So Your Baby is Breech… What now?

In this season of change for myself, I wanted to take time to start writing more often, and with that writing, review some of the information I’ve learned as a student midwife.

Recently, the subject of breech birth has been coming across my path. Often when that happens to students–when a particular subject keeps coming up–we start to wonder whether that is preparation for an upcoming birth. I hope this is coincidence and not the truth, but I’m paying close attention just in case. I do have a new preceptor on the horizon, a very experienced homebirth midwife with whom I’ve worked for one birth a few months ago, but there are no births coming very soon for me. So–knock on wood–hopefully the next birth I attend will be smooth and easy.

All that prefacing to say… Let’s talk about breech birth.

First, what is breech? In short, it’s when baby is upright in the womb instead of head-down. A baby may have their bottom coming first with either their legs extended upwards (Frank Breech) or their legs crisscrossed (Complete Breech), or they may have their foot coming down first (Footling Breech). When it comes to breech, Complete is the ideal scenario, producing the fewest additional complications, followed by Frank. Footling does come with more complications, for a variety of reasons. A woman may make a different choice about what to do about her breech baby depending on what kind of breech it is, so it’s important to make a note of the different kinds of breech that may be encountered.

The big question is, Can this be considered a variation of normal? Or does it always mean that something else is going on and baby is in danger?

The answer is… there is no absolute answer. Some babies have come down breech (sometimes without anyone knowing until baby came out) and had no trouble at all. Some have come out breech and had many complications. I don’t think we can say there are any absolutes, but we can say, at least statistically, that breech birth does have a higher potential of creating complications.

Complications of breech could include cord compression (where the cord gets stuck and “clamped” by baby’s wonky positioning, cutting off blood supply to the baby), aspiration in the newborn (if baby startles with their head still inside, they could breathe in fluids, causing breathing problems later on), stuck baby (because the bones of the skull do not fold the same way they do in vertex–head down–presentation, it’s more likely for baby’s head to get stuck), and injury to the mother (mother is more likely to tear). There is also a higher risk of cord prolapse (when the cord comes out before the body, which is a serious complication), since the baby’s bottom doesn’t fill the pelvis and stop the cord from coming out like a head does. When a baby is coming breech, midwives will often prepare for the worst and be ready to resuscitate as soon as baby is out, due to the increased risk of complications.

This is not to say that anyone should panic if their baby is breech. Many babies are born breech without complications, with the help of skilled and confident care providers, and these can be amazing, empowering, beautiful births. My view is simply that each mother should be informed, and should make her choice based on the facts (both of her individual situation and on statistical information), and she should be aware of all her options before she decides. Informed decision-making is my only goal here.

So if your baby is breech, what are your options?

  1. Spin that baby! The first step that most midwives will suggest is to visit http://www.SpinningBabies.com to start following an exercise regimen meant to turn the baby around from breech to vertex. Many times, the physiology of the mother (tight ligaments, torqued muscles, joints out of place) can influence a baby to turn breech, and releasing those can allow baby to turn. Other times, baby is just being silly, and doing certain exercises can encourage baby to flip around to vertex. Other non-invasive methods to encourage baby to turn head-down include moxibustion, chiropractic care, massage, and verbal instruction. Some are more evidence-based than others, and mothers should explore all possibilities.
  2. Accept and trust. Some women feel breech is a variation of normal, and without absolute indicators of complications, believe they should birth breech without attempting to turn baby around, or simply trust that baby will turn around when it’s time to birth. While that’s a beautiful thought, the higher incidence of complications (which cannot be predicted) should also not be dismissed or ignored. I do advocate for women to make their own choices in birth, but I also strongly feel these choices should be informed, and a long discussion should be had with the midwife to review the risks versus benefits.
  3. Perform an External Cephalic Version. This procedure involves a care provider physically turning baby from the outside. They will oil up the mother’s belly to provide lubrication. Then, with firm-but-cautious movements, will use their hands to guide baby into a head-down position. This should only ever be done by a care provider who has received full training in how to do it, and mothers with anterior placentas (where their placentas are located at the front of their belly) should only have this done in a hospital, where an ultrasound can keep track of placenta health and show the care provider where to put (and not put) their hands. It is more invasive, but compared to the risks of delivering breech, may be worth a try.
  4. Schedule a cesarean. This is always an option. Perhaps not the ideal option for all women, but in many areas, it may be the only option, if doctors trained and experienced in breech are not locally available. Breech is not the kind of birth you want to pressure your doctor into. If they are not comfortable with it, a cesarean is the safest option. You do not want an uninformed care provider accidentally causing more harm by delivering breech without the knowledge of how to do so. It is quite different from vertex birth, and requires an entirely different mindset. The same goes for midwives. If your midwife is not comfortable with breech, or if she is not permitted by her license to deliver breech (birth centers in Oregon are not allowed to deliver breech unless birth is imminent), and if turning techniques have not worked by the time you are in active labor, then it likely is the safest option to have a cesarean.

