Warning: This article contains radical ideas about labor, birth, and women’s right to intelligently choose what’s best for them and their babies! Read at your own risk of empowerment! Updated August, 31, 2017.

The Induction Pressure Cooker and Women’s Autonomy

According to recent data from the latest Listening to Mothers III national survey of 2400 mothers who gave birth in US hospitals from mid-2011 to mid-2012, women are being pressured by their healthcare providers to have inductions. Many women, in their desire to avoid induction, which sometimes also means changing plans from birthing center or home birth to hospital birth, will try to self-induce labor rather than endure a hospital induction. At least 64% of nurse midwives in the US, based on surveys, support the use of natural methods of labor induction.

As a homebirth midwife and also a family doctor licensed to practice obstetrics, I have worked hard to help women avoid unnecessary inductions. Sometimes this has put me at odds with what the medical profession says I “should” be doing – but if things are ever going to change in how obstetrics is practiced, then those of us who can must take a stand for a woman’s right to choose what she feels is best for her and her baby – even though this may be in conflict with conventional obstetric practice.

The sad reality is that conventional medical practices are not always based on the best available medical and scientific evidence, or the best interests of the mother. They are heavily influenced by doctors’ fears of getting sued, data that is skewed by the interests of professional societies, insurance reimbursers, hospital risk assessment teams, and even medical journal articles that have been written by or paid for by medical device and pharmaceutical companies. We have to take a stand for honoring the wisdom of nature rather than succumbing to pressure and fear.

We must also fiercely protect one of the fundamental tenets of medical ethics: respect for autonomy. Autonomous individuals act intentionally, with understanding, and without controlling influences. When it comes to obstetrics, however, some medical authorities have questioned whether pregnant women should retain the right to autonomy, since their decisions affect not only themselves, but also their babies. Thus some women have found themselves with court orders to undergo hospitalizations and obstetrics interventions – including cesarean sections – against their will! It is in the spirit of women’s autonomy in the face of a compromised obstetrics system that I present what I know and have used in my own clinical practice, for getting labor started when the pressure to do so is on for gray area medical reasons.

Medical vs. Elective Induction: An Important Difference

Labor inductions are done too often and many times, for non-medical indications. Unnecessary inductions can lead to a host of additional unnecessary interventions – including cesarean sections – that substantially increase health and safety risks for mom and baby. To be clear, I am opposed to elective induction. Period.

Labor induction should always be based on a medical indication, and the rate should not exceed about 10% of all births. Yet in the US the national average is at least 23% – double what it was 2 decades ago.

Reasonable indications for induction include maternal high blood pressure associated with preeclampsia or eclampsia (this is different than slightly elevated blood pressure in late pregnancy), medical conditions that can put you or baby at risk in labor (uncontrolled diabetes, HIV, heart disease, kidney disease, a blood clotting disorder, or possibly cholestasis of pregnancy), and intrauterine growth restriction. Medical indications require medical inductions – that is, they should be done using conventionally accepted methods under medical supervision – for your and baby’s safety.

Labor should not be induced “electively,” meaning done for convenience-sake, or for cultural, psychological, or “social” reasons rather than medical ones. Elective induction prior to 39 weeks increases the risk of preterm delivery, which potentially increases baby’s risks of lifelong health and developmental problems. Elective induction also increases your risk of cesarean section if you are a first-time mom. All methods of induction carry the risks of complications.

Living far away from the hospital, having a history of fast labors, or having more than five prior vaginal deliveries are not medical indications for induction.

The Induction Gray Zone

So if I am opposed to induction, why am I doing a how-to blog? Because countless healthy, intelligent, and responsible women have approached me over the years, seeking natural alternatives to the medical induction they are being threatened with for “gray area” medical reasons. And when faced with the only option being hospital induction, knowledge of age-old traditional methods of induction becomes power.

Gray zone reasons that women are  typically presented with include her being told that:

  • Her baby is too big so she is going to be medically induced before it gets any bigger.
  • She is too overdue so she is going to medically induced.
  • Birthing center or homebirth policy requires her care to be transferred to the OB for a hospital birth if she hasn’t had the baby by a certain window after the due date.

Why are these gray areas?

