Without question, this page is the most visited page in the Birthsong website. You may have come upon this page searching for ways to "naturally" induce labor-- looking for ways to speed up the process and jump start Mother Nature. You may be tired of being pregnant, hate the uncertainty of not knowing when labor will start and are anxious to meet your new baby. You perhaps are looking for a non-pharmocological/non-medical method by which to do it. If this describes your reason for coming upon this page, allow me to share something you may not want to hear: there is no "natural" way to induce labor. The very term is paradoxical. You cannot force something to happen against its own timing and will and call that "natural." Enjoy your pregnancy. Be patient. Trust in your body to do what it needs to do exactly when it needs to do it. 99.9% of women will go into labor on their own without the aid of drugs, hormones or other invasive procedures. And, by letting your baby and your body decide when the time is right, you will be laboring in harmony with the perfect rhythm of nature and allowing for the most optimal birth possible. This is a time for meditation, reflection, and patient expectation. Prepare your mind, your heart, and your body for the new life which is to come forth. Live in the moment and don't worry about the future. Relish the eternal moment of now in which you live. Patience is a virtue that you will need to possess for motherhood and pregnancy is as good of a time as any to learn it and embrace it.
Nature provided a perfect process for birth. Yes, sometimes, as with all things, it does not go exactly according to plan. Sometimes there are difficulties and unexpected outcomes. But most of the time, it works out miraculously well. It is when we fail to trust in the ancient and sacred process of birth, in its perfect timing, that we fail ourselves. When your body is fully ready to open up and birth your baby, it will happen. Your baby will be perfectly prepared. Your body will be fully ready. The complex interplay of neurotransmitters and hormones will create a symphony within you that will echo forth your own unique and flawless birthsong.
The best way to experience labor and birth, as it was meant to be, is to open yourself up to the universe, surrender your will and with trust, honor the timeless and perfect process of birth.
~ Jennifer Ayers-Gould. BA LPN ICCE ~
The following articles go into more detail about labor induction:
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.
A: 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
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
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.
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
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.
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,"
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.
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.
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
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.
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.
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
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
Reprinted from Midwifery Today
E-News (Vol 1 Issue 50, Dec
To subscribe to the E-News write:
For all other matters contact
PO Box 2672-940, Eugene OR 97402
the Baby Decide: The Case Against Inducing
Labor Mothering Magazine, March-April
2001, by Nancy Griffin
was a sunny Friday afternoon, and Tracy was
three days past the due date for her first
baby. After finishing up the tenth call of
the day from well-meaning but anxious friends
and relatives, she headed out the door for
her weekly checkup with her obstetrician. "If
you don't go into labor by your next appointment,
we may have to induce you," her doctor
had advised. Tracy wondered if the slight menstrual-like
cramps she'd had the past few days meant that
something was happening at last.
the doctor's office, a vaginal examination
revealed that Tracy was 2 centimeters dilated,
her cervix 80 percent effaced, with the baby
at minus one station. According to an ultrasound
scan, her amniotic fluid levels seemed borderline
low, and because she was having mild contractions,
the doctor suggested that she "go on over
to the hospital and have a baby today!"
Tracy called her husband at work. He rushed
to meet her at the hospital, where she was
admitted and hooked up to an IV. Eight hours
later, with no further progress, Tracy received
an epidural, and labor was induced by the intravenous
administration of the commonly used drug Pitocin.
A few hours later, her bag of waters was broken
artificially; 36 hours later, Tracy was recovering
from a C-section after delivering a healthy,
7-pound baby girl. Why did Tracy have to undergo
a C-section? What, if anything, had gone wrong?
two decades ago, Roberto Caldreyo-Barcia, MD,
former president of the International Federation
of Obstetricians and Gynecologists and an eminent
researcher into the effects of obstetrical
interventions, made the stunning statement
that "Pitocin is the most abused drug
in the world today."1 According to the
Journal of the American Medical Association,
16 percent of expectant mothers are induced
in the US; another 16 percent go into labor
spontaneously but are helped along ("augmented")
by Pitocin or a variety of other labor-stimulating
interventions.2 Other estimates range from
12 to 60 percent of mothers, depending on whether
the numbers refer to type of induction or augmentation,
the population sample, or the mother's socioeconomic
is a synthetic oxytocin (the natural hormone
that induces labor) made from pituitary extracts
from various mammals, combined with acetic
acid for pH adjustment and .5 percent chloretone,
which acts as a preservative. The World Health
Organization deplores routinely using Pitocin.