I don’t want to make this too long, so I’ll stop there. But if you are still curious about breech, you can always watch videos on youtube about it, google it on your own, or have a chat with your midwife about the available options for your area and per her license.

Here are a few resources to get you started:

Definition, Statistics, and Other Details

Evidence Based Birth: Evidence for ECV

Spinning Babies: About Breech

Ina May Gaskin’s Take on Breech

Peggy O’Mara’s Take on Breech

 

 

 

 

 

 

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New Year, New Identity

It’s hard to know where to start. I’ve not written here in a long time because I’ve been busy. So very busy. In particular, I’ve been busy in my midwifery apprenticeship. But that came to an end today. I’m not giving up on midwifery–it’s too much a part of who I am, and I’ve invested far too much to give up now. But I had to come to a point of recognizing my limitations, and knowing that the way I was learning it was not the way that was right for me. It took me two years at that apprenticeship to realize it, but today I finally said that I was ready to take a step back. I only wish it hadn’t been after several months of struggling and barely hanging on by a thread.

Being in a birth center is wonderful for my OCD brain. Everything in its place. Plenty of spare supplies. Knowing where things are. Having the routine of what needs done. But when exhaustion, family issues, and mystery health concerns crept up on me, it took away my organization, my memory, my growth. I was stunted by my own personal struggles, and couldn’t progress. Not when I was being pulled in so many different directions. Others can handle it, and I admire them for it, but I couldn’t. Not in this body, not with the family I have, not with the limited resources available to me. I had to acknowledge my limitations, my mistakes, my failures.

As I said, I won’t–can’t–give up on midwifery. But for now, it’s on hold. I don’t know when I’ll find a new preceptor. I don’t know when I’ll finish. I don’t know how that will all fit into my still-crazy home-life. With one child severely disabled, another being homeschooled with multiple learning disorders, and the third being so intensely high-need, I will likely never escape that need to attend to my home, first and foremost. While others may manage their homes and their midwifery training with grace, they do not have my children, and I can’t keep pretending that they don’t need more care and attention than other children.

They also don’t have the health concerns that I have, which can’t even be named because I don’t know what’s going on with me. I don’t know why I’ve been having episodes of vertigo that send me to the ER. I don’t know why I have all the symptoms of hypothyroid and adrenal fatigue but all my labs are in perfect range. I don’t know why my previously perfect blood sugar and previously textbook blood pressure are both rising (while keeping a low-glycemic and mostly whole foods diet). I don’t know why I feel as if I could sleep all day and still never wake refreshed. I don’t know why I suddenly have the memory of a goldfish and the emotional stability of a thirteen year old girl during her first PMS. These are all mysteries which doctors are yet to solve, and which are affecting me greatly in both my career and my home life. Until I find a way to manage these things, and until I can build up the energy required to care for mothers and babies, I must step back and care for myself. I must attend to my own body before other women can trust me with theirs.

