Mod Midwives: 12 Myths and Facts About “Natural Induction”

In honor of the 12 days of Christmas, we are going to talk about the 12 Myths and Facts About “Natural Induction.” In today’s podcast we tackle:

  1. Pineapple: this is possibly one of the more colloquial induction methods. It may be the bromelain that gets the credit, but we were fuzzy on how this works, specifically. Rebecca Dekker of Evidence Based Birth (EBB) did tackle this one and concluded it’s probably not effective or harmful.
  2. Walking: we suspect this is less likely to start labor and more likely to just keep baby in a good position.
  3. Dates: we are compelled by the new research on eating dates in late pregnancy, and are cautiously optimistic that there may be something to this. This is another one Rebecca Dekker tackles on EBB.
  4. Red Raspberry Leaf: this staple of midwifery advice may or may not increase uterine activity which may or may not help get labor going. But there is little research to back it up.
  5. Evening Primrose Oil: EPO is meant to ripen the cervix, but has actually been implicated in *longer* labor times and longer ruptured membranes. We also wonder about the blood thinning effects of EPO AND the message that you need a supplement in order for your body to work well. For this reason, we would caution against this.
  6. Spicy Food: we find this one implausible and unlikely. We pretty quickly dismissed this as myth given how many people around the world eat spicy food every day.
  7. Acupressure: we admitted to not knowing much about acupressure, and reserved judgement, but a little digging shows it may not be effective.
  8. Sex: we were both pretty positive about the effect of sex on the start of labor–both from a prostaglandin and oxytocin perspective. We thought we’d seen some research to back this up, however, this recent systematic review and many more of its kind cast doubts about efficacy.
  9. Nipple Stimulation: we’ve both had great luck with “nipple stim” as an augmentation technique, but felt there were major drawbacks as well, so we suggest proceeding in collaboration with your midwife. This technique, though, is pretty well-supported by research.
  10. Membrane Sweeping: we are firmly in the camp that using “stretch and sweeps” judiciously and when the timing and indications are good (see link to Bishop Score below). However, there are lots of considerations and it’s not for everyone all the time. Talk to your midwife about this one! And, important to note, there is mixed research evidence, but our clinical experience is that it is effective.
  11. Foley Bulb Catheter: there is a growing body of evidence about using a saline-filled urinary catheter for labor induction. This is not one to be used lightly–it is a straight up induction method, but one that may be accessible and appropriate for the community birthing setting (unlike pharmacological methods of induction, which are strictly prohibited out-of-hospital). There is evidence to support that Foley Bulbs are both safe and effective.
  12. Castor Oil: we have both seen castor oil to be very effective–its action on the intestines often jump starts uterine contractions. Again, this is a definite induction method and should be used under supervision and with caution, but there is good research to support its effectiveness as a labor induction techniques. Gina also tells the story of her castor oil baby.

We also talk about Bishop Score as an assessment of readiness for induction, took a little walk down the topic of confounding factors, and discussed the importance of talking to your provider about when and if to try these methods–please keep your sleep-deprived midwives in mind during your decision-making!

We hope you enjoy this week’s podcast!