The Physicians' Desk Reference says that Pitocin
should be used only when medically necessary,
beginning with a minimal dosage, as there's
no way of predicting a pregnant woman's response.
The induced mother should receive oxygen, be
continuously monitored by EFM, and have competent,
consistent medical supervision. At the first
sign of overdosage, such as tetanic contractions
or fetal distress, Pitocin should be discontinued,
and the patient treated with symptomatic and
support therapy. After being induced, the laboring
mother can still help her labor progress through
natural techniques such as walking (if she's
not had an epidural), changing positions, emptying
her bladder once an hour, and nipple stimulation.
Pitocin can cause increased pain, fetal distress,
neonatal jaundice, and retained placenta; and
recent research suggests that exposure to Pitocin
may be a factor in causing autism.19-20
survey by Robbie Davis-Floyd, a cultural anthropologist
at the University of Texas, found that 81 percent
of women in US hospitals receive Pitocin either
to induce or augment their labors.21 Regardless
of exactly how many labors are induced in the
US today, the majority aren't medically necessary,
and between 40 and 50 percent resulted in failed
induction.22 A review of the medical literature
on routine induction of labor reveals that
disagreement among medical researchers in different
countries is rampant, and no conclusive evidence
exists that routine induction of labor at any
gestational age improves the outcome for either
mother or baby.23 Caldreyo-Barcia concluded
that induction is medically required in only
3 percent of pregnancies24 and that therefore
approximately 75 percent of all inductions
put both the mother and baby at risk.25
"Cultural Warping of Childbirth"
Induction of labor is defined by the American
College of Obstetricians and Gynecologists
(ACOG) as "the stimulation of uterine
contractions before the spontaneous onset of
labor for the purpose of accomplishing delivery"--that
is, artificially starting a labor that has
not begun naturally on its own. Augmenting
labor, often confused with induction, is a
slightly different process, used to help or
speed up a labor that began on its own. Midwives,
physicians, and other healthcare providers
have been inducing labor for as long as the
human race has attempted to gain control over
the processes of nature. A basic fear of the
natural process of childbirth has led, over
many centuries, to what President of the American
Foundation for Maternal-Child Health Doris
Haire describes as "the cultural warping
of childbirth." Justifiable fear about
the possible death of a baby or mother in childbirth,
combined with beliefs in magic, rituals, drugs,
herbal remedies, and much later, technology,
has led to the use of a whole host of "cures"
for labors that didn't seem to start "on
his classic book Husband-Coached Childbirth,
Robert Bradley, MD, compares the arrival of
human babies by nature's schedule to fruit
ripening on a tree. Some apples ripen early,
some late, but most show up right in season.
Along with Grantley Dick-Read, the father of
what we now call "natural childbirth,"
Bradley advocated relaxation, trusting nature,
and allowing babies to show up when nature
oxytocin, or Pitocin, was successfully synthesized
in 1953, and two years later it was available
to physicians for the inducing and augmenting
of labor. By 1974 it was well known that Pitocin
had a 40 to 50 percent induction failure rate;26,
27, 28 and in 1978, largely due to the work
of Doris Haire, Pitocin was investigated by
the US Senate and the General Accounting Office.
Between 1978 and 1981, Haire testified at three
congressional hearings on obstetric care, which
included reports on the dangers to mothers
and babies of the routine and elective induction
of labor. (Elective induction is defined as
the induction of labor without a clear medical
compelling theory, presented at the 1996 annual
meeting of the American Psychiatric Association
by Eric Hollander of Mount Sinai Medical Center
in New York, links autistic children with Pitocin-induced
labors. Hollander suspects that Pitocin interferes
with the newborn's oxytocin system, producing
the social phobias of autism. When he administered
oxytocin to autistic patients, it made them
four times more talkative, and according to
the patients themselves, twice as happy, although
not all patients responded.29
1978, the FDA advisory committee removed its
approval of Pitocin for the elective induction
of labor. (The drug has never been approved
by the FDA for the use of augmenting labor.)
