By the time most women hit the 38th week of pregnancy, they are about ready to be done being pregnant. They are huge, clumsy, exhausted, peeing every 5 minutes and anxious to meet the angel they have been carrying for nine months. I certainly was. Your due date comes and goes...nothing. A few more days tick pass, each of them longer than the one before, each strung out with longing and anticipation. Your care provider may or may not start talking to you about induction, but regardless, you are probably wondering how to get your baby out. If that's you, here are a few tips and tricks you can try to naturally induce labor.
Please note that you should always talk to your care provider before trying any method of natural induction. Just because something is "natural" does not mean that it is safe or the right choice for you in your particular situation.
What does induction (of any kind!) need to work?
First off, for induction of any type to work well, your body needs to be ready to go into labor soon. That means that your cervix needs to have moved from posterior to anterior, ripened and potentially started effacement and dilation. This is particularly important when trying natural induction.
My midwife describes natural induction using the analogy of "a tree with dead leaves." When a tree's leaves are green, it takes a storm to bring them down. But when they are dead, any passing gust of wind will send them swirling. These methods may act as that "gust of wind" if your baby is ready to come. But if your baby's not ready, no amount of wind will cause it to fall.
Another factor to consider is that natural induction works best when you are already overdue. With permission from your care provider, there is nothing wrong with trying some of these methods earlier because many may help ripen your cervix, but don’t be discouraged if they don’t induce labor.
Unfortunately, there is a sad lack of research on alternative methods to induce labor. Many of these methods may be tried with minimal side effects but their true efficacy is insufficiently studied.
Beneficial methods for natural induction
Sex - This may or may not sound like the most appealing thing at the end of your pregnancy but sex can benefit you in many ways. Why? Semen contains prostaglandins, which are hormones that help soften and ripen the cervix. In fact, medications such as Cytotec and Cervidil (which are used to ripen the cervix) are prostaglandins!
Orgasm can also be beneficial because during orgasm your body releases oxytocin, which is the main hormone that contributes to uterine contractions. Touching, kissing and hugging also release oxytocin. In other words, sex and intimacy are just plain good for you at the end of pregnancy!
Castor oil - While castor oil in and of itself does not induce labor, it irritates your bowels, which work in connection with your uterus. Many midwives use this method, but most caution that it is only effective if you are overdue and partially dilated. Use this method only under medical supervision, as it can quickly dehydrate you. If you do go this route, consider mixing the oil with something to make it a little more palatable. My midwife suggested I make a castor oil root beer float! She also said that eating Reese’s peanut butter cups afterwards can help cover up the castor oil’s taste, which can be brutally nasty.
Nipple stimulation - Nipple stimulation is thought to help release oxytocin. In her book, coauthored by Ruth Ancheta, “The Labor Progress Handbook”, Penny Simpkin cites a Cochrane review as saying,
“when the cervix was favorable and breast stimulation was compared with no intervention, the number of women not in labor by 72 hours was significantly reduced by the use of nipple stimulation.” (1)
She notes that it is also worth trying before turning to pitocin to augment labor.
To use this method, you can stimulate your breasts yourself, have your partner do it or even use a breast pump. Most experts recommend only stimulating one breast at a time. Be sure to stimulate the entire areola, not just the nipple. Move your hand around the areola in a firm but gentle circular motion for 5-15 minutes and then switch breasts.
Walking - We’ve all heard that walking supposedly can start labor, right? The thought process behind this is that when you are upright and walking, baby’s head puts pressure on your cervix, which in turn stimulates oxytocin release. Even if you don’t experience this effect, walking can help your baby move into a favorable position in your pelvis, as can bouncing on a birth ball, swaying or dancing. Be careful not to overdo it, though. No matter how much you want that baby out, going into labor exhausted is not a good idea.
Acupuncture - Many people believe that acupuncture can help initiate labor and even provide pain relief during it. A study done in Austria on 45 pregnant women found that,
“Acupuncture at points LI4 and SP6 supports cervical ripening at term and can shorten the time interval between the estimated due date and the actual time of delivery.” (2)
Once again, however, it should be stressed that most of the articles on acupuncture as a method for induction said that the woman needed to be at her due date or beyond for any hope of the method to work.
Acupressure - While I was unable to find much scholarly information about the efficacy of acupressure to induce labor, it is simply a form of acupuncture without needles. Therefore, if acupuncture is potentially beneficial for labor induction, it seems reasonable to try acupressure if you are unable to do acupuncture. Remember how all those pregnancy books warned you not to rub your ankle and heel? That’s because there are two pressure points located in that area, which are thought to potentially stimulate labor.
If you do want to try acupressure, try pressing or rubbing between the thumb and index finger for about a minute (this method may also help reduce pain in labor because it releases endorphins). Another point to try is the outside of the ankle
“just behind where the bony prominence is. The other ankle pressure point is inside the leg, above the ankle. This area may be difficult to find but it is more sensitive to touch than the rest of the leg.” (3)
Another pressure point to try is the muscle between the neck and shoulder. Again, massage or press it as feels comfortable.
Not everyone will tolerate acupressure well. If it hurts or causes any kind of discomfort you should discontinue. On the bright side, if you have someone else do the acupressure on you, you will receive the benefits of oxytocin release as you are touched, rubbed and stroked.
Evening Primrose Oil - This is said to be a cervical ripening agent because it contains substances that your body supposedly changes into prostaglandins. So, although it won’t start your labor, it can help to ready your cervix, which makes the success of induction much higher and, often, your labor shorter.