  • Estimates of fetal weight can be grossly inaccurate. Many women are induced before they are really ready for labor, sometimes even ending up with a cesarean, only to have a perfectly reasonably sized baby that wasn’t too big at all. Besides, what IS too big? Many women – even first time moms – can birth “big” babies without induction and without a problem. Size isn’t everything!
  • Though we are enamored with them, due dates, even based upon ultrasound, are notoriously inaccurate leading to induction at what is calculated to be at term or post due, only for baby to be right on time, or premature. One radical idea is just to ignore your due date entirely! (Though you’ll have to convince your midwife or doc to do the same!)
  • By all conventional medical standards, the length of a normal human pregnancy extends all the way to the end of the 42nd week of pregnancy. However, statistically, there is considered to be a slightly increased risk of stillbirth after 40 weeks of pregnancy. According to Up to Date, “Perinatal mortality increases as pregnancy extends beyond 39 to 40 weeks of gestation… The perinatal mortality rate at ≥42 weeks of gestation is twice the rate at term, increasing four-fold at 43 weeks, and five- to seven-fold at 44 weeks. However, the absolute risk of fetal or neonatal death is low.

Nonetheless, this small risk represents a major legal concern for doctors who deliver babies. An obstetrician can expect to be sued 3 times in her career, is legally liable until a child turns 18 years old for any problems that can be attributed to a birth she attended, and the stakes of a lawsuit, in addition to the stress, can be financially and professionally devastating. Induction has become the answer addressing risks to baby. According to some researchers, however, the statistics maybe be overinflated and skewed in favor of induction. And I repeat, according to Up to Date“the absolute risk of fetal or neonatal death is low.”

Au Natural: What Really Works for Stimulating Labor? Is Any of it Safe?

It is generally optimal to let labor commence on its own. When it does, the conditions are usually best for a natural labor and birth. The baby’s head is in the right position, hormones are kicking in left and right, and the uterus has built up a nice repository of oxytocin receptors primed and ready to embrace your body’s natural oxytocin which will naturally stimulate contractions.

Unfortunately, we don’t all live in a perfect world where nature is respected and honored – thus sometimes we have to make a choice between trying to get labor going naturally and getting it done in the hospital. Occasionally, too, nature does need a nudge. Fortunately we have resources at our fingertips to help things along.

There are a number of options for getting labor started. Few of these have strong evidence behind them and not all of them have been proven to be safe for baby. Nonetheless, many women find these to be a preferable alternative to the risks of medical induction methods and being in the hospital.

Over the years in my own practice, I have found membrane stripping, nipple stimulation, the use of some herbs, and castor oil to be the most effective, particularly in combination. Of these, only membrane stripping and nipple stimulation are considered to be safe.

Here is a review of the most common approaches to getting things going:

Membrane sweeping (also called membrane ‘stripping’)

This does not mean breaking the waters. It is a technique your doctor or midwife can do which involves sweeping her index finger around the inside of your cervix and “lifting” the membranes up off the inner cervix. It is easily performed in the office and has been shown to be both safe and effective in stimulating labor within 48 hours. It is estimated that one in eight women will successfully go into labor with no increased risk of infection as a result of the procedure. It may need to be repeated at an additional office visit on a subsequent day. According to Cochrane Collaboration review, corroborated by several good quality studies, sweeping of the membranes was associated with reduced duration of pregnancy and reduced frequency of pregnancy continuing beyond 41 weeks, with significant decreases in the need for further medical induction. Discomfort during vaginal examination, mild cervical bleeding, and irregular contractions are the main “side effects.” Last time I did it was when my daughter-in-law was in her 41st week. She went into labor within the day…

Nipple stimulation

Pulling on the nipples very firmly in a motion intended to simulate a baby’s suckling stimulates uterine contractions and has been used to induce labor (a breast pump is not usually recommended). It usually works within about 72 hours in women with favorable cervices on Bishop scoring (something non-invasive your midwife can calculate with a cervical exam). Breast stimulation causes the uterus to contract, likely through increased levels of the hormone oxytocin, which stimulates contractions. It is typically recommended to be done manually for about 30 minutes at a time on one or both nipples, repeated twice daily. There is little data on safety but it does not appear to be associated with any complications. Safety has not been evaluated in high-risk pregnancies. A plus is that nipple stimulation is associated with reduced postpartum hemorrhage. It’s kind of difficult to do it firmly enough to yourself so having your partner or a close pal do it is more effective. It may be a little uncomfortable but don’t let that worry you about breastfeeding, which can also be uncomfortable at first, but gets easy.

Herbs

Herbs, especially blue cohosh and cotton root bark are popular amongst midwives, including certified nurse midwives, to stimulate labor. They are typically used in the form of alcohol extracts, taken in doses of several milliliters at a time, repeated up to 4 times/day, or more often under skilled guidance. While these herbs can be highly effective, and I have used them extensively in my practice over nearly 30 years, the use of blue cohosh has been implicated in serious complications in the newborn including heart attack and stroke at birth in three published case reports. Midwives also report increased risk of meconium in the baby and need for resuscitation, though this may be due to the factors that led to the use of the herbs, including the baby being overdue.

