the rate of fetal growth slows down near term. The average baby will gain no more than 4 to 8 ounces during that additional two week period. This quarter to half pound gain is hardly likely to significantly affect the birth outcome.
-Gail Hart
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Four of my five babies born in hospitals were induced (the fifth baby was a section). I have had one Pitocin drip, two AROMs, and one Prostin plus AROM. I have also had my membranes stripped in numerous late dates pelvic exams.
These induced births were unpleasant for many reasons; for example, the Pitocin made my contractions agonizing, the AROMs made my babies go into terrible positions for birth, and the Prostin meant twelve hours of useless, tiring, constant contractions (not to mention it's just plain disgusting to now know there was pig semen in me). These babies were induced to "get things going," and all inductions made me believe I could never "get things going" all on my own.
Not once was I told of the terrible risks that accompany labor induction. Induction was always portrayed as safe, easy, expedient. But I now know that the drip made my baby more likely to have debilitating oxygen deprivation, the AROM put my babies at higher risk of death by cord prolapse, and the long-term effects of having the sperm of another species in me are not even known. The full hazards of induction are extensive and poorly researched. (And the idea of "natural induction" is illogical--any birth made to come before its time holds risk, and the words "natural" and "induction" together create a genuine oxymoron.)
With my sixth baby, I would certainly have been induced again if I had chosen to remain within medical confines to give birth. I went a full four weeks past my "best before" date, but I had wisely chosen the care of Gloria Lemay, the least interventionist birth attendant in my province. As the weeks went by, she reassured me of my body's innate birthing wisdom and of my baby's beautiful birth. It was difficult. I genuinely believed I couldn't give birth without artificial coercion, but I trusted her. And when the time was right I simply, easily, beautifully, and magnificently gave birth.
Any woman who is impatient to get her baby out or any attendant who is impatient for her, must know that inductions hurt terribly in many ways and have effects that are not even fathomable. Inductions undermine a woman's faith in her own body, and pilfer from her the most crucial rite of passage a woman can have. The birth attendant's job is to help women trust birth and be their strong anchor when fear, distrust and impatience threaten to overwhelm completely. It is the attendant's job to keep women and babies safe and mind the pregnant and birthing woman's body as the cathedral of life that it is, never to be desecrated by tubes, hooks, needles, animal semen, beef and hog pituitary gland extracts, or overeager fingers. Birth can be trusted, and is safe.
-Leilah McCracken
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I read Phil Watters' comment about induction in the Dec. 3 issue and at first I was almost offended, but as I thought about it, I realized he is right! Midwives, we need to remember that one of the biggest reasons couples opt for homebirth is to *avoid* intervention. If we don't help protect them from that, we have done them a disservice.
Induction should never (in home or hospital) be done because mom is "antsy." One of the biggest reasons homebirth is a safe option is because nature is (or should be) allowed to do its own thing! Only in recent times has everyone started worrying about "due dates." Judging by the increasingly poor mortality rates in the U.S., all our "labor management" has not improved things much!
If I had not been a firm believer in this before I entered midwifery, I would have been after I spent time in a backwoods, doctorless maternity clinic in Bolivia. Those ladies had nothing going for them according to U.S. standards and they never worried about "due dates," yet their bodies gave birth very well to healthy babies, and I *never* saw a "deteriorating placenta!"
If mom gets impatient and uncomfortable, it is our responsibility to counsel her to be patient and help her understand the reasons why patience is still the safest option. A safer option than worrying about "due dates" would be to ensure that mom has an optimum diet so she and baby have optimum health when they go into labor.
A 280 day pregnancy is an *average* based on a 28 day cycle. To create an average, there must be those on either extreme. On the other hand, I know midwives will sometimes induce labor simply due to pressure from the medical community to conform to their standards. A case in point: A former client of mine has had seven healthy babies. The first two were medically induced, knock-em-down, drag-em-out, hospital horror stories. The next five were born in the comfort of her own home, and all were beautiful, uncomplicated, healthy births. Only one of her babies was born close to due date. She has gone 43-46 weeks every other time! All her babies weighed 10-11 lbs and she pushed them out with 2-5 pushes. No, she is not diabetic, and her mother had big babies, too. Except for birth weight, when assessing her babies according to gestational age charts, her babies always appear to be 39-week babies. If this lady were induced because her "dates" were "right" or because her baby was "big enough to be born," or when she got antsy and uncomfortable, she would always have had premature babies. For this lady, 43-46 weeks is normal, (she is one of those who helps create the averages) and induction would be harmful. She is the only mom I have ever "induced" (with herbs) and she and I both agreed to do this only because of pressure from the medical community. We knew that if we would have to transport her at that stage of "overdue" pregnancy, the flack could be pretty devastating, so we chose herbal induction as a safer option than chemical induction and hospital birth.
Phil Watters is right! Consumers often pressure their doctors to do things for convenience and comfort (if you can call medical induction comfortable!) and on the other hand, sometimes midwives do things because of pressure from the medical community. It's a two-way street, and either way we are doing couples a disservice, first for not seeing to it that they are educated well enough so that they don't want induction, and second for giving in to what we know is not wise or safe.
-Elaine
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Reprinted from Midwifery Today E-News (Vol 1 Issue 50, Dec 10, 1999)
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