If you choose to go this route, you can take 1-3 capsules orally or vaginally for about a month before your due date. Again, talk to your healthcare provider for dosage recommendations.
Dates (the fruit) - Interestingly enough, a small prospective study done between the 1st of February 2007 through January 31st, 2008 at Jordan University of Science and Technology revealed that the consumption of dates, known as Phoenix dactylifera, had surprising results.
The women who consumed date fruit had significantly higher mean cervical dilatation upon admission compared with the non-date fruit consumers (3.52 cm vs 2.02 cm, p < 0.0005), and a significantly higher proportion of intact membranes (83% vs 60%, p = 0.007). Spontaneous labour occurred in 96% of those who consumed dates, compared with 79% women in the non-date fruit consumers (p = 0.024). Use of prostin/oxytocin was significantly lower in women who consumed dates (28%), compared with the non-date fruit consumers (47%) (p = 0.036) (4)
It is unfortunate that larger studies have not been done on this method, as the initial results seem promising. In this particular study, the women consumed dates for 4 weeks before their due dates, so if you plan to use this method know that you will be eating a lot of them. If you do go this route, keep in mind that dates have a lot of fiber (but are also nutritious!), so you may spend a great deal of time moving your bowels!
Black Licorice - Real black licorice contains a chemical called glycyrrhizin that is thought to stimulate the production of prostaglandins. If you eat enough licorice, it can also cause some diarrhea, which can potentially stimulate your uterus. As there is no conclusive evidence out there on this method, it’s a bit of a shot in the dark but if you like the taste of black licorice, why not give it a try?
The methods listed here are often mistakenly thought to potentially induce labor. While the logic process behind the methods is often sound, for practical purposes, these methods aren’t applicable (for example, eating pineapple core could induce labor but you’d have to eat the equivalent of seven pineapples for it to have any effect!).
Red Raspberry Tea - Does not start labor or ripen the cervix. What it is thought to do is,
“supposedly increase the uterus' contractility and strength of uterine contractions. This is thought by some to shorten the duration of labor and improve the efficiency of uterine contractions, reducing labor discomfort.” (5)
To illustrate just what a lack of thorough research there is on this method, according to an article in Complementary Therapies in Clinical Practice,
“PubMed, ISI Web of Science, AMED, EMBASE, Natural Medicines Comprehensive Database and Cochrane Library were searched [for information about the use of red raspberry leaf tea in pregnancy and labor]. Altogether 12 original publications with focus on safety or efficacy during pregnancy, pharmacology and in vitro tests explaining mode of action or constituents in Rubus idaeus [American red raspberry] were reviewed. Limited documentation exists and part of it is 50 years old or older.” (6)
There are no known side effects to trying the tea except that when you do go into labor, it may cause you to have overly strong contractions. Many experts recommend against its use.
Greasy food - This is thought to potentially cause stomach upset, which in turn can stimulate the uterus. There is no evidence that this is the case.
Pineapple - Fresh pineapple contains an enzyme called Bromelain that is thought to work like a prostaglandin on the body. Unfortunately, you would have to eat the equivalent of about seven pineapples for this to work, and who is going to do that?!
The methods listed here could potentially work to induce labor but are thought to be harmful. Unfortunately, many people - experts, even - do not realize this and still use them. Please steer clear of these methods!
Black and blue cohosh - While both of these herbs, especially taken in conjunction with each other, are recognized as being uterine stimulating herbs, they are not safe to induce labor. Unfortunately, many people, even medical professionals, suggest their use.
A survey of 500 members of the American College of Nurse–Midwives suggested that more than half of them employed herbal medicine products for the purpose of inducing labour. The herbal medicine products most frequently named were blue cohosh (64%), black cohosh (45%). (7)
These herbs have not been extensively studied, but it is thought that cardiotoxic alkaloids and caulosaponin, which are both contained in blue cohosh, can lead to severe problems such as myocardial infarction, profound congestive heart failure, cardiovascular shock seizures, kidney damage, and the need for mechanical ventilation.
Spicy food - This was one of the most interesting finds in my research. OB/GYN North, says this about spicy foods:
“What the research is now showing is that these foods may be something to avoid prior to labor. Certain spicy foods release capsasins, which may be counterproductive in labor. When the baby descends down the birth path, the pressure exerted releases endorphins which are a natural pain killer. In effect, the capsasins counteract the endorphins and rob the mother of her natural ability to have a pain-free birth.” (8)
I set out determined to find sound scientific evidence for natural methods of induction. After weeks of scouring the internet, I have come to the sad conclusion that there is simply no sure way to naturally induce labor - no good way, even. It was hugely disheartening to see the lack of research into many of these methods.
In a way, my findings are simply a poignant reminder that babies come on their own time and generally won’t be rushed by our tricks. Despite all our technological advances, due dates are, at best, just an educated guess. So sit back, put your feet up and enjoy a favorite snack. Try some tricks if you must, but remember that your little one will come when it’s ready and not before.
(1) Penny Simpkin and Ruth Ancheta, The Labor Progress Book: Early Interventions to Prevent and Treat Dystocia (Wiley-Blackwell, 2013) pg 244
Penny Simpkin and Ruth Ancheta, The Labor Progress Book: Early Interventions to Prevent and Treat Dystocia (Wiley-Blackwell, 2013) pg 244