While the existing adverse reports are unlikely due to the herb, the pharmacology of blue cohosh does not allow this association to be ignored. Thus the use of herbs to induce labor should preferably be done under the guidance of a midwife or other reliable health professional skilled in the use botanical medicines in pregnancy.  My extensive academic research on blue cohosh and herbs for labor induction is presented in the American Herbal Pharmacopoeia Blue Cohosh Monograph.

Red raspberry leaf is a safe exception. It may be taken in a strong tea, prepared using ¼ oz. (about 4 grams) of the dried herb to 1 pint of water, steeped for 20 minutes, and several cupfuls taken daily until labor commences. It is not associated with causing preterm labor and has been associated with decreased complications at birth for the mother and baby.

Evening Primrose Oil (EPO)

EPO has been used extensively by midwives to help “ripen” the cervix when taken in doses of about 1500 mg orally and the oil of several opened gel caps also applied directly to the cervix for up to a week prior to when you hope to go into labor. Overall studies are very limited. In one report, women taking oral evening primrose oil had, on average, a labor lasting 3 hours longer than women who did not ingest evening primrose oil. Nothing should be inserted into the vagina if your waters have broken.

Castor oil

There is little formal data on the effectiveness of castor oil to induce labor, but many women who try it report it to be very effective. Unfortunately, it causes terrible diarrhea that may lead to anal burning and irritation during labor. If you use it and get loose stools, make sure to replace your fluids and electrolytes. I have actually used the warmed oil topically on the belly as a massage oil and it may have been helpful in stimulating some labors – but I’ve never used it without also using nipple stimulation and some herbs.

Acupuncture

Acupuncture has been used to help ripen the cervix and induce labor. A Cochrane Collaboration review of 14 trials reporting data on over 2220 women randomized to receive acupuncture compared with sham acupuncture or usual care. Most trials were from Western countries; two were from Asia. The data wasn’t too impressive but there were was a great deal of inconsistency in the points that were used, the sizes of the studies, and other parameters that make it hard to fully interpret the data. It is a harmless method if clean needles and proper techniques are used.

Acupressure

Acupressure is the application of pressure usually using the fingertips, in place of needles, on acupuncture points. The accompanyingPressure-Points diagram illustrates the points typically used. Firm pressure is applied for several minutes, repeated several times daily. There is no evidence that these points used alone actually get labor going. In my experience it takes more than this to put a mom into labor!

Sex

Human sperm contains a high amount of prostaglandin, a hormone-like substance that ripens the cervix and helps labor to start and it has been suggested that sexual intercourse may be an effective means. There isn’t enough evidence to show whether it really is effective or how it compares with other methods, but if your water isn’t broken and you want to give it a try – no harm, no foul. Most midwives recommend three times per day to maximize the chance that it will work!

Spicy Foods

There is absolutely no evidence that spicy foods can trigger labor and since they can cause heartburn in late pregnancy, they might not be the best option…

The Next Dimension

There’s a lot more to labor and birth than meets the eye or that always has an obvious physical or medical solution. Our emotions and beliefs have a tremendous impact on our experience. We can’t necessarily account for the mystery, but we can do something about our emotions, especially fear, about labor and birth. Animals in nature don’t go into labor when they are frightened. In fact, labor will stop if a mammal is threatened by a predator. Adrenaline inhibits oxytocin which helps to stimulate and sustain contractions. Sometimes we go overdue because our bodies or babies are just not ready for birth yet and need a little more time in the oven. Sometimes fears might be holding us back. If you are overdue and being pressured by someone to go into labor, aside from asking them to back off a bit, it’s a good time to dig deep for any skeletons in the closet. I’ve “met” all kinds of skeletons in my practice: the grandmother who died in childbirth, the mother and three sisters who never went into labor and all needed cesareans, the mother or best friend who has been giving you a hard time for planning a home birth. Get centered and clear out everyone else’s baggage and your family history baggage and see if this helps.

Having a heart to heart with baby is another “next dimension” idea. One of my dear friends was quite overdue with her first baby. She was planning a homebirth but the screws had been on about a hospital induction. A nurse on L&D at that hospital herself, she really preferred to have her baby at home, but of course was willing to do what she needed for her baby’s best interest. One evening she wrote a flowing letter to her baby, telling her that she’d do whatever was needed for her safe and healthy birth, and that she felt being born at home was really such a wonderful option. She waxed poetic – and lo and behold went into labor within hours of finishing that letter!