So with this break, though I keep reminding myself I’m not giving up, I feel a loss of identity. I feel a loss of self. Over the past two years, I’ve found so much of my identity in the title of “student midwife”. I thought I had found a home in the birth center where I’d been training, but it turns out that birth center work–at least, in a birth center as busy as that one is–cannot work for me. It cannot be sustained with all the other plates I’m spinning. I made friends which were more like sisters. I had purpose there. Now I feel everything is on hold, and I don’t know what I’m doing.

This is not to say that I don’t still have those friends, who are more like sisters. They were, and continue to be, some of my biggest cheerleaders and supporters. My decision to leave was not one that has resulted in being ousted or rejected. I don’t feel rejected at all. I feel loved, supported, cared for, and missed. I have simply come to realize that in this season of life, I cannot be part of the staff. At another time, perhaps when my children are older and my health is in another place, I would be welcomed back, if I was ready. But for now, I’ll no longer be wearing the logoed scrubs, or a representative of the birth center (though I believe I’ll always carry a little bit of it with me wherever I go). And that is my choice: for my family, for my health. There is no bitterness or anger; there is only the acknowledgement that I had other priorities in my life, and I couldn’t do my job well while juggling those other things. I will always be a part of the Rogue family, just not on staff at this time. Those midwives, and the students I worked alongside, are some of my closest, dearest friends. They always will be. In that kind of intimate work, you can’t help but feel connected to the people you work with. But for me, my time there–at least for now–is complete.

I’m trying to enjoy the pause. Trying to spend more time with my kids, tidy the house a little more, study whenever possible, and care for myself (body, mind, and spirit). But the identity I had found at the birth center is gone. And now I can’t help but ask, “What now?” and “Who am I?”

I can’t help but question my decision to keep moving forward and to continue pursuing midwifery. Is this the right career for me? Can it be done? Will I ever succeed? A great loss like the one I’ve experienced will of course bring those questions to mind. Even when it’s my own decision, and I know it’s for the best, I have my doubts about my own ability to finish what I’ve started. I must keep telling myself it’s not over. I have no idea how it will be accomplished, but I will finish what I set out to do. I will be a midwife–someday. How soon that will happen, only God knows.

But for now, in the pause, in the time between, I will heal. I will care for my family. I will prepare for the future. And I will take on those identities that had been in the background. Wife, mother, homeschooler. I will rest, grow, and strengthen myself for the journey ahead.

There are probably dozens of inspirational quotes I could end this with. But this one, it seems to me, is the most poignant for the situation and one that is speaking to me the most in these dark moments. I hope it inspires you as well.

 

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“Shy” Is Not a Bad Word

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I’m frustrated. 

Several times over the past few years, I’ve found conversations online as well as articles and blogs which put shyness into a negative connotation. And really, these conversations have covered it all.

A child’s shyness is something to be overcome.

They need to come out of their shell.

Maybe there’s something wrong with them and they need a dietary change.

Did they have vaccines?

Have their blood tested for a genetic disorder.

Don’t call them shy. You don’t want them to feel bad…

Utter nonsense–all of it!

Can we finally accept that shyness is a personality trait and not something to be ashamed of? Not something that needs fixed? Not something that our children should feel shame about?

I’m begging you. Please. Let’s stop stigmatizing shyness! 

As a shy introvert (the two are different), I have had to learn social skills to function in a world primarily made of not-shy extroverts. I’ll admit it’s resulted in some social awkwardness and too-frequent nervous rambling in an attempt to connect with people… But on the whole, I’m a pretty well functioning adult. But no one pushed me to “get out of my shell”. No one was ashamed to call my shy. No one thought it was a bad thing. It was simply… who I was. Who I still am, at my core. I can cover it up when necessary and pretend to be a little less shy, but when I lean into my own personality, that’s who I am.

I also have a shy daughter. She uses that word herself. I find it empowers her to accept who she is, and gives her vocabulary to describe how she’s feeling at that time. She will now say, “I’m feeling a little shy right now.” And I totally understand that, so I don’t force her to say hello to the elderly stranger at the store.

