A friend of mine who is having a baby any day now wrote to me. She is due tomorrow. When checked last week, she was 1 cm dilated.  Her doc said that they would induce about 4 days after her due date if no progress has been shown. She does not want to be induced and would like ideas about how facilitate a natural labour.  Below is part of my response.

So about induction….I have a few thoughts about this. I think it’s awesome that you wish to have a natural labour and let me assure you, you can do it.  Your body was made for this.  I have a few presuppositions about pregnancy and childbirth which inform my outlook and my practice.  On a side note I think it’s a very useful exercise for women to identify their underlying beliefs at the beginning of pregnancy (if not earlier). Why? Because your beliefs will ultimately inform your decisions and impact the course of your pregnancy and subsequent labour.

Some of my presuppositions are as follows:

• Pregnancy and childbirth are natural, normal processes. They are not a medical condition.

• A healthy female body is capable of growing, nurturing, carrying and delivering a baby. Your body knows how to do this intuitively, but the confidence we have in our body’s ability to do what it was designed to do has been seriously hampered by many factors. These include fears and expectations, the medicalization of birth, media and entertainment, our culture and society, and what we’ve been told about birth in the past.
• Except in the case of true medical emergencies or high risk pregnancies, medical interventions should be extremely limited, if not virtually non-existent, for the optimal functioning  the mother and baby.
• The body is smart – it typically will not grow a baby that is “too big”, and it will adapt in various ways to facilitate the birth of the baby (such as releasing hormones which relax ligaments). All of the adaptations that take place during pregnancy are truly incredible!
• The process of giving birth is perhaps more about the mental and emotional state than physical states. In other words, expectations, fears, and beliefs about what is happening will in fact regulate what happens on a physical level. It is a known fact that fear increases pain and slows labour.
• Being coerced or shamed or frightened into accepting an intervention is medically and ethically irresponsible. In a normal pregnancy and childbirth, the parents of the baby should be presented with all the options. The full risks and benefits of each intervention, the process, and the alternatives to each intervention should be thoroughly discussed and understood. Then it’s the parents who are the ones to make an informed choice about the course of action.  That choice should be respected by their practitioner.

You can probably see where I am going regarding an answer to your concerns about induction.

I feel that inducing labour, in many cases, is medically unnecessary.  It can often be what kick-starts a cascade of interventions which can have serious consequence.  Some women have been known to go to 44 weeks and they and baby were just fine.  So why is inducing labour an unnecessary thing in a normal birth? For several reasons:

1)      Unless you know the exact moment you conceived, gestational age of the baby is actually arbitrary. It is the best “guess”, or an estimate, of the expected arrival of baby. We get so fixated on dates unnecessarily. As a Christian, I believe the scriptures which say that God has our days numbered. He is control of when we are born and when we die.  So I feel that the baby comes when God says “Ok, Go now!” And I’m OK with that.

2)      There might be a valid reason why the baby is chillin’ in the womb a little longer than what health-care practitioners would like. We don’t really know if we are doing some sort of damage to development in the long run by forcing the baby out prematurely.

3)      Labour is a beautiful process between mother and baby. The baby trusts you and has developed a relationship with you over the past 40 weeks. The mother’s job is to be open (in every sense of the word) and provide a safe passage; and the baby’s job is head down in the correct orientation.  To induce labour is to artificially start a process that perhaps neither mother nor baby is ready for – which can have negative physical and emotional consequence.

4)      There are serious health risks to inducing labour.  I will provide some links at the end which explain this better than I can here.

Don’t be worried that you’re only 1 cm dilated right now. That is not a valid reason to induce.  (I will include a link to the Society of Obstetricians and Gynaecologists of Ontario with clinical practice guidelines for inducing. But keep in mind it is a medical guideline…which means that the presuppositions about birth may be different from mine or yours.)  Remember that the cervix has to be fully effaced AND fully dilated before stage 2 labour (active pushing) can begin.  Every woman is different. Some women get to 100% effacement (which is a thinning of the cervix) and are only a few cm dilated. Then after they reach that stage, they dilate very quickly.  Some women dilate very quickly but are not fully effaced.  Some progress linearly through both processes.  My point is that there is not set rule about how or when a woman should dilate and efface.  Everyone is different and it’s all variations of normal.