Sometimes there’s just an element of mystery in the world of birth that I can’t explain. For example, my patient who went 2.5 weeks overdue but just “knew” her baby would be born either on her own or her mother’s birthday, which were one day apart. She kept begging me to wait a few more days. Baby looked good so I waited. Sure enough, after a very quick labor for a first-time mom, that baby was born on her grandma’s birthday!

Anne’s Story

Anne, a 28-year old petite woman, was over 41 weeks pregnant with her first baby and was planning a home birth. She’d had some mild irregular cramps for the previous 2 weeks, which were especially bothersome at night, but no signs of labor. Her cervix was undilated and about 30% effaced when she was checked by her family practice doctor, who was her back-up physician for her birth. Her doctor recommended she insert misoprotol to induce labor. She was supportive of Anne laboring and birthing at home if the misoprotol kick-started her labor but if not, wanted her to come to the hospital for induction at the end of the week. Anne was not keen on the use of misoprotol due to risks of it causing overly strong uterine contractions that – rarely – can lead to uterine rupture.

Anne contacted me upon her family doctor’s advice. Of note, I do not support the home-use of misoprotol for labor induction. I feel it is best used in the hospital under medical supervision. We discussed natural options and Anne decided upon nipple stimulation and the use of herbs. Her husband was to do nipple stimulation for 30 minutes on one breast in the morning, and repeat for 30 minutes on the other breast in the afternoon, twice each day. Anne began taking a combination of herbs that included equal parts of blue cohosh root, cotton root bark, and black cohosh root, with the instruction of taking 1/4 measured tsp. every 4 hours, stopping overnight, and for up to 2 days maximum.

By the middle of Day 1 Anne began having mild uterine contractions. By 1 pm on Day 2 her labor kicked in full-on, with contractions 5 minutes apart, so the herbs were discontinued. The baby’s heart was monitored regularly with a fetoscope and was normal throughout labor. Her beautiful daughter was born at home, late in the afternoon, on Day 2 of the herbs, with no complications for mom or baby.

Tough Choices

Ultimately, you have the right to make your own best decisions. It can be super tough to know what to do when your midwife is under pressure to get your labor going, or your doctor is telling you one thing and your momma-protective-bear-intuitive-self is telling you another. Keep in mind that the decision to induce is rarely an emergency. You have time to think it through. Feel it out. You have time to ask questions. If you do need an induction, you’ll know you made an educated choice.

You can talk with your physician about alternatives to hospital induction. A Cochrane Collaboration review of 28 studies found that home induction of labor with certain medications can be feasible and safe in some circumstances; this might be an option your doctor would consider rather than keep you in the hospital during the early part of the induction, which can sometimes take several days.

Nipple stimulation, red raspberry leaf tea, and membrane stripping are great, safe, and often effective options that can be combined and also repeated. Give yourself a few days of lead time to give things a chance to work.

Also, make sure to clear out any unfinished emotional business and allow room for some mystery and magic. You might just be amazed at what can happen!

Want to join me, Christiane Northrup, Sarah Buckley, Ina May Gaskin and others as we discuss the risks of labor induction? Here is a link to a free video excerpt on elective induction, generously shared by Happy Healthy Child. Please watch here — you’ll be inspired!

To your best possible birth!

Love,

AJR-Sig

 

 

 

 

 

 

 

 

47 Comments

  1. I love your blogs. They are so helpful in bringing me back to reality. The natural way has always seemed so familar, but with all the brain washing of modern med. Its been hard to stay grounded. Thank you for your knowldge.

  2. hi aviva,
    what helped me with my first birth at week 40 was inserting a tampon with clove oil into vagina and removing after 4 hours,later that night my water broke!!Another good one is climbing steps or taking walks around your neighbourhood!

    • hi heather. there’s no data that i know of. but also no increased infection in studies evaluating for this — but no mention of GBS that i’ve seen. There’s minimal risk of rupture with membrane stripping, however, GBS itself does increase rupture risk slightly.

