Natural induction of labour

Our acupuncturists and massage therapists are often requested to provide ‘induction’ services for women who wish to go into labour. Mostly these are women who are overdue for their dates and who do not wish to undergo medical induction. Sometimes they are referred by a medical carer, but often they have found us in desperation through Google or word of mouth after being told medical induction was imminent.

Acupuncture and massage can each be very effective in helping a woman to relax and encourage the natural onset of labour. The term induction is possibly used out of context here and can be cause for concern among your medical carers as they equate it with medical induction, with inherent risks and a cascade of interventions that may follow. Importantly, neither acupuncture nor massage has the same effect on a woman as medical induction using synthetic syntocinon. Labour is rarely initiated immediately or during treatment (though occasionally this will happen in a very ‘ready’ mum). With both acupuncture and massage induction, labour will have the same gradual onset as would occur with a natural onset of labour.

“At full term, the intention of our induction treatment is to calm the mind, relieve anxiety
and worry, promote restfulness and enhance and strengthen energy flow. When necessary, we gently move energy around the baby to encourage optimal positioning and engagement,
gentle cervical stimulation to help soften and ripen the cervix and encourage appropriate hormone balance for this stage.” Rachel Steward, Registered Acupuncturist

The natural induction approach in mums who are more physically and emotionally prepared and ready for the challenges of labour and babies who are ready to be born! Natural induction can help prevent the need for medical induction in many cases, and, for most, it feels preferable to avoid medical intervention where possible.

However, working with pregnant women at the last minute is usually the least preferred option. Seeing pregnant women when they have become fearful of induction and anxious about time frames actually makes the job more difficult and the hoped for outcome somewhat less likely. A mum’s highly adrenalized and fearful emotional state actually works against the production of oxytocin – the hormone which is required for them to go into labour naturally in the first place.

Why is medical induction something to avoid if possible?

It is important to say that sometimes a medically induced labour is a necessity for the health of mother and baby. But there are some good reasons to avoid it if you can. The inherent risks associated with medical induction are medically acknowledged and consequently, constant fetal monitoring is necessary throughout the labour. This means wearing a monitor on your belly for the duration of the labour and these monitors may or may not be attached to a machine, restricting your movements and capacity for active labour. Even if your hospital provides remote monitoring (not attached to the machine), you still have to wear the monitor on your belly and it seems we are yet to find a device that can fit a pregnant, contracting, active belly which means your midwife is constantly hovering, holding the monitor trying to get a good trace of your baby’s heart rate. At the very least this is disturbing for the mother and in most cases becomes down right annoying.

Medical induction involves a continuous intravenous application of synthetic oxcitocin (Sintocinon) – another thing you are attached to for the whole labour. Sintocinon stimulates labour differently to the natural co-ordination of hormones between mother and baby in a natural onset of labour (think, 0-100 in 5-15 minutes compared with a slow, steady progression over hours or days that gradually stimulate contractions as well as hormones and endorphins to help you work with contractions and gradually increasing pain). Medically induced labour starts quickly and intensifies quickly. It takes a very well prepared mother with good support to find her rhythm and work with these contractions without the help of endorphins and other hormones which won’t kick in until later. While an induced labour can find its rhythm and progress as any other labour would, those first few hours of contractions can be very challenging to say the least.

Consequently, what is known as the “cascade of interventions” often follows the onset of a medically induced labour. Epidural, caesarean and assisted births (forceps/vontuse) and episiotomy have all been shown to be far more likely to occur following a medical induction.

Following you will find some tips for getting your labour started without the help of medical induction. However, we cannot know who will need to be induced and who will not. There are too many variables at work in each individual for this to be predictable. The TWO BEST things you can do to help ensure a natural onset of your labour:

1. Make sure you are birthing in the context where you feel most comfortable and safe. Whether this be hospital, birth centre or home under either obstetric or midwife lead care is less important than the fact of your feeling of safety. It is imperative that you feel good about where you are going to give birth to your baby. If you have doubts, find a good childbirth educator, birth attendant, midwife or sympathetic obstetrician to discuss your concerns with.
2. Get good birth support. A doula/birth attendant or independent midwife is invaluable support for you and your partner during labour. It has been shown again and again that continuous care from a known, trusted provider throughout the birth enhances birth outcomes. This will most certainly be the case if you need to be medically induced and is the best thing for helping you have a birth you feel satisfied with, regardless of which way it goes. Having someone to answer your questions, calm your nerves, reassure your doubts, help you research and understand your options, remember to ask questions you may not, support your partner and implicitly trust in your capacity for a normal physiological childbirth is just immeasurably helpful.

Ideally, pregnant women should begin acupuncture or massage from around 34-36 weeks to help prepare them for birth. This treatment approach entails weekly treatments geared toward a relaxed, healthy body and mind that is balanced to create the right conditions to enable labour to occur naturally and without intervention. When the time comes, we find actual induction treatment unnecessary for many of these women as they are well prepared and go into labour without help.

Choose your practitioner carefully as a good understanding of pregnancy, labour and birth dynamics is essential to obtain a good result. Pushing for contractions to begin without considering the full picture can produce spurious labour and result in extended on and off contractions which can be exhausting for the mother. Considering factors such as how the baby is currently positioned and what physical and emotional stressors are playing out for the mother help to determine what needs to happen at each appointment to progress positively.