The current Physicians' Desk Reference clearly
states that "Pitocin is not indicated
for elective induction of labor." An innovative
New York Public Health Law, section 2503, passed
in 1978, requires physicians and midwives to
provide full, informed consent to laboring
mothers regarding the use of drugs during labor
despite the problematic nature of inducing
labor and the lack of hard data supporting
these protocols from carefully designed controlled
trials, the routine elective induction of labor
in both normal and gray-area pregnancies (ones
not yet showing clear medical indication, just
possibilities) is still common.
According to ACOG, "Induction of labor
is indicated when the benefits to either the
mother or fetus outweigh those of continuing
the pregnancy."30 A very small number
of babies (a typical estimate would be less
than Caldeyo-Barcia's 3 percent, mentioned
above) actually need to be induced for medical
reasons. Another 3 to 12 percent seem to want
to drive their mothers crazy and hang out inside
that wonderful, warm, loving womb. No one knows
why these suspected "postmature"
babies choose not to make an appearance exactly
when those of us on the outside want them to.31
the percentage of babies born exactly on their
predicted due date is so small it's a wonder
we bother with due dates at all. It's perfectly
normal for 80 percent of healthy babies to
have anywhere from a 38- to 42-week gestation.32
Several generations ago, a physician might
tell an expectant mother that she was due "sometime
in late October or early November"; today,
women are given a "precise" due date,
often determined by ultrasound testing. Many
instances of so-called postmaturity result
from nothing more than an inaccurate due date.
Mittendord of the University of Chicago Medical
Center has isolated 16 factors that can influence
the accuracy of a predicted due date. Ethnicity
may play a role; African-American women, for
instance, often have pregnancies that are,
on average, three to eight days shorter than
those of other women. First-time mothers can
almost be counted on to deliver ten days or
more after their due date. The length of gestation
seems to peak for babies of mothers who are
around 29 years of age, so maternal age may
be a factor. Caffeine consumption makes pregnancies
shorter. Taking The Pill up to two months before
conception can cause havoc with due dates.
Finally, because biologic variation in fetal
size increases throughout gestation, ultrasound
dating can be deemed somewhat reliable only
in the first trimester.33
gestational age of an unborn baby is best determined
by looking at a number of different factors.
If you combine an accurate date of the last
menstrual period with a first-trimester pelvic
exam, fundal measurement (from the pubic bone
to the top of the uterus), date of "quickening,"
and a fetal heart tone, then confirm these
findings with a first-trimester ultrasound,
you'll end up with a due date that is still
only 85 percent accurate, plus or minus 14
days. Second-trimester ultrasounds tend to
be inaccurate by plus or minus 8 days, and
third-trimester ultrasounds by a whopping 22
probably best to stick with the "late
November, early December" method unless
you are fortunate enough to know the exact
date of conception, another way to attempt
to pinpoint a due date. Medical science recognizes
in vitro or artificial insemination as the
only accurate means of determining conceptual
age. However, if a woman was using an ovulation
predictor test correctly, or her husband was
home between business trips only once after
her period ended (and she actually wrote this
date down on a calendar), she could nail down
her due date by counting forward ten lunar
months from conception. Even so, she might
end up with a baby who stubbornly decides to
belong to that 10 percent who go beyond 40
weeks. Despite all of these calculations, an
induced baby may turn out to be premature rather
Exactly Is Postmaturity?
ACOG defines a post-term pregnancy as one that
lasts beyond 42 weeks of confirmed gestational
age. The need to diagnose postmaturity accurately
is important because perinatal mortality, the
risk of fetal distress, and the need for C-sections
double by 42 weeks.34-38 Risks of true postmaturity
include stillbirth, meconium aspiration, and
"dysmaturity syndrome," found in
some babies adversely affected by being in
a declining uterine environment. Robert Hamilton,
assistant clinical professor of pediatrics
at UCLA, says that in all his years as a pediatrician,
he has seen actual postdate babies less than
5 percent of the time. Moreover, the vast majority
of post-date babies overcome problems after
birth and are ultimately healthy.39, 40 AGOC
estimates that 95 percent of post-term babies
are born safely between 42 and 44 weeks.41-45
(Perhaps these babies were meant to "ripen"
a bit later than their "average"
most accurate current criterion for diagnosing
postmaturity is the mother's amniotic fluid
volume. As placental function decreases in
a true postmature pregnancy, blood flow and
blood pressure in fetal organs decreases. The
result is lower levels of amniotic fluid, as
measured by an amniotic fluid index. Fluid
levels of less than 5 centimeters are considered
low and greatly increase the risk of cord prolapse.