  3. Thank you Aviva, Much food for thought. Your words here reflect my own heart. It’s a big question, with modern Obstetrics deeply effecting the lives of expectant mothers in Bali. Families with any means at all make sacrifices to go to the OBGYN, who does an ultrasound with every 3 to 5 minute visit, and not much more. All too often it’s “Prenatal Scare” not “Prenatal Care”. The Bumi Sehat midwives are blessed to have good relations with our back-up docs. However, all too often young 1st time mothers are pressured to have cesareans… sometimes the reason is simply:” Your baby is a boy, and too precious to risk having a natural birth. With cesarean, I can guarantee your baby will be born alive.” It’s heartbreaking. Yet, we keep the faith, and do our work with as much open hearted grace as we can muster. Love, mOM Shanti, Ibu Robin

  4. As always thank YOU for such a wonderful article. I had my baby at the hospital with a nurse midwife. She was exactly 2 weeks late. My midwife did some tests to make sure if the baby was alright. She was fine so she let me go and was willing to let me go until the Tuesday after she was actually born. I trusted my body and knew that she would come when she was ready. I used Hypnobabies and yoga. I had a wonderful support system that supported me in my decision. I am glad I waited and did not induce. I agree with what you said about due dates. It is a “guess” date. Go with your gut! Don’t be forced into something you don’t feel comfortable with. You can do it!

  5. Hi Dr. Romm,

    Thanks for the great article. I have three little ladies, have done three home births and have been overdue with all three. I went naturally into labor 10 and 8 days past dates with the first two. I used EPO with both and then 5-W from Nature’s Sunshine with the second — seemed to help. With the third birth, I started having bouts of contractions nearly a week early as well as other signs of labor beginning. Then they would stop. This went on for over two weeks. Finally at 10 days post dates I had an ultrasound which showed amino. fluid too low for a LPM to do a home delivery in my state.(Apparently a high leak.) I prayed, drank water like crazy and had another ultrasound the next morning which showed my amnio. fluid just over the minimum. Baby was in good position, doing well, and I was nearly effaced and 1-2 dilated. We went home, did warm castor oil packs while resting,swept membranes, and then started cottonroot (every 30-45 min.) and nipple stim., 10 min. on with breast pump, 10 min. walking, 10 min. resting. Did acupressure and diffused essential oils (I’m not usually into them, but a good quality lavender and frankincense really seemed to point the energy of the body downward and in an opening fashion.) Also did one of those catheters (forgetting the name, a Foley?) that is usually used for opening the urinary tract, but put it in the vagina. It fell out when I was around 4 and was getting a regular labor pattern. We started nipple stim. @ 4 PM, and by 10 PM I was having regular contractions. They persisted through the night, with ebbs and flows and then around 4 AM labor really hit hard. I needed coaching and back pressure continuously through the contractions till birth nearly 5 hours later. That was the most intense 5 hours I have had with any of my births, but she was born at home! I was completely willing to go into the hospital and do a CS if that’s what was needed, but I am grateful for the miracle of this birth. It turned out that a cord looped around the shoulder and down the back was what held things up those previous weeks.
    The midwife who guided us through this birth commented that she had never in a busy 30 years suggested induction without medical reason, but she thought that if we had another baby, she would suggest inducing at 41 weeks, because my babies seem to be at their peak at 41 weeks and then start going downhill. We’ll consider that if needed in the future.

  6. When will we talk more about ways to encourage the mama to take back her birth and to reject intervention (medical or natural) for the good of her and her baby? As opposed to giving her potential yet unstudied methods to “try out” on her body and her baby so that she can acquiesce to the unscientific, unnecessary demands of an out of date hospital system or unjust laws?

    • Well, I agree with you there for the most part. Sometimes nature needs a nudge ’cause our lifestyles aren’t always keeping us in synch with our natural rhythms — then the natural methods can be really helpful. But yes, ultimately taking a stand against all forms of pressured inductions would be ideal!

  7. Dear Aviva,
    I am faithful reader of your blogs. I always find it encouraging and hope-inspiring that other women, and especially midwives and medical doctors have the same ideas and opinions about pregnancy, birth, health and food.
    I’m a Belgian women of 53, mother of 3 (28, 26 and 21) and like you, already a grandmother, of 2 little boys (5 years old and 5 months, both from my 26 year old daughter). My two youngest were born at home and it was a wonderful experience. In both cases I used castor oil to induce the births as I was over 41 weeks pregnant and my doctor threathened with induction.I took 2 table spoons and had mild diarrhea (not terrible!) soon followed by contractions and the breaking of my water. My contractions came very fast and regular and were very painful. The warm water of my bath was the only way to cope with the labor pain. My daughter was born 4 hours later (i didn’t gave birth in the water though) and my youngest son was born after 5 hours, same scenario but 4 years later!

