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Birth Plans

Starting Labor

The first decision to make regarding starting labor, is if it is appropriate to Induce Labor (start labor artificially). After making the decision that it is safer for your baby to be born right away, you will need to work with your midwife to decide the safest way for you to start labor.

Natural Labor Stimulation Techniques

Some women are successful at using natural labor stimulation techniques to begin their labor. Generally these women are already showing signs of their body preparing for labor such as frequent Braxton-Hicks contractions, cervical softening and pelvic stretching.

Some of the most commonly used methods are sexual intercourse, increased activity levels (such as going for walks), oral doses of castor oil, nipple stimulation and herbal preparations of blue or black cohosh.

There is disagreement among natural childbirth experts about the use of "natural" labor stimulation. Some feel anything a mother uses or does that is not part of her normal routine is an intervention and should not be considered natural. For these midwives, using castor oil or cohosh would not be considered part of a natural childbirth. Other midwives feel using a compound tht comes from nature is a better option than using a medical technique. They feel the risks to such approaches are minimal and therefore they should be included in a natural childbirth plan as a way to avoid more risky inductions.

Stripping the Membranes

One technique used to induce labor is for the bag of waters to be pulled away from the cervix by a midwife during a vaginal exam. This can cause a back ache, cramping and some light bleeding for a day or two. Success rate of this technique is not known.

Mechanical Dilation

If the bag of waters is intact but the cervix is not ready to dilate, your midwife might recommend a mechanical dilator. These are tools placed inside the cervix to open it slowly with pressure. One style is like a balloon that presses on the cervix to open it. Another slowly gets larger as it absorbs fluids, causing the cervix to slowly open.

These devises work on pressure and therefore do not add chemicals to the body. For this reason they are often seen as a superior method for a woman hoping for a natural childbirth. However, the liklihood of labor starting from mechanical dilation is low. Additionally, the mecanically dilated cervix may only dilate, not efface.

Prostaglandin Treatments

If it is necessary to begin labor, but the cervix is hard and long, efforts to begin contractions with artificial oxytocin will probably not be successful. In these cases, it is generally necessary to "soften" the cervix and make it ready to stretch. There are two main types of prostaglandin treatments used in hospitals today. One is a cervical cream called cervidil, the other is a pill called cytotec.

Artificial Ruputure of Membranes

Artificial rupture of the membranes is a technique reserved for times labor must absolutly begin. It is often used in combination with oxytocin to improve effectiveness. Once the membranes have been ruptured, a mother will be monitored closely to ensure labor is progressing as expected. If the membranes have been broken for a particular amount of time (18 or 24 hours) without good labor progress, the mother will be recommended to receive a cesarean.

Oxytocin (Pitocin)

If it is necessary to begin labor and the cervix is soft and stretchy, your midwife may recommend using oxytocin to begin your labor. This will require you to have an IV and be monitored continuously during the administration of the drug. In some places oxytocin can be used on a trial basis. If labor does not begin within a specific amount of time the pitocin is turned off and the mother is given a night to rest before trying again. In other places oxytocin is combined with artifiical rupture of membranes This improves the effectiveness of oxytocin, but removes the freedom to stop and begin again the next day.

Risks of Artificially Starting Labor

There are risks associated with each method of labor induction. The risks vary in their severity depending to the type of induction and the reason for the induction. Be sure to discuss all options and their benefits and risks in your situation with your midwife before making a decision.

General Risks for all types of induction (including natural induction techniques)

  • The baby may not be ready to be born (pre-mature).
  • May not "solve" the problem, labor is a complex response to hormonal changes which is not always easy to stimulate.
  • May cause extremely strong contractions or contractions to come faster than expected.