A normal level is 8 centimeters or more; 5
to 8 centimeters is borderline. (Borderline
fluid levels can be caused by something as
simple as dehydration, so a woman should be
sure to drink plenty of water throughout her
is not known whether the increased risk to
the baby is caused by the postmature pregnancy
itself, or if some babies who are inherently
at greater risk are more likely to be overdue.
Therefore, it is difficult to determine via
research if the timely induction of labor decreases
the risk in post-term pregnancies. The American
Academy of Family Physicians' 1996 Assessment
of Post-Term Pregnancies concludes that whether
there is any "fetal testing modality that
will provide the most accurate prediction of
a healthy fetus is debatable."46
Does Labor Begin Naturally?
Up until recently very little was known about
how natural labors actually begin. Scientists
knew that the release of oxytocin resulted
in both uterine contractions and milk production.
Pioneering research by scientists at Cornell
University, the University of Pittsburgh School
of Medicine, and the University of Auckland,
New Zealand, suggests that it's the baby's
brain that initiates birth.47
researchers discovered a pea-sized region of
the fetal sheep brain called the paraventricular
nucleus, which actually serves as a biosensor
designed to trigger the events leading to a
birth. Two hormones, corticol and adrenocorticotropic
hormone (ACTH), reach peak levels in the fetal
bloodstream just before birth. Peter W. Nathaniels
of Cornell University suggests that the "fetal
brain may act as a tiny monitor, tracking its
own development."48 When the baby is ready
for birth, the paraventricular nucleus signals
the fetal pituitary gland to increase ACTH
secretion. The pituitary, in turn, tells the
fetal adrenal gland to secrete more cortisol.
These hormonal increases cause changes in the
mother's hormones, including the release of
oxytocin, which lead to uterine contractions.
Because scientists speculate that a malfunction
of the fetal biosensor may account for early
or late births, this research may prove helpful
in the future, both to stop premature labor
or to effectively induce a truly postmature
of the currently available methods of inducing
labor bypass this important first step of fetal
paraventricular nucleus biosensor interaction
between the hormonal systems of both mother
Our Unborn Babies
Labor should be induced only when medically
necessary, never simply for convenience or
because a woman is sick of being pregnant.
The risks in these situations far outweigh
the perceived benefits. Determining postmaturity
or a woman's readiness to give birth are complex
processes. We are just beginning to understand
the long-term effects on the fetal brain of
drugs such as Pitocin, and the exact long-term
effects of inducing or augmenting labor are
unknown. Pregnant woman wanting information
on the safety of a drug can consult the Physicians'
Desk Reference or call the product safety officer
at the pharmaceutical company where it is manufactured.
all babies appear to be harmed by the inducing
or augmenting of labor, but these procedures
do carry risks. According to Doris Haire, "The
fact that Pitocin can shorten the normal oxygenating
intervals that occur between contractions is
a threat to the integrity of the fetal brain
and can have lifelong consequences for the
women owe it to themselves and their unborn
babies to do everything they can to stay healthy
and thereby minimize or prevent the need for
medical induction. Babies born from natural,
spontaneous labors have the best overall outcomes,
and their mothers experience easier labors
and quicker postpartum recoveries.
Methods for Inducing Labor
Suggestions for the natural induction of labor
have ranged from taking castor oil to having
sex. Before turning to a few techniques that
might actually work, let's take a look at some
of the "old wives' tales" that have
made the rounds.
oil simply causes the person taking it to empty
her bowels quickly and efficiently. Because
the uterus is so tightly wedged against the
intestines, movement in the bowel can sometimes
trigger uterine activity. Castor oil looks
like a pretty silly remedy when one realizes
the complex interaction between the brain chemistry
of the mother and the baby leading to labor.
Take castor oil only under the supervision
of a midwife or a doctor. Balsamic vinegar
and senna tea have similar but much weaker
effects on the intestines.
herbs, such as black cohosh (Caulophyllum),
blue cohosh (Cimificugua), achyranthes root,
goldenseal, motherwort, wild ginger, and red
raspberry leaf, have been used to induce labor.