    When my daugther gave birth 5 months ago, her midwive gave her evening primrose oil to apply locally on the cervix. She was already 42 weeks pregnant then and it was her last chance to start the labor spontaneously. Else she’d had to have an induction at the hospital. Her baby boy was born a day later. I was so glad that she choose the natural way, even if she preferred to deliver in the hospital. She has not inherited my preference for the natural order of things 🙂

    However, I also wanted to ask you about a serious problem my daugther Nina is now facing. Already during her pregnancy she suffered from pain in her back. Afterr the birth and during the breastfeeding this pain became almost unbearable. Her family doctor did’t take her very serious for a long time. Finally she decided herself to consult a specialist and a photo was made. This revealed 2 fractured vertebrae and oedema around this zone. No wonder she was in such a pain. Remained the question what had caused this. Only a few weeks later she managed to have an appointment with a doctor specialised in bone diseases. They measured her bone density and it was not good. The diagnosis is osteoporosis caused by the pregnancy and the breastfeeding, apparently a very rare disease. She immediatly had to stop the breastfeeding and take calcium and vitamine D. Now she also takes a medicine to help build the bone again. This medicine gives her quite some pain in her bones. Of course she can not carry any weight or make movements which are heavy for her back as there is a considerable risk that the fractured vertebra will collapse! Not easy for a young mom with a baby of 5 months.
    She trained as a kindergarten teacher and was going to start working this September. The doctors told her she will probably never be able to be in this profession.

    My question is: have you ever encountered this disease in your career and patients and are there other things that she can do to help build the bone again? Are there herbs or natural medicines which can be used or specific food she should take?
    Thanks,

    Anne

    • Hi Anne, I have encountered osteoporosis, yes, many times, but have NEVER heard of it caused by pregnancy and breastfeeding — makes me wonder if something else is going on because pregnancy and BF should NOT cause that level of severe bone loss…. I am so sorry she is going through such terrible pain! Given the severity of the situation, she may need the meds, but in general, I make sure there is adequate stomach HCL, vitamin K2, plenty of magnesium and D, calcium from absorbable sources and some form of gentle weight bearing. I would also want to make sure there is no unusual underlying cause. While pregnancy does affect calcium in bone, there should be some protective effects from increased estrogen in pregnancy. Congrats on being a gramma! Aviva

  8. Thank you, Aviva!

    I’ve also read that eating dates towards the end of pregnancy reduces length of pregnancy (therefore fewer medical inductions) and length of labor. Here’s a link to a study:
    http://www.ncbi.nlm.nih.gov/pubmed/21280989

    How far past 42 weeks gestation are you personally comfortable with supporting clients to continue being pregnant and letting nature take it’s course? Will you share some thoughts about this specifically?

    • Hi Eliah,
      Hadn’t heard about the dates before. Kind of funny – dates for your dates. Sort of doctrine of signatures-ish! How far past 42 weeks depends on dates, the mom and our relationship, what I think is going on, what she thinks is going on and how things look from a sort of general prenatal perspective. I’ve gone into the 42nd week with mom but by the beginning of week 42 am usually thinking about getting things going if TRULY post dates. I takes with a grain of salt. Due dates, I mean. Not fruit ones. 🙂

  9. It took me having an awful hospital birth to slap me in the face with reality that natural birth was for me. I used membrane stripping and castor oil to induce my 42 week baby. I birthed at a birthing center in Ventura County… 4 hour labor.. 7 lb baby.. which the sonogram tech told me was close to 10 lbs. I have 206 pictures from that labor/birth that I still look at till this day. My midwife Sue Turner is a saint. She met me on a Sunday morning to strip my membranes again.. I don’t see a dr doing that!!!

  10. Hi! My clinic wants to induce me at 39+ weeks so I don’t go over my due date just because I am 41 years old. My pregnancy is completely normal so far. My first delivery at 39 years old was a day after my due date. I did retain some placenta but otherwise all was normal. Thoughts? Advice? Not keen on the idea. Thank you!

    • Hi Vivi!
      So sorry to just now get to you post!!! I was on a bit of a response hiatus because of preparing for medical boards. I trust that all has gone beautifully and you are now snuggled in happily with a cute few months old baby! 🙂 Aviva

  11. My daughter gave birth about six weeks ago, after a 44-week pregnancy. Her very mainstream OB didn’t like my daughter’s decision to wait for labor to start naturally, but respected it. Baby was monitored closely and looked fine. In her final two weeks, she tried everything but the castor oil, which she wasn’t comfortable with, to get her labor started. Finally, at almost 44 weeks, labor started on its own. My daughter was hoping for an intervention-free natural delivery, but didn’t feel comfortable delivering outside of a hospital. Unfortunately, what she got was every intervention, culminating in an emergency C-section–baby did not tolerate pitocin and heart rate was dropping. Turns out baby was “looking up at me,” according to the OB who did the CS. I find it hard to believe that the baby’s position was not discovered or even considered until 27 hours of hospital labor, that stalled at 6-7 cm. Baby would not come down. Is it unreasonable of me to think that they should have been aware of baby’s position earlier and possibly been able to get him to turn instead of just putting him into distress so the could do the CS and get it over with. I say that because they knew baby wasn’t tolerating the pit, but restarted it anyway. 30 minutes later it’s emergency c-section time. Arrrgh…