The best approach is to support the mother, body and mind to find support and correct treatment for the most positive outcome for mother and baby – a naturally occurring and effective labour that gives birth to a healthy baby and mum.

Now for some tips to maximise your chances of going into labour naturally!

Top tips for getting your labour started

• PATIENCE! Not easy at this time, I know! In the same way that your body knows how to initiate a period, have a poo and digest your food without you controlling it, your body also knows when it is time for your baby to be born. A delicate balance of hormonal communications between your baby and your body are silently at work helping your baby mature and giving your body the right signals for when your baby is ready. Trusting in this process disables your fears, inhibits the production of anxiety related hormones and enables your body to produce adequate hormones to go into labour spontaneously. Meditation, lots of rest, gentle yoga, long walks and surrounding yourself only with loving, positive, safe and supportive friends/family are highly recommended.
• Sex (if you’re up for it!): Semen is a natural source of prostaglandins – the very same stuff that is in the gel your obstetrician might use to induce you if overdue. Nature has its own version and orgasm is bound to get that pelvic floor rocking!
• Nipple stimulation: gentle rubbing or rolling of the nipple can bring on contractions.
• Walking: particularly up stairs or hills but just around the block is good to get your pelvis moving. But remember you really need to find the balance between REST and activity. There is no point getting yourself into labour in a totally exhausted state. You need your energy FOR your labour so be active and get walking but don’t overdo it and make sure you REST A LOT! Also try dancing (especially belly dancing), bouncing on a fit ball or a tractor drive down the paddock (or just a drive down a long bumpy road used to do the trick in the old days!)
• Raspberry leaf tea – a strong cup every 2 hours: Raspberry leaf has a direct tonifying effect on the smooth muscle of the uterus. This means it will stimulate more Braxton Hicks contractions (practice contractions your body uses to strengthen the uterus) if the uterus is weak, or relax the smooth muscle if it is too taught. Very useful throughout the last trimester, but a great addition to your self-induction efforts.
• Homeopathic birthing drops: available at FGHG and taken weekly from 34 weeks and daily in the lead up to labour.
• Induction Acupuncture: Acupuncture has been proven to be a successful induction method for labour, and also helps to shorten labour times. We recommend patients begin birth preparation up to six weeks prior to their due date. With this approach we find patients are more likely to go into labour spontaneously & respond best if induction methods are required.
• and/or Induction Massage: Massage is particularly good if you are tired, wound up, stressed or if you are feeling fearful (especially if you are fearful of acupuncture!). Massage helps to relax the whole body and consequently changes the chemistry from stress to relaxation. Research does show that relaxation, touch, love, enjoyment and pleasure all help to stimulate oxytocin – the love hormone that really gets your labour going. Oxytocin can be ‘inhibited’ by adrenalin which is why massage is so important along with relaxation, PLENTY of rest and making sure you are getting lots of support around any fears you may have about your labour. Our massage therapists also use acupressure points (similar to acupuncture), essential oils and other techniques to facilitate the onset of labour.
• Castor oil: this one is a little contentious with many health professionals warning against it due to the risk of inducing diarrhoea and dehydration. However, while it is true that castor oil will move your bowels and give you a good clean out, diarrhoea is usually only caused when too much castor oil is taken. We recommend no more than 30mls of organic, cold-pressed castor oil per dose per day. The best way to take it is mixed into something very tasty like your Vitamin C powder, vigorously shaken and then down the hatch super quick. It is not yummy! Of course in pregnancy we recommend only using organic castor oil which can be sourced from FGHG. Try one dose and a good REST …
• Curry: did you think this was an old wives tale? The spices in a good curry have a similar affect to castor oil – if your bowels are sensitive to a good curry (and perhaps a little more pleasant to consume!). As the bowels and uterus are supplied by the same nerves, anything that stimulates the bowels will naturally stimulate the uterus into action also. Emptying the bowel can also help bring the baby’s head further down onto the cervix, which can itself help kick things along. Try a curry before bed and a good long REST …
• Stretch & Sweep: part of the magic trilogy (acupuncture, castor oil and a Stretch & Sweep), this one has to be done by your midwife or obstetrician if they are willing. A stretch and sweep is like an uncomfortable vaginal examination where the midwife/doctors fingers sweep the membranes from the cervix and give the cervix a good stretch. Often this disturbance will activate contractions. This can only happen if your baby is engaged (head well down in the pelvis) and the cervix is ‘ripe’ (soft, pliable and starting to open). It is really a last resort if all your other efforts have not been successful.

And of course, don’t forget the value of talking to your counsellor, midwife or dear friend. There is nothing like a good cry and emotional release to clear your blockages and get things moving. And did i mention REST …

Milly Dabrowski is a writer, registered Acupuncturist and Co-Director of Fertile Ground Health Group, a Melbourne-based natural medicine practice specialising in preconception care, fertility and pregnancy. In ten years of practice as an intuitively inspired acupuncturist and birth attendant, Milly has been intimately involved in supporting women and families through all of life’s major transitions.

Milly sees purpose and opportunity in life’s major challenges and all her work is now directed to working with transformational change. Her mantra “there is nothing good health is not good for” and her passion for leaving people open to their true self and potential now inspire her work as a coach, mentor, speaker, writer and change agent.