No long-term follow-up study has ever been
carried out to show that the use of herbal
remedies is safe for inducing labor. All drugs,
including medicinal herbs, reach the baby,
and any dosage that has an effect on the mother
is going to have an overdosing effect on the
baby simply because the mother's body weight
is about 20 times greater. A pregnant woman,
therefore, should never self-prescribe any
medicinal herb. Anyone who must be induced
for a medical reason, and who wishes to use
alternative induction methods, should be guided
by a knowledgeable herbalist, acupuncturist,
fats and oils such as pennyroyal and safflower
have historically been used to treat all manner
of female complaints and are considered to
be alternatives to cervical gel (artificial
prostaglandins applied directly to the cervix
to "ripen" it). Safflower is simply
a safe cooking oil, but pennyroyal is known
to have potential abortive effects.
is considered by some American practitioners
as potentially effective in jogging a late
labor, but traditional Oriental practitioners
almost never use acupuncture on women at any
time during pregnancy. Traditionalists believe
in trusting Mother Nature.
advocate the use of the oils of lemon, clarysage,
and fennel, which are massaged into the abdomen
and inhaled by the expectant mother. Anything
inhaled by a pregnant woman, however, is also
inhaled by her baby, and cannot therefore be
is an age-old method of induction that seems
to be effective. Prolonged and continuous nipple
stimulation results in the natural release
of oxytocin and is a proven nonmedical method
for inducing labor.50, 51, 52 The release of
semen onto the cervix during intercourse can
promote cervical ripening because semen contains
prostaglandin, a hormone partially responsible
for cervical softening.
relaxation--mental, physical, and emotional--prevents
the pregnant woman from releasing adrenaline,
a hormone that stops labor so that the expectant
mother can find safety first before her baby
of these things, together with a healthy lifestyle,
good nutrition, and a healthy pregnancy, combine
to produce healthy babies who show up on time--the
exact moment when nature intended.
indications for inducing labor
may include, but are not limited
to, the following conditions
in either mother or baby:
Premature rupture of the membranes
Maternal infection or medical
problems, such as diabetes mellitus,
kidney disease, or chronic pulmonary
Suspected fetal jeopardy
Severe blood incompatibility
Severe pre-eclampsia or toxemia
Postdate pregnancy, where there
is a proven danger to the baby
American College of Obstetricians
Korte and Roberta Scaer, A Good Birth, A Safe
Birth (New York: Bantam, 1984).
Statistical Bulletin (January 21, 1998).
of Labor," American College of Obstetricians
and Gynecologists Technical Bulletin 217 (December
of Labor in Postterm Pregnancy," ICEA
Review 12, no. 1 (February 1988).
5. See Note
Management While Waiting for Spontaneous Labor
Compared to Immediate Induction Following PROM,"
New England Journal of Medicine (1996).
of the Postterm Pregnancy, American Academy
of Family Physicians, 1996.
Critical Review of the Recent Literature on
Postterm Pregnancy and a Look at Women's Experiences,"
Induction v. Spontaneous Labor: A Retrospective
Study of Complications and Outcomes,"
American Journal of Obstetrics and Gynecology
Pregnancy, Part 1 and 2," Journal of Nurse-Midwifery
Much Ado about Nothing?," British Journal
of Obstetrics and Gynecology (1986).
Pregnancy: The Management Debate," British
Medical Journal (1986).
Induction of Labor," The Lancet (May 1975).
Goer, Obstetrical Myths v. Research Realities
(Westport, CT: Bergin and Garvey, 1995).
Inch, Birth Rights (New York: Pantheon, 1984).
in Normal Birth," The World Health Organization.
Davis-Floyd, Birth as an American Rite of Passage
(Berkeley: University of California Press,
in a Parallel World: A Bold New Approach to
the Mystery of Autism," Newsweek, May
Physicians' Desk Reference, 52nd ed. (Montrale,
NJ: Medical Economics Co., 1998).
Morbidity and Mortality and Long-Term Outcome
of Postdate Infants," Clinical OB-Gyn
31. See Note 7.
34. See Note 4.
35. See Note 7.
36. See Note 8.
37. See Note 10.
38. See Note 11.
39. See Note 4.
40. See Note 7.
41. See Note 4.
42. See Note 7.
43. See Note 8.
44. See Note 10.
45. See Note 11.
46. See Note 7.
47. "Fetus Tells Mother It's Time for
Labor," Science News.