Unfortunately, that elderly stranger sometimes confuses shyness with rudeness. I try to smooth it over a bit, explaining, “She takes a while to warm up to people, and that’s okay.” Sometimes they accept this, sometimes they don’t. But it doesn’t matter what a stranger at the grocery store accepts or doesn’t accept. I accept my daughter for who she is, she accepts herself for who she is, and that is enough.

As a Christian, I believe that God created us intentionally, with personalities that ultimately will be used to His purpose. Do some people change those personalities and cling to the negative attributes instead of the positive ones? Absolutely. That’s why we have people struggling with addiction, anger, and deviant behavior. But shyness is not one of those negative attributes. It’s a variety of the human experience.

Of course I want my daughter to feel brave and confident. I want her to make friends and to be polite. I want her to not feel fear when she meets someone new. But giving her that encouragement, instilling in her that confidence, and bolstering her bravery–that all begins with accepting who she is and not making her feel like there’s something wrong with her. She doesn’t need to be fixed; she simply needs to be loved. 

So let’s stop viewing shyness as a negative attribute. Let’s accept and love our shy children, and strengthen them with that love and acceptance. Let’s recognize shyness as just another personality trait, and not as something that needs corrected.

Shy is not a bad word.

 


 

What do you think? Are you a shy person, or do you have a child who is shy? What has your experience been with shyness being viewed negatively? How do you think we can change this perspective?

 

 

 

 

 

 

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On Becoming Oregonian

It was just over seven years ago that my husband and I, along with our girls (just under two and a newborn at the time) packed up and left California, heading for Oregon. We had no choice in the matter, really. California was just too expensive for our family to really be sustained there, and my in-laws lived in Oregon, so we had family support and somewhat of a plan when we got there. When we arrived, we had somewhere around $200 to our name. After all the moving expenses and having lived paycheck to paycheck as it was, that’s all we had. To say it was a leap of faith would be an understatement.

Since that time, a great deal has changed. We’re more stable now, though the economy seems to be insistent about making it consistently difficult to get ahead, and we’ve settled into this Oregon life. We’ve grown as individuals and together, and we’ve added to our family. I’ve found my calling and am working towards that goal: something I thought was an impossible dream while living in California.

Looking back over the years has made me ponder the question, “Are we Oregonian now? Has it been long enough? Have we shed enough of our California-ness to say that we are Oregonians?” Native-born Oregonians would probably say no, that we never could be true Oregonians. I mean, can one truly call themselves an Oregonian without having a preference of Duck or Beaver? But we never really cared for sports in California, either, so I don’t think it’d be fair to hold that against us.

Yet I still see so many ways in which our lives–and our perspectives–have changed since we’ve moved to Oregon, and I can see the subtle ways it’s tempting me to call myself an Oregonian, rather than a Californian living in Oregon.

For instance…

The Coffee. I enjoyed coffee on occasion–when meeting friends or at an event–in California. My addiction, however, developed in Oregon. I don’t know if it’s the colder months through fall and winter, or whether there’s something in the water, but now it calls to me. It’s something I need, not just something I want. And having never been in the habit of visiting coffee shops in California, the convenience of a Dutch Bros stand pretty much every 0.5 miles makes it all too easy to feed that addiction.

The Bubble. By this I mean the reluctance to leave one’s immediate surroundings. It’s something that’s totally foreign to a big-city native, because most things require you to travel longer distances, and to endure the endless traffic on the way. For years I went to school at a college 30 miles away, which took an hour (at least) to get to, four days a week. Now I work 25 miles away, and though it only takes 40 minutes (if there’s traffic), there’s still something about it that feels far. Maybe it’s having to go through mountain passes to get there, or the feeling of great expanses of farms and forests in between, but yes–it feels farther than it actually is.