If your health care provider is recommending induction, especially before 42 weeks which is still in the range of “normal gestation”, then I would suggest the following:

• Have a serious conversation with your doctor asking why it is medically necessary to have an induction. Your purpose is to understand the reasoning behind the recommendation.  Perhaps there is a legitimate one.  Ask about the method that is proposed for induction. Ask about the risks and benefits to induction in general and to the specific proposed method.  Ask if there are any alternatives.  Then YOU get to make the choice if you wish to be induced at that time or not. Don’t make an emotional fear based decision.  Make a reasoned one. It is OK if you choose to get an induction – just as long as you made a well thought out decision.
• If you are anxious about getting the baby out by a certain deadline, then you can try to induce yourself naturally. There are many ideas which you can google. Natural methods of inducing labour include things such as eating or drinking certain things, nipple stimulation, walking, acupuncture, or having sex.

About facilitating a natural birth – here are some things you can try:

• During active labour (stage 1) I’d encourage move move move. Keep moving. Dance, sway those hips, stay on your feet for as long as you can. Do stairs or go for a walk. Sit on a birth ball and wiggle around. Put on music and just have fun.  Lean on something and rotate your pelvis in circles, up and down an in figure 8s – both directions.  Just don’t lie down unless you need to rest for a bit.  Moving is great for you and baby.  It helps the baby rotate easier.  It keeps your pelvic girdle open. It facilitates oxygen delivery to the pelvis. It  helps “sift” or “shimmy” your baby down your birth canal. It distracts from the pain and helps keep joints from stiffening up. It ensures you have to keep breathing.  If you listen to your body, then you will want to move. Staying still is very counter intuitive during labour.

• <span “font-family:symbol;mso-fareast-font-family:symbol;mso-bidi-font-family:=”” symbol”=””> Stage 2 labour is the pushing phase. I would encourage you to get off your back. This might be frowned upon by hospital staff, but oh well.  It’s your experience, not theirs.  It’s your body and your baby.  It a simple and well known fact that when you are off your pelvis and tail bone (sacrum and coccyx), you have greater pelvic mobility.  If you can explore various positions that keep your pelvis open that help to keep your pelvic floor open. This will greatly help with reducing pain. It will also facilitate easier passage of the baby because there is less resistance to overcome (both tissue resistance and literal space in the body pelvis).  If you are tethered to a bed for any reason (this includes continuous fetal monitoring, epidural, stationary IV…)  then it becomes much more difficult to move and to get into optimal birth positions. I know that TV shows always show women pushing while on their back but it is unfortunately the worst position you can possibly be in. You can try a sitting or supported squat position, side lying, hands and knees, or evening standing.  I gave birth on all 4s and I was actually surprised at how easy it was. I also did not tear.  I know everyone is different, but the point is to keep your pelvis as open as possible. That means get off your tail bone when it’s time to push.

• Breathe breathe breathe.  Oxygen is important for you and baby during this process. Regulated controlled breathing will go a long way in reducing your pain. You will have less tension in your body. You can focus on something else that is rhythmic. You can vocalize low tone sounds through the contractions (this ensures you’re breathing), which will help regulate your heart rate as well and prevent you from getting anxious or panicky. When it comes time to push, you can also focus on continuing to breathe.  If you are told your baby is in distress, take a moment and breathe.  I have posted an article on the Mama’s Physio FB page about the importance of breathing and spontaneous pushing….I will include it in links below.

• Other things that help with pain relief include: water (a bath or shower or birth pool if they have one at the hospital).  Heat packs.  Massage. Manual pressure. Taking weight off your lower body by leaning or hanging from a person or sling, TENS unit, acupuncture….you can try all these things to help with pain management which will facilitate a natural labour. There are other ideas too you can google.

• Emotions and beliefs – these have the power to shut you down or open you up.  Remember that YOU CAN DO THIS. Your body was designed for this and is functioning perfectly well.  Millions of women before you have gone through this and so can you. You are strong, capable, and perfectly designed.  The pain you feel is temporary and it is pain with a purpose – to introduce you to your new little life. =) Meditate on what is true and don’t allow yourself to give into a spirit of fear. Instead know and believe that you have been given a spirit of POWER, LOVE and a SOUND MIND.

Here are some links you can check out:

http://sogc.org/guidelines/induction-labour-replaces-107-aug-2001/

http://www.bellybelly.com.au/birth/induction-of-labour-to-induce-or-not-induce#.VEoBcfnF-So

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595289/pdf/JPE150043.pdf

http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804305/ – this is the article I posted on FB

Do a google search for birth and labour positions and see what you find.

Anyway…this is quite long, but I hope it is helpful.  Love you lots. Wish you were here and can’t wait to meet your new little addition.
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What about you? What are your thoughts on inducing labour? What are your strategies for faciliating a natural labour? If you could do it all over again, what would you do differently this time around?