49. Personal interview, Doris Haire, September
50. Jacques Gelis, History of Childbirth (Boston:
Northeastern University Press, 1991).
51. Richard Wertz, Lying-In: A History of Childbirth
in America (New Haven, CT: Yale University
52. See Note 18.
Method. The American Academy of Husband-Coached
Childbirth. 91413-5224 PO Box 5224, Sherman
Oaks, CA 91413. 800-4-A-BIRTH (800-423-2397)
The American Foundation for Maternal and Child
Health. 439 E. 51st Street, New York, NY 10022.
International Childbirth Educators Association.
PO Box 20048, Minneapolis, MN 55420. 612-854-8660.
American College of Obstetricians and Gynecologists
(ACOG). 409 12th Street, SW, Washington, DC
20024-2188. 202-863-2518 (Resource center).
National Association of Parents and Professionals
for Safe Alternatives in Childbirth (NAPSAC).
Rt. 4, Box 646, Marble Hill, MI 63764. 573-238-2010.
Internet Resources (available by subscription
or at libraries)
Infotrac, Medical Lexus, Medline, Elsevier
Brackbill, Yvonne. The Birth Trap. C. V. Mosby,
Bradley, Robert. Husband-Coached Childbirth.
Bantam Books, 1996.
David-Floyd, Robbie. Birth as an American Rite
of Passage. University of California Press,
Dick-Read, Grantley. Childbirth without Fear.
5th ed. Harper & Row, 1984.
Edwards, Margot, and Mary Waldorf. Reclaiming
Birth. The Crossing Press, 1984.
Elkins, Valmai Howe. The Rights of the Pregnant
Parent. Shocken Books, 1980.
Goer, Henci. Obstetric Myths versus Research
Realities. Bergin and Garvey, 1995.
Inch, Sally. Birth Rights. Pantheon Books,
Korte, Diana, and Robert Scaer. A Good Birth,
A Safe Birth. Bantam, 1984.
McCutcheon, Susan. Natural Childbirth the Bradley
Way. E. P. Dutton, 1984.
Mitford, Jessica. The American Way of Birth.
Penguin Books, 1992.
Romalis, Shelly. Childbirth: Alternatives to
Medical Control. University of Texas Press,
Rothman, Barbara. In Labor: Women and Power
in the Birthplace. W. W. Norton, 1982.
Griffin, MA, AAHCC, is the mother of a 16-year-old
daughter and owner of the Mommy Care Mothering
Center in Los Angeles. She is a Bradley Method
childbirth teacher at St. John's Hospital,
a lactation educator, and an expert in pregnancy
and postpartum exercise. Nancy would like to
thank Haire for her invaluable assistance with
baby: Is induction of labor necessary? by Henci Goer
What’s involved in inducing
Many obstetricians and some midwives
recommend inducing labor if you are near or
at full-term, and they think the baby is larger
than average -- macrosomia, literally, “big
body.” Typically, they use an estimation
that the baby weighs or will soon weigh 4,000
grams (8 lbs. 13 oz.) as the threshold. Inducing
labor usually involves the following:
Prostaglandin treatment if the cervix
is still long, firm, and thick: Prostaglandins
are a family of compounds, two of which
are known to soften a cervix that isn’t
ready for labor. These same two can also
stimulate contractions. Prostaglandin
E2 is inserted into the vagina either
in gel form (Prepidil) or in a tampon
(Cervidil). Prostaglandin E1 (Cytotec)
comes only as a pill because it is not
formulated for the purpose of inducing
labor. A piece of the pill may be inserted
vaginally or the pill may be given orally.
Breaking the bag of waters (amniotomy or
artificial rupture of membranes): During
a vaginal exam, the birth attendant snags
and tears the membranes using an instrument
that resembles a crochet hook with a small
sharp tooth under the curled tip.
Oxytocin (Pitocin or “Pit”):
Pitocin is given intravenously via a pump
that controls the dose.
Why would practitioners want
to induce labor for suspected big baby?
The theory goes that inducing labor will prevent:
Cesareans, due to the baby growing too
large to fit through the pelvis.