The Driving. I can’t say I’ve lost all my California driving habits (some of them I actually summon when I’m running late), but I have grown accustomed to the strange law requiring drivers to remain in the right lane when not passing. It really only works on two- or at most, three-lane highways (doesn’t really work on four, five, six lane highways I was accustomed to driving on in California), but now I get irritated when drivers don’t follow that law. Usually when they’re hanging out in the left lane going under the speed limit and just plain getting in the way. But my point is, my driving has changed.

On the subject of driving, however, I have to ask–why are Oregonians so afraid of merging lanes and making left-hand turns? I can’t believe how much space they require just to do those things. It’s like they want a full two miles open to feel confident in doing those. I don’t get it. Okay, so maybe I haven’t lost my California driving. But I don’t think that’s always a bad thing.

The Weather. As a self-proclaimed spoiled San Diegan, I have fought for years against the evil that is a Southern Oregon summer. Temperatures hovering around 90-110 for weeks on end, with little relief outside of air conditioning. And, again as someone who has been spoiled, the single-digit winters were such a foreign concept to me that I couldn’t imagine going out in that weather in anything less than a full snowsuit. And yet… The other day, I came out of a store and thought to myself, “It doesn’t feel all that hot today. Must be cooling down…” I checked the weather app on my phone and it was 97. There’s something disturbing about that. And I have been known to go out in single-digit weather in just a slightly thicker hoodie and those cheap knit gloves. No parka or snowsuit or heavy boots. Just my regular jeans, tennis shoes, a thick hoodie, and thin gloves. I’ve acclimated, and that’s both strange and comforting.

The Condiments. Fry sauce with French fries; ranch dressing with pizza. Sure, I still put hot sauce on almost everything, but those two condiments are somehow part of Oregon culture, and I’ve adopted them. I’d never heard of fry sauce in California, and truth be told, it’s just mayo and ketchup, so it’s nothing special. But still, it’s something that was new to my California eyes and taste buds, which I now really enjoy. And ranch with pizza was rare back in California; only the pizza from my high school cafeteria was ever eaten with ranch in my pre-Oregon days. But now, for some reason, it just makes sense to use it if it’s available.

 

So maybe I still say “the” in front of freeways (even the Oregonian ones), and maybe I still crave a California burrito from time to time. Maybe I drive a little too much like a Californian from time to time, and I don’t complain quite as much as the locals do when I have to drive far. And yes, I still say “dude” quite a lot, and laugh when an Oregonian says there’s “traffic”. But I’d say, for being here just seven years, I’ve inched over into an Oregonian identity. And the longer I’m here, the more I see how I am distancing myself from California and choosing to become Oregonian, slowly but surely.

 

What about you? Have you changed states and found yourself identifying more with the new location than with the old one? 

 

 

 

 

 

 

 

 

 

 

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Mama, Take Care of Yourself

I was tired from a sleepless night (induced by a headache), I needed to get groceries so there was no real breakfast food and I wound up eating very little, my kids seemed extra whiney, I still had that annoying headache, and I had a less-than-stellar day at work the day before (I made some mistakes and was frustrated with myself). It wasn’t the worst day, but it was difficult.

The kids wanted a snack, a hug, some attention. I just couldn’t handle the neediness and the constant wanting–asking–demanding. My oldest, who has ADHD (among other things) couldn’t focus on her schoolwork while my toddler kept trying to climb on me while I was giving instructions to my ever-distracted second-grader. I snapped and starting yelling, begging my children to just leave me alone and stop whining. This made them whine and cry even more. I decided to run away–for their sake and mine–but rather than take the time to cool off (as I knew I needed), I ranted about how messy the house was as I marched from the living room into my bedroom.

Not my best moment. Certainly not the brightest picture of gentle, attachment parenting.

But it was real, as are my failings.

Once I was alone in the stillness and solitude of my room, I quieted my thoughts and focused on fixing. What had made me snap? Was it really my kids? They were just being kids, and most other days it doesn’t bother me to have my toddler wanting to cuddle with me, or my daughter to take her time doing math. So the problem, I knew, was with me. But it wasn’t because I’m a “bad mom”. It’s not because I’m lacking in understanding how to deal with kids, or lack of experience in caring for children, or a lack of desire to be a gracious, gentle, patient parent.

