To read the previous part, go to Induction.
Updated article : February 2023.
Many factors can prevent labour from starting. In this article, I want to talk about natural, mechanical and pharmacological ways to trigger labour.
- Being overweight (BMI above 40)
- Women over age 35
- Baby’s weight evaluated at over 4kg
- Breech birth
You can stimulate labour using natural methods. They vary in their effectiveness, but why not try them?
For example, sexual relations can help provoke contractions due to excitation. It releases oxytocin (to induce contractions) and the prostaglandins contained in sperm help soften the cervix muscle. If it can help start labour, go for it!
Nipple stimulation (or breast compression), either manually or with a breast pump, can help secrete natural oxytocin. Use your own breast pump or one at the hospital or birthing home. The worse that can happen is nothing. Then you’ll have to shift to plan B.
While scientifically unproven, acupuncture and osteopathy can help start labour naturally and slowly. Naturopathy or homeopathy can also help provoke contractions. Castor oil, which is a powerful laxative, can also help induce labor in a more natural way. By provoking contractions of the smooth muscles of the intestine and by rebound effect, those of the muscles of the uterus. Always follow the dosage which is 60 ml in a single oral dose, and only after 39 weeks of pregnancy. It is very important not to exceed the dose, as diarrhea and abdominal cramps are to be expected, as well as the risk of dehydration. Up to you to see if you are comfortable with this.
Finally, a cervix massage, also called stretch and sweep (circular rubbing of the cervix) can be done by your caregiver at the end of pregnancy. They will insert their fingers to try to separate the membranes of the amniotic sac from your cervix. Your cervix needs to be sufficiently dilated and effaced. This can be uncomfortable for the mother, but only for a short time. There may also be slight bleeding and irregular contractions that follow. This procedure can help start labour by releasing prostaglandins locally (hormones that stimulate contractions) which help prepare the uterus for childbirth. Some data indicates that regularly performing this procedure can induce labour and reduce trigger rates. (JOGC January, 2023)
Artificially breaking water with a needle is a way to start labour.
There are mechanical and pharmacological ways to help start labour. A tampon soaked with prostaglandin (ex.: Cervidil) in intravaginal gel form or applied to the cervix (endocervical) to help it efface and dilate. This is an effective way to help the cervix mature and start labour when the cervix is not ready for induction. Following this procedure, the woman usually has to stay in bed for about two hours and kept at the hospital for monitoring for several hours afterwards. Please note that your doctor will evaluate if you should use this product. If you have had a previous caesarean or if you have broken your water, the final decision can vary. You can also introduce a Foley catheter (balloon catheter) into the cervix and blow it up to put constant pressure of the cervix’s internal mucosa to soften it. These two methods alone can be enough to start labour. If the catheter hasn’t fallen out after 24 hours, it’s removed by deflating it. There are also been, for some years now, the use of a medication to take orally to provoke contractions (oral misoprostol). This medication is more and more used when the situation of the pregnant woman allows it. It works by causing an increase in uterine tone after a single dose and this molecule alone, used repeatedly, can be used to trigger labor instead of the traditional intravenous formula (JOGC, January 2023).
You can see why it’s essential to understand the different alternatives to make the right choice and to understand what is happening to you. That said, if your cervix is mature (seen as “favourable”), and the membranes are accessible, you can have your water broken artificially to start labour. This is called an amniotomy. You may then be intravenously administered Pitocin or Syntocinon (artificial oxytocin) or oral misoprostol to help with the start of labour. This hormone is naturally secreted by the body, but if it is not present for the start of labour, it will be added to your blood to help trigger labour. The concentration and dose will be based on protocols established in each hospital.
The woman’s chances of giving birth within 24 hours are higher if oxytocin is combined with breaking their water. You will be hooked up to an intravenous to introduce the product, which will provoke steadier contractions. Sensitivity to oxytocin increases at the end of pregnancy. This procedure will usually lead to stronger and earlier contractions than natural labour, and there is an increased risk of hypotension (reduction in blood pressure). The father or significant person can be with the woman throughout the procedure. A fetal monitor will be installed to check the baby’s heartbeat when the oxytocin solute rate is increased to monitor their wellbeing.
When introducing an artificial hormone, contractions may not be steady and strong from the start but will increase their intensity and come closer together over time as the flow increases. At the outset, you may be asked to eat a light meal, but never during active labour. To be adequately hydrated during labour, you can drink clear fluids with no residues that include electrolytes, unless the circumstances don’t allow for it.
Why not try more natural methods before turning to artificial hormones when the situation allows for it!
Artificial triggering using artificial hormones may not work on the first try. The medical team will re-examine the situation and decide whether to induce again or perform a caesarean section if there’s an emergency.
So now you know all about induction!
Here are some videos that are related to the topic which can help you prepare for the birth of your baby.
Please read these related articles:
- The Realities of Childbirth
- I’m going to be a dad soon! (in french)
- Ha! Hormones! (in french)
- Caesarean Sections
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