Shoulder dystocia, a situation where the
head is born, but the shoulders hang up
behind the pubic bone.
Birth injuries, namely, broken collar bone,
or injury to a complex of nerves controlling
the shoulder and arm (brachial plexus
injury). Birth injuries often, though
not necessarily, occur in conjunction
with shoulder dystocia.
However, studies consistently show that inducing
labor for suspected big baby accomplishes none
of the above (2-3,5,7,9-10,15-16). These studies
include two trials, randomly assigning women
thought to have big babies either to induction
or to await spontaneous labor (7,15). Random
assignment trials produce the strongest evidence
because they eliminate bias by ensuring that
the two groups are truly similar.
Why doesn’t inducing labor
Whether a woman carrying a big
baby has a cesarean depends largely on her
caregiver’s management, not her pelvis.
In proof of this, the cesarean rate for babies
weighing 4,000 grams or more was three percent
in 1958 in Great Britain (4). These days, U.S.
obstetricians may perform cesareans on as many
as half of women with babies of this size (11,16).
The practitioner’s belief
that women cannot safely birth big babies vaginally,
or cannot birth them vaginally at all, will
lead to cesarean sections. Several studies
illustrate this factor at work. Studies have
C-section rates for mothers having
big babies can vary enormously among individual
practitioners. One study reported that having
a private obstetrician tripled the odds of
cesarean compared with having a resident or
a midwife (2). Another found rates among obstetricians
ranging from less than five percent to one-third
Doctors may be likely to order
planned cesareans for women suspected of carrying
big babies. This was true for one-third of
the women in one study (3).
When obstetricians believe that
women are carrying a big baby, far more of
them may have cesareans than when doctors don’t
think the baby is that big, but it actually
is. A study reported that half the women whose
babies had estimated birth weights of 4,000
grams or more had cesareans versus less than
one-third of women with lower estimated birth
weights but whose babies were just as big (16).
The reverse is also true. When
ultrasound predicts a big baby, women may be
just as likely to have a cesarean when the
ultrasound is wrong than when it is right.
In yet another study, roughly half the women
predicted to have babies with birth weights
in the top ten percent had cesareans regardless
of whether their babies actually weighed in
this range (11).
Doctors may not give women a
fair chance to labor when they think the baby
is big. A study found that when obstetricians
thought the baby would weigh 4,200 grams (9
lbs. 4 oz.) or more, half the cesareans for
poor progress were performed in early labor
(16). When they didn’t think the baby
was that big, although it was, they performed
cesareans for poor progress in early labor
less than twenty percent of the time.
Inducing labor for a suspected big baby increases
the odds of c-section compared with starting
labor on your own. Most, though not all, studies
conclude this (2,5,9-10,16). This could be
the belief that women can’t, or shouldn’t,
birth big babies vaginally coming into play.
It could also be the fact that labor induction,
even with pretreatment to prepare the cervix,
is more likely to end in a cesarean in first-time
mothers than starting labor spontaneously.
While shoulder dystocia and birth
injuries are more likely in bigger babies,
they occur in non-macrosomic babies and occur
rarely even in big babies. For this reason,
a policy of induction could have little effect
on outcomes even if it reduced the incidence
of these problems. To give you an idea of the
numbers, an analysis of nearly 15,000 births
reported shoulder dystocia rates of twelve
percent in non-diabetic mothers of babies weighing
4,000 grams or more and one percent in babies
weighing less than this. A similar analysis
of birth injuries in nearly 20,000 babies found
that less than two percent of babies weighing
4,000 grams or more experienced a birth injury
as did less than half a percent of smaller
Further diminishing any potential
benefit, few cases of shoulder dystocia result
in injury. In one study, of 825 cases of shoulder
dystocia in infants weighing 4,000 grams or
more, only thirty-six, four percent, experienced
five minute Apgar scores less than 7, a broken
bone, or a brachial plexus injury. Of these
thirty-six complications, eight were a broken
bone. Breaking a bone is not serious because
bones heal. Subtracting the eight instances
of fracture, only three percent of babies with
shoulder dystocia were at risk for long-term
consequences. Even so, more than nine out of
ten babies with brachial plexus injuries will
completely recover as will eighty-eight percent
of infants with five minute Apgars of 7 or
What are the potential problems
with inducing labor?
