How Can I Get Labour Started?

This is one of the most asked questions in the pregnancy groups. Okay, full disclosure; this was a trick question. There are a number of things you need to ask yourself and a number of things to you need to know before you will have the answer you are looking for.

The First Question is: Why Do You Want To Go Into Labour?

I'm guessing the answer is because you feel pressured to get a medical induction and you want labour to start on its own before the dreaded induction date comes. Or maybe you are feeling pretty uncomfortable and you just want this pregnancy to be over already.

So, What Triggers Labour?

When your baby is ready to come earth side they release something called pulmonary surfactant.

"Surfactant is a soapy-like substance. It coats the inside of the lungs and keeps the air sacs (alveoli) open. The alveoli is where gas exchange in the lungs occurs – oxygen is taken up by the blood and carbon dioxide is released and then exhaled. Without enough surfactant, the alveoli collapse and are almost impossible to open again in normal situations. If the alveoli collapse, they can also stick together and tear. The last stage of lung development begins around 36 weeks of pregnancy, and it continues until your child is about 8 years old."

"During late pregnancy, the uterus has an increased number of immune cells (macrophages). Macrophages help fight lung infection by effectively sweeping up any viruses or bacteria that might be present. A protein found in lung surfactant actives the macrophages, which begin to migrate to the uterus wall. Once there, a chemical reaction takes place, stimulating an inflammatory response in the uterus that begins the process of labour."

https://www.bellybelly.com.au/birth/what-causes-labour-to-start/

So you can see why waiting for this process to happen on it's own is pretty important!

Okay Then, How Does The Induction Process Work?

The induction process has three phases:

1) Cervical "Ripening"

2) Artificial Rupture of Membranes

3) Intravenus Artificial Oxytocin.

Prostaglandin is naturally produced in the body at sites of injury or infection and is involved in cervical effacement (thinning) and dilation (opening). In a medical induction, you may either attempt to make your body produce prostaglandin by having a "sweep" done or by having a Foley Catheter inserted. The alternative is to have a gel containing prostaglandin applied or to have Cervidil inserted.

Once the cervix has been ripened to about 4 centimetres an amniotomy (Artificial Rupture of Membranes) is performed to hold the cervix open. And just a side note here, an amniotomy is appropriate during a medical induction, but if labour has started on its own, it doesn't not help labour progress and exposes you to more risks.

Once the cervix is ready, oxytocin (called Pitocin or Syntocinon depending on where you live) is started to begin uterine contractions.

Now here is the tricky part: If cervical ripening actually triggers you to go into labour, it was very likely that labour would have started on its own had you just waited a day or two. And if that is the case, then you have exposed yourself to risks for no reason. If you try cervical ripening and it doesn't work, you need to be prepared for the possibility of having to see the induction through to the end. Each and every one of these procedures comes with risks, from the least invasive to the most invasive.

Cervical ripening comes with the risk of infection and accidental premature rupture of membranes. Rupture of membranes also comes with the risk of infection. Artificial oxytocin comes with many risks including contractions which are too long and too frequent (uterine hyperstimulation). It can also cause contractions which are too painful to manage, leading to increased use of pain medication, epidural and ultimately a cesarean section.

You can read more about it in this book:

"Why Induction Matters" by Rachel Reed

Okay But What About "Natural" Induction Methods?

The first thing to note is that even "natural" induction methods are still interventions and come with risks. The next thing to know is that most things that are recommended in social circles aren't actually evidence based (spicy food, bumpy roads, pineapple, etc...).

There are a few things that you can do that have some evidence behind them:

Lots of sex with semen! Yes, semen has naturally occurring prostaglandin in it and it's preferable to having a doctor apply it. However, not everyone feels like having sex at the end of pregnancy or has a partner with a penis.

Nipple stimulation! Studies of frequent nipple stimulation have show that it is beneficial compared to no intervention at all. It works best if the cervix has already started to ripen, and it should not be used too early as it can potentially cause preterm labour.

Special mention for eating Dates! There have been some studies that suggest that eating dates at the end of pregnancy can improve cervical ripening and shorten active labour. Dates are also highly nutritious.

All of these methods also come with risks depending on your circumstances, as well as a need for more high quality research to support them. For a deeper dive into the evidence behind "natural" induction methods head over to the Evidence Based Birth Website.

In Which Circumstances Should I Consider An Induction of Labour?

An induction of labour should be considered when there is a medical condition present that puts you or your baby at risk. If you and your medical provider have come to the conclusion that it is more risky to continue the pregnancy than to give birth, it is important that the process is discussed with you and that all of the potential risks along the way are explained.

Preterm rupture of membranes is sometimes also a reason for induction. It is good to note that about 79% of people who's water breaks early, go into labour within 12 hours and about 95% go into labour within 24 hours. Having your water break with "no signs of labour" isn't necessarily a reason to start an induction process depending on your individual circumstances.

Some common reasons for a medical induction which are not evidence based include going past your "due date", or having a "big baby".

Waiting Is Also An Option

You always have the option to decline an induction. Beware of misinformation and scare tactics coming from care providers, friends, family and even your partner. Being informed in what is real information is important and powerful. If your care provider is uncomfortable with your choices, you can also have a candid conversation with them and ask them why. Come to a solution that gives you both the birth that you want but also puts them at ease. Sometimes it's as easy as signing a form.

Conclusion

Your best bet is to choose to wait as your first option. Ultimately, you are the expert of your own body and you know what is best for you and your individual circumstances. There is no right or wrong answer here. Trust your intuition and make the best decision for you and your baby and not what is best for the people who are not going to be affected by your decision.

* This post provides information and a different perspective and is not meant to be taken as medical advice. *

You may also be interested in reading:

Understanding Medical Labour Induction

Top 5 Ways to Avoid Labour Induction