All pregnancies end... at least humans don’t have to endure 22 months of pregnancy like many elephants!
Written By: Dr. Mary Powell
At the end of pregnancy, many women become more uncomfortable and are anxious to meet their newborn. They also may be given numerous suggestions on how to help themselves go into labor. Labor most often happens in the week before or after a woman’s due date. What exactly starts labor is still a bit of a mystery to medical science. We have some medications and procedures that are quite successful in starting labor when used for inductions of labor, but the initiation of spontaneous labor is still not well understood. The greatest advantage of spontaneous labor over induced labor is that it is usually faster. Labor is hard work so less time in labor is usually preferred by all!
However, there is very reassuring data that induction of labor is safe even for low-risk women (those without medical conditions like diabetes or high blood pressure) as early as 39-week gestation. In the past women and medical personnel were concerned that induction carried additional risks for both mom and baby. A large study published in 2018 showed that induction lowered a women’s risk of having a c-section, reduced the woman’s risk for high blood pressure problems from developing at the end of pregnancy, and reduced her baby’s risk for needing respiratory support after delivery. For women to be good candidates for an elective induction at 39 weeks it is important that their pregnancy is well dated. In other words we need to be confident that your estimated due date is accurate. If a woman begins her prenatal care late in pregnancy the due date can be a lot less certain.
So what can women do to help themselves go into labor naturally? There are many ideas out there, but not many of the suggestions have data to support they are effective. I strongly discourage my patients from trying Castor Oil and those that do still try it often regret it. Castor Oil is a laxative and often results in intestinal cramping and diarrhea, but not labor in most cases. Many women will also be given some of the following suggestions: eating pineapple, walking excessively, going on bumpy rides, eating spicy food, evening primrose oil, and raspberry leaf tea -but none of these have shown conclusive evidence of really helping someone go into labor.
Nipple stimulation may trigger release of the hormone oxytocin, which we know is involved in making uterine contractions stronger and more frequent. You don’t want to overstimulate the uterus so be sure to discuss with your physician or midwife before considering taking this step. Having sex when you are near your due date or beyond also shows a small chance of helping the labor process begin. There are prostaglandins in the semen that may help soften the cervix and start contractions.
There is a procedure called membrane sweeping or stripping of membranes which does have some data showing it increases a woman’s chance of going into spontaneous labor and decreases her need for a medication-induced labor. This is a procedure that can be done during an office visit by an Obstetrical provider. It involves the provider inserting one or two gloved fingers into her cervix and sweeping in a circular direction between the bag of water covering the baby’s head and the lower part of the woman’s uterine wall. The woman’s cervix must be dilated some for this procedure to be possible. This action results in the release of several chemicals, including prostaglandins which we know are involved in the initiation of uterine contractions. This procedure can be a bit uncomfortable and may result in some bleeding from the friction forces on the cervix. Most women feel the potential benefits of labor outweigh the discomfort.
If you are nearing the end of your pregnancy and interested in helping your baby out; please discuss with your obstetrical provider your options. There is great news to keep in mind. All pregnancies end and at least humans don’t have to endure 22 months of pregnancy like many elephants!
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