While conferring no benefits,
inducing labor increases the likelihood of
overly strong contractions, fetal distress
and, as documented above, probably cesarean
How might having an induced labor
affect your birth experience and postpartum
Having labor induced will medicalize
your experience, in that you will need an IV
and continuous electronic fetal monitoring.
You will likely be confined to bed for most
or all of the labor. Contractions will probably
be more painful, so if you wanted to avoid
pain medication, this will make it more difficult
to achieve that goal. An epidural will help
eliminate the pain, but introduces a long list
of potential problems of its own. You may run
a additional risk of the labor ending in a
cesarean, with all that entails in complications,
pain, and recovery time.
Acker DB, Sachs BP, and Friedman
EA. Risk factors for shoulder dystocia. Obstet
Combs CA, Singh NB, and Khoury JC. Elective
induction versus spontaneous labor after sonographic
diagnosis of fetal macrosomia. Obstet Gynecol
Delpapa EH and Mueller-Heubach E. Pregnancy
outcome following ultrasound diagnosis of macrosomia.
Obstet Gynecol 1991;78(3):340-3.
Francome C and Savage W. Caesarean section
in Britain and the United States 12% or 24%:
is either the right rate? Soc Sci Med 1993;37(10):1199-218.
Friesen CD, Miller AM, and Rayburn WF. Influence
of spontaneous or induced labor on delivering
the macrosomic fetus. Am J Perinatol 1995;12(1):63-6.
Goer H. The Thinking Woman’s Guide to
a Better Birth. New York: Perigee Books, 1999.
Gonen O et al. Induction of labor versus expectant
management in macrosomia: a randomized study.
Obstet Gynecol 1997;89(6):913-7.
Kolderup LB, Laros RK, and Musci TJ. Incidence
of persistent birth injury in macrosomic infants:
Am J Obstet Gynecol 1997;177(1):37-41.
Larsen JS, Pedersen OD, and Ipsen L. Induction
of labor when a large fetus is suspected. Ugeskr
Leaphart WL, Meyer MC, and Capeless EL. Labor
induction with a prenatal diagnosis of fetal
macrosomia. J Matern Fetal Med 1997;6(2):99-102.
Levine AB et al. Sonographic diagnosis of the
large for gestational age fetus at term: does
it make a difference? Obstet Gynecol 1992;79(1):55-8.
Rouse DJ et al. The effectiveness and costs
of elective cesarean delivery for fetal macrosomia
diagnosed by ultrasound. JAMA 1996;276(18):1480-6.
Ruth VJ and Raivio KO. Perinatal brain damage:
predictive value of metabolic acidosis and
the Apgar score. Br Med J 1988;297:24-7.
Sandmire HF and DeMott RK. The Green Bay cesarean
section study. IV. The physician factor as
a determinant of cesarean birth rates for the
large fetus. Am J Obstet Gynecol 1996;174(5):1557-64.
Tey A, Eriksen NL, and Blanco JD. A prospective
randomized trial of induction versus expectant
management in nondiabetic pregnancies with
fetal macrosomia. Am J Obstet Gynecol 1995;172(1
Weeks JW, Pitman T, and Spinnato JA 2nd. Fetal
macrosomia: does antenatal prediction affect
delivery route and birth outcome? Am J Obstet
* History: In Dec. 2001, Tatia Oden French entered a well-known and well-respected hospital to deliver her first child. She was 32 years old, in perfect health, and looking forward to a natural, unassisted childbirth. There were no problems during the pregnancy. According to her doctor's calculations, she was a little under 2 weeks overdue. She was given the drug Cytotec to induce her labor. Cytotec, also known as Misoprostol, is a drug manufactured to treat ulcers. It is NOT approved by the FDA, or the drug company, to induce labor. Ten hours after being administered Cytotec, Tatia suffered hyper-stimulation of her uterus. Her uterus ruptured, forcing an emergency C-Section. Both Tatia and her baby Zorah died in the operating room. The Tatia Oden French Memorial Foundation, a non-profit corporation, was formed in March 2003 to give ALL women of childbearing age complete information concerning medical interventions and drugs which are administered during childbirth. We do this hoping that women may then be able to make FULLY informed decisions regarding the birth of their children.