I wasn’t caring for myself.

And no, I’m not talking about yuppy, unrealistic “me time”. I’m talking about the basics. Let’s go back over that first paragraph again.

  1. I hadn’t slept well. Most moms suffer from sleep deprivation in one form or another. And yes, coffee helps, but sometimes one night in particular (like mine, in which I had a headache, couldn’t get comfortable, was having stressful OCD moments regarding work, and had a snoring husband) simply drains us of all reserves. We can’t seem to get going and are especially sensitive to everyday stressors.
  2. I hadn’t eaten well. Again, many moms are prone to eating “whatever they can, whenever they can”–leftover chicken nuggets, the other half of the PB&J sandwich your kid didn’t finish, a few slices of lunchmeat and a cheese stick–and they don’t always make the healthiest food choices. Healthy food isn’t just what you eat (salad or pizza?) but also how often you eat it, and what is appropriate for your individual body. For myself, I need to be extra careful because of my thyroid issues and hypoglycemia. “Hangry” is a real thing for someone with chronic hypoglycemia. In fact, whenever I’m a bit snippy, one of the first questions my husband asks is, “Have you eaten lately?” More often than not, my answer is in the negative.
  3. I was frustrated with myself for a mistake I made at work. Work stresses are far from uncommon. There’s a reason work is called work and not “super happy fun time where we get to take naps and eat chocolate all day”. Not that I don’t love my job–I really do–but in some ways, that’s what makes mistakes harder to swallow. The feelings of letting someone down, of not doing as well as I want to do… those are only made worse by OCD which replays those moments, striving to recreate and correct those mistakes, but knowing they can’t be taken back. It’s no one’s problem but my own, and I know I’ll work through it as I have in other times of mistake-making, but sometimes that can be one more drop that adds to the gooey mess that is Mommy Rage and its close cousin, Mommy Guilt.
  4. I still had a headache. Physical aches and pains can be exhausting and distracting. I had already tried to resolve the headache with a heat pack, but–as you would have guessed–the kids kept interrupting and I was not able to get rid of the pesky pains which made the morning harder to deal with.
  5. My kids seemed extra whiney. Why was that? It could have been my skewed perception; or it could have been that they were sensing my frustration and responding in kind. Children are very sensitive to those things. Either way, my response was out of proportion, even though in the moment, it seemed only natural.

Why do I say all this? To excuse myself? To give a justification?

On the contrary. It’s a matter of learning and preventing from this point forward. Knowing that I can’t be at my best when I’m overly tired, hungry, and obsessing over my mistakes, I can change things from here and take strides to prevent the perfect storm in the future. I won’t always be able to avoid being fatigued, but maybe on those days I can make more of an effort to eat better. I may not always be perfect at work and will certainly continue to make mistakes as I learn my position, but when those things do happen, I can make a point to see a bodyworker and get some of that tension out even before it manifests as intense pain. And maybe I won’t always be able to make good food choices (as sometimes we run out of food before I can get to the store), but maybe I can be more proactive in taking time to rest and not running myself ragged.

These are all “maybes”, of course, and we know I can’t always prevent all of those situations from happening at once (being a special needs mom who homeschools and is in an apprenticeship will almost guarantee these situations in the future), but being more aware and making a greater effort to care for myself will (hopefully) bring more peace to my home and strengthen me to parent my children in a gentler, more patient way.

So what do you do to safeguard against these kinds of days? How do you prepare for those hard days in the future? What are your triggers and how do you cope when they arise?

 

 

 

 

 

 

 

 

 

 

 

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Binkel Books

Happy 2017!

I’m just dropping a short note here to let my readers know that I will be embarking on a new adventure, reaching out into the world of reviewing books. I’ve done just one here (coupled with an author interview), but I’ve decided to have a separate blog dedicated solely to all things books. It will primarily be reviews, but I may also have author interviews (as they become available to me), snippets from my own writing (the books I’ve been too self-conscious to publish), and maybe even some giveaways and contests. I’m hoping to review a wide variety of books across different genres, spanning from fiction to birth/parenting, and even some children’s books.

