Baby's Coming -- But When?
Folk wisdoms for inducing labor have been passed through generations, but do any of them really work?
By Gina Shaw
Reviewed By Cynthia Haines
When a pregnant Plains Indian woman was near term and showed no sign of going into labor, tribe members would tie her to a rock in an open field and stage a mock "attack," pulling up their horses only at the very last minute, in hopes of inducing labor. The Pilgrims, for their part, would stand women whose babies were late against a pole, strap them to it, and pound the pole up and down against the ground -- apparently hoping to shake the baby loose.
There are almost as many pieces of "folk wisdom" about how a woman can get labor started as there are pregnant women. Are any of these old tales true? It depends on whom you ask. Even doctors and other medical professionals disagree about some of the classic labor-inducing strategies.
Props to Prostaglandin
Prostaglandins are hormones that help in inducing labor. If you're well beyond your due date and your doctor induces labor, he will probably use a prostaglandin gel to help "ripen" the cervix. So if you're trying to persuade your baby to make her debut with a home remedy, "The endgame here is stimulation of the prostaglandins," says Pat Alagia, MD, vice chair of obstetrics and gynecology at Virginia Hospital Center in Arlington, Va., who shared the tales of historic labor-induction practices.
So how do you stimulate those prostaglandins naturally? The same way you made the baby in the first place. "Sex is a for sure. Semen has prostaglandins in it, and orgasm releases oxytocin, which causes uterine contractions," says Cindy Siegel, CNM, a nurse midwife with Ob-Gyn Associates in Providence, Rhode Island, who delivers babies at the highly ranked Women and Infants' Hospital.
Alagia agrees. "Ejaculate contains prostaglandins, and that's what you want," he says. "I can't tell you the number of patients who've called me and said 'I went into labor at 10:27. Want to know what we were doing?' I tell them, 'No, but I have an idea!'"
Not everyone agrees. "It's theoretically possible that prostaglandins in the seminal fluid could cause some contractions, but I don't think that there's any proof that that will induce real labor," says Brian Gleason, MD, an assistant professor of obstetrics and gynecology at the University of Alabama at Birmingham. "There's really nothing you can do on your own," for inducing labor, he says.
In any case, if you have a normal, healthy pregnancy and don't have any risk factors, such as placenta previa, you can keep having sex throughout the nine months. "When women are full-term, the dads are nervous. They don't want to hurt them. I've had mothers bring their partners in so I can tell them face to face that it's OK," Siegel says. "Of course you have to be very careful and gentle, and only have sex in positions that are comfortable for the woman." Often that can be lying on the side, which doesn't allow a lot of penetration and provides support for the stomach.
A Good Walk Spoiled
Many people believe that if you're near term and things aren't getting started, just getting up and walking around a lot can help in inducing labor. Probably not true, says Alagia. "Walking doesn't do anything to stimulate the prostaglandins." Still, he adds, "It's probably not going to hurt anything, either. If nothing else it'll make the mother more comfortable."
"Walking does help the baby settle down into the pelvis more," agrees Siegel. "It's better than being sedentary and sitting around on the Barcalounger, which can get the baby into a bad position."
Gleason isn't even sure that walking does much for positioning, but he wouldn't say it's a bad idea. "It gets you up and moving and loosens up your muscles, but it doesn't necessarily position the baby or help get labor started," he says. (And you shouldn't suddenly start a vigorous exercise program after eight months of inactivity -- your body isn't ready for it.)
Down the Hatch
Some people swear by castor oil or enemas for inducing labor. Does that work? Possibly -- if you're "ripe" already. "Castor oil sometimes causes diarrhea with intestinal cramping. In women with a ripe cervix, at term, this can transmit that irritability to the uterus and get it to start contracting," says Siegel. "If the other option is going in to have labor induced the next day, some women will choose to try that to avoid all the other possibilities. I can also tell you that some women try it and it doesn't do anything. They still get diarrhea and it's very unpleasant, but they don't go into labor."
If castor oil and similar remedies have any effect, Alagia says, it's because they stimulate the "gastro-colic reflex." "It's a secondary thing -- by stimulating the colon, you get this gastro-colic reflex, which can cause the release of prostaglandins," he says. That may be why some people think eating spicy foods -- which, you probably know, can also have a pretty pronounced effect on your bowels-- also helps in inducing labor.
An old wives' tale, says Gleason. "There's no connection between the GI tract and the uterus, so that doesn't help. My experience is that those women are miserable," he says. "It's not going to harm the baby, but it can make you very uncomfortable."
Herbs and herbal teas, especially cohosh, are often touted for inducing labor, but there's no evidence that they work, say most experts, and some might be harmful. "We have controlled trials looking at Pitocin and the drugs we use to stimulate labor. We know how they work and how to control them," says Siegel. "With herbs like cohosh, we don't have any trials, and knowing how much to use and when is much more gray. It's not something I'd recommend that people run out and try."
Siegel gives more positive reviews to evening primrose oil, which contains gamma linolenic acid, or GLA, a precursor to prostaglandins. "Taken orally or vaginally, some practitioners swear by it as a way to ripen the cervix," she says. It probably doesn't have any effect on actually inducing labor, though.
Some herbs, including cohosh, contain phytoestrogens, which can affect a woman's clotting factors, something you don't want to treat cavalierly at the end of pregnancy. "You really wouldn't want to take estrogens at the end of pregnancy, because you're in a thrombogenic phase. Your clotting factors are high, because your body's going to have to shut the blood flow off at the end of labor," Alagia explains. "Phytoestrogens can potentially affect your clotting factors, so I would stay away from those."
Tying yourself to a pole is also probably not a good idea.
Originally published March 31, 2003.
Medically updated February 2005.
SOURCES: Pat Alagia, M.D., vice chair, obstetrics and gynecology, Virginia Hospital Center, Arlington, Va. Cindy Siegel, CNM, Ob-Gyn Associates, Providence, R,I. Brian Gleason, MD, assistant professor of obstetrics and gynecology, University of Alabama at Birmingham.
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