    • hi lori,
      nope, the presentation of the baby’s face often doesn’t become clear until well in to labor — even pushing — so not always possible to know ahead of time.
      rest assured! 🙂
      and congrats on the grand baby. they are SO delish!!!
      aviva

      • Thanks! Grandbabies are definitely the reward! #4 is due in 8 weeks…can’t wait. Anticipating a natural water birth this time, which, if all goes well, will be awesome and amazing. #2 was born that way…it was the birth experience I wanted 28 years ago, but was out of reach for me. I’m thrilled my daughter found an amazing doc who delivers more like a midwife and that water birth is available for her at a local hospital. Best of both worlds for sure!

  12. great article wish I found it when pregnant and overdue with my first as I was forced to have an induction when baby was clearly not ready to come out… it was a gong show… horrible painful,,, went on for days with water broken and babys heart dropping my blood pressure went through the roof given epi which meant not allowed to move just lie unhelpfully on bed and I swear when they had me push which didnt feel like i should be yet (found out later it was not time) every ounce of me was telling me to squat as weird as that sounds pushing lying down felt awful wrong but i had no clue then…. seizure and c-section now on third pregancy and because my second was also c-section (for good reasons not elective the baby stopped moving no heart beat on doppler and faint flutter of heart on ultrasound he was resuscitated after he was removed and after very rough start and 11 weeks nicu came home and adter much therapy he is a happy thriving healthy 2.5 year old boy and i thank god for that obgyn that gave me that c-section every night ) i have no choice but to have one again and this will of course be our last child…. had i read this then I would have fought harder to do what I had intended and waited for her to be ready to come out or trying for a more natural induction method… unfortunately no matter how loud our instincts scream to us when we are pressured by medical personnel and made to feel stupid or wrong we dont listen to what our bodies already know we cave to the pressure of doing the “right” thing…..

    for the record my daughter who was supposedly three weeks overdue weighed 7ilbs and 2 oz and had those little hairs that fall out all over ears back etc… I firmly believe she was not overdue she was just not finished baking yet lol…

    And i found this because my cousin is being told baby 37 weeks is getting to big by friday coming up at most not going to advise her to try any of the above as i dont want her inducing early either but i am going to advice her that yeah if she feels waiting is right thing to put her foot down and wait she is not diabetic, no high blood pressure, no nothing to say we need to induce just an ultrasound a week ago that guessed he was already over 9 pounds.

    I was scheduled for c-section for this baby after 39 weeks as she said before then its not good for baby and that if i go into labour high risk for uterine tear so we thought the induction for size before then was odd and also have a friend who safely and naturally delivered her first baby who was 10 pounds 9 oz and thats bigger then 9ilb of guesstimate wait

  13. I recently saw a midwife (Canada) suggest a labour inducing smoothie of apricot juice, almond butter, castor oil, and lemon verbena essential oil. My education to date strongly advises against the internal use of essential oils so I was quite surprised to see it suggested. All I can find online are some vague references to this being common in Germany but would love to know more as women in the community often ask me about natural ways to get labour started and this was a new one. Thanks in advance for any insight you can offer!

    • Yes — I’ve heard this but cannot confirm it as a true traditional use. The castor oil alone is so labor stimulating that it’s hard to imagine how one would sort out the effects of the lemon verbena. Also sounds absolutely vile to drink!

      • Yes, was absolutely vile to drink; poured it over ice to make it extra special! Just got the recipe from my doula in canada today. I started my 41st week and am dodging the induction card as well. I will keep you all posted on how the drink worked or not. Definitely feel nauseated.

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  15. Hi Aviva,

    I have factor Leiden 5 (no clots history), I’m 33 weeks pregnant on Clexan from the beginning with pregnancy follow up at high risk pregnancy clinic.
    The doctor told me today that my labor will be induced, most likely on week 39. I wasn’t aware of that, planned to deliver without Epidural if possible. Now reading about the induction medicines, it worries me and I wonder what the risk of waiting for labor to begin naturally is and whether the natural methods you suggest can be used with my condition.
    Thanks
    Gabriela

