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How Can I Get Labour Started?

Updated: Mar 25



This is one of the most asked questions in the pregnancy groups!  If you’ve found yourself here, looking for the answer, I'm guessing that you’re feeling pressured to agree to a medical induction that you don’t want.  Maybe you even have one already scheduled but you want labour to start on its own before the dreaded induction date comes. Maybe you have a medical condition and you legitimately need this baby to be born soon.  Or maybe you are feeling pretty uncomfortable and you just want this pregnancy to be over already.  Trust me, I get it! But getting your body to go into labour isn’t as simple as curb walking while drinking a spicy pineapple smoothie.


So, What Triggers Labour?


When your baby is ready to come earth-side, they release something called pulmonary surfactant.  Surfactant coats the inside of their lungs and enables the air sacs to open.  Surfactant is necessary for your baby to breathe the outside air once they are born.  This last stage of lung development begins at around 36 weeks of pregnancy.  


There is a protein found in surfactant that activates certain immune cells in your uterus.  These immune cells move to the uterus wall and once there, a chemical reaction takes place, stimulating an inflammatory response that begins the process of labour.



Okay Then, How Does The Induction Process Work?


The induction process has three phases:


  1. Cervical "Ripening"

  2. Artificial Rupture of Membranes

  3. Intravenous Artificial Oxytocin.


Prostaglandins are lipids that are naturally produced in the body at sites of injury or infection and they are also involved in cervical effacement (thinning) and dilation (opening).  In a medical induction, the cervix is irritated, either by a “sweep” or with a catheter in an attempt to make your body produce prostaglandins at the site of the cervix.  Alternatively, prostaglandins can be placed directly on your cervix with a gel or a vaginal insert.


Once the cervix has been ripened to about 4 centimetres an amniotomy is performed to hold the cervix open.  An amniotomy is appropriate during a medical induction, but not if labour has started on its own.  In that case it will not help labour progress and receiving one may expose you to unnecessary risks.


Once the cervix is ready, an oxytocin (called Pitocin or Syntocinon depending on where you live) drip is started in your IV 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 may have exposed yourself to risks for no reason. If you try the cervical ripening and it doesn't work, you need to be prepared for the possibility of having to see the induction process through to the end.  When considering an induction, it is helpful to know your “Bishop Score” as it can be an indicator of how likely the induction is to actually trigger labour.  A score of 6 or less is considered unfavourable.  Determining your Bishop score involves checking the state of your cervix.  You can ask your health care provider for details about that.  


Each and every one of the induction procedures comes with its own set of risks, from the least invasive to the most invasive.  It is important to discuss the process and all of the risks involved with your care provider ahead of time.  Don’t wait until the last minute to have these conversations.  


Some of the risks involved: 


  1. Cervical ripening comes with the risk of infection and accidental premature rupture of membranes. 

  2. Artificial Rupture of Membranes also comes with the risk of infection. 

  3.  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.


If you decide to have a medical induction and it’s not going well, keep in mind that you also have the option to stop the induction and wait.  Stopping the induction will likely require some strong advocating skills.  You can also pivot and opt for a cesarean section.  I always recommend having a cesarean plan as part of your back up plan, no matter what type of birth you are planning.


(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 try that do have some evidence behind them:


  1. Lots of sex with semen! Yes, semen has naturally occurring prostaglandins 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 who produces semen.

  2. Nipple stimulation! Studies of frequent nipple stimulation have shown 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.

  3. 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, but just beware, if you have gestational diabetes then this option is best avoided as dates also have a really high concentration of sugar in them.


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 have had their water break 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, the internet 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 other people who are not invested in the outcome and who are not going to be affected by your decision.


(This article provides information and a different perspective and is not meant to be taken as medical advice. Please ask your care provider about your unique individual situation.)


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