    • hi gabriela, with leiden factor 5 and appropriate treatment i don’t know that it is truly medically indicated to induce. i’d check with your maternal fetal medicine doc and ask for her/his reasons, evidence, and rationale. i’d voice your concern and request a natural progression to labor if they consider the risk low. we do know that induction increases the risk of cesarean which increases the risk of clotting post-op due to longer periods of immobilization. so maybe they’d support waiting a little longer….but i’d really check in with WHY they are feeling an induction would be important so you can have the info you need to make the best decision for your safety and baby’s. very best wishes! aviva

  16. Hi there, I am 37 weeks. Dr wants to induce end of this week due to cholestasis. My midwife said start taking evening primrose oil 3x a day to help soften cervix for the induction. Is it worth a try? Any side effects? This pregnancy has been SO hard. We had s stillbirth last year so emotionally getting through this pregnancy been nearly impossible! But besides that I still have severe hyperemesis as it never went away…I have home care with midline in for fluids since week 5! Now cholestasis…I am hoping primrose oil will help…thoughts?

    • Hi Lindsay,
      So sorry about your prior loss and this hard pregnancy. I don’t check my blog comments frequently – just every couple of weeks — and there are hundreds, so sorry not to see this sooner. By now you’ve likely had your baby and hopefully you are both safe and well. I would recommend the induction for future reference, given your history. EPO can be helpful, but the evidence suggests it’s not a fully reliable method and in your case, the stakes are high. After this pregnancy, if you plan to have more babies, I’d work with an integrative reproductive doctor, or a functional doctor who specializes in OB (me, Joel Evans, Leslie Stone, Bethany Hays) to try to get on track before a next pregnancy. Warmest wishes, Aviva

  17. I am 33wks pregnant with my third and my Dr is pushing for an induction that I don’t want. With my first I had an extensive blood clot and was out on boys thinners for the remainder of my pregnancy. I was induced at 39wks and it was a horrible experience. After all the test results were in they found I don’t have any citing disorders and believe it was likely due to increased pressure on my small veins. With my second baby an induction was also planned but I went in to labor 3wks early at just barely 37wks. I had been on blood thinners throughout this pregnancy as well and had taken a dose that morning and baby was delivered before 12 hours after that dose and there were no complications with bleeding. Thus time I spoke to my hematologist and he said he saw no reason I should have to be induced considering how things went the last time but my OB still wants to schedule one. My husband and I are very against it but it is for a legitimate medical reason. However I still feel like I’m being pushed to do something unnecessary. Would you recommend I do the medically induced labor or try some methods at home? I would probably only try things like waking/stairs, sex, and stimulation.

  18. Hi Aviva,
    I’ve read about the use of EPO all over the internet and I’ve never really gotten a clear answer to one question I have. Is EPO really linked to thinning blood? It was recommended to me by my midwife, however with the lingering possibility of a caesarian I am extremely hesitant to take anything that is considered a “blood thinner”. Have you seen many women experience hemorrhage or extensive bleeding after using EPO? Any advise would be greatly appreciated.

    Thank you!

  19. Great post! Thank you so much. I’m only 38 weeks so I know I have time but I’m pretty keen to avoid a medical induction. My husband’s Aunt is a midwife of 30+ years in the UK and recommends many of these things so I’ll be starting to given them a go soon. Nice to read an MD supporting natural induction and avoiding the medicated variety.

  20. Hello all…
    This is an interesting post !
    A new trend in the world among expecting moms is the thought of employing a maternity specialist for help in the birthing process. I want to ask you Should I keep getting acupuncture after I deliver? I further want to ask that I have never heard of this until now. What exactly is membrane stripping and why is it done? Do you have to be a certain amount of weeks or dilated? Thanks for this great information.

    I really liked this article.

    Thanks again!

  21. The blue cohosh if you get the pill or tincture can that be inserted as well? Do u recommend it? I am 42 wks with second baby. What do you recommend with blue cohosh? Love your blog. 🙂

    • Nope, not for insertion… I don’t recommend blue cohosh unless you are working with someone knowledgable who can help you with it. Best with baby!

    • Especially first time moms I wish I KNEW THIS…and doctors do bully new moms with fear for not any medical reasons????????????????

  22. My doctor wants to induce me at 39 weeks due to a Velamentous cord insertion. Is this necessary, and would natural induction be safe?

    • Hi Heidi,
      I don’t know that induction at 39 weeks as opposed to going into labor naturally is an absolute indication, but it may be that your doctor wants you in hospital when you do enter labor – and that’s the only sure way to control for that. The risk of a bleed is higher – for you and baby – if the cord rips in labor. I know that’s scary sounding – sorry – but in this case, induction may be reasonable. I’d discuss your concerns openly with your OB and see if this is the only option. If so, it is reasonable. I would not try natural induction at home.

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