I hope you join me over there, because I’d love to have you! My readers here have been so wonderful and kind, and I could use some love on the new site!

So without further ado, here’s the link to Binkel Books!

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A Doula’s Thoughts on Natural Induction

[A doula is NOT a licensed healthcare professional. This is simply a compilation of information that has been found over the years through research and in discussions with licensed care providers such as midwives. It is not meant to take the place of any medical advice, and is for educational purposes only. Always discuss your options with your provider and make your own informed decisions.]


I participate in a number of natural birth groups on Facebook. Groups for those having home or water births, those who are generally “natural-minded” and happen to ask questions about birth, and those that are specifically for birth professionals. Due to the wide array of people that you find in any Facebook group, which is not bound by region, religion, or even language, you will find an immense variety of perspectives on the subject. I want to explore some of those perspectives, and while I won’t come to one particular conclusion, I hope this can serve as an educational guide to help parents make an informed decision that is right for their birth.

First, there are a few questions that should be asked.

  1. Why are you inducing? The question must be asked. Is it impatience? Is it pressure from a care provider? Pressure from family? Unfortunately, this is the reality many birthing families are facing. Outside of births where a complication indicates a necessity for induction (such as pre-eclampsia), there is no solid evidence for inducing simply because of a due date. In fact, when left to go into labor on their own, most first-time mothers will go to 41 weeks. Why are we rushing to deliver the baby if there are no complications and the evidence weighs in favor of waiting? A mother and her partner need to decide whether the reason they want to induce is one borne of fear, of impatience (from themselves or from outside entities), or whether there is any true need at all. It is a curious thing to me that so many people who insist on doing things naturally would want to induce (even if by natural means) simply because they’ve come to their due date. But each person must ask these questions of themselves, their care providers, and their family support, to know whether induction is right for them. In the vast majority of births, only patience is needed; there is typically no harm in simply waiting, and sometimes a greater risk of evicting baby before they are ready to come earth-side (baby may have trouble breathing, have a low birth weight and low blood sugars, or may be in a difficult position which can cause injury to mother or baby).
  2. What do you consider “natural” induction? I’ll get into more detail on the specific methods down the page a bit, but this question should be asked when a mother is considering induction. Is it anything that isn’t pharmaceutical? Or does that also include non-chemical but more invasive techniques (such as stripping membranes or using a foley catheter)? When you have a toolbox of methods, you can pick and choose which ones you consider natural, create borders for outlining to what extent you will attempt the induction, and focus on the methods that you feel best suit your goals.
  3. Who is doing the induction? Are the parents inducing at home by themselves, without guidance from a care provider? Or is the care provider going to oversee the process? This can make an impact on which methods are used, as some have risks associated that need to be considered before attempting. It’s always helpful to have someone educated formally on birth to help navigate the induction, who can give advice that may lead to a more effective induction and a more positive birth experience. For instance, some mothers just want to keep moving to get things going, but they wear themselves out and are too exhausted when labor finally comes. A doula, midwife, or OB can give suggestions for how to stay in certain positions which would encourage baby’s descent without wearing the mother out early in labor. That’s just one example.

Now that we’ve covered the philosophical side of induction, let’s discuss the methods. I’ll include both pros and cons to each. I’ll be moving from least invasive to most invasive.

  1. Chiropractic adjustment. This is not induction in the sense that it does not cause contractions. However, it primes the body and aligns the pelvis, making room for baby to descend. It’s basically “clearing the runway” to ensure that baby does not encounter physical blockades as they make their way through the birth canal. While this is typically non-invasive, and may be very relaxing for many mothers, the downside is that there may not be a chiropractor in your area who has experience with pregnancy. I have had good adjustments and bad adjustments, and the chiropractor you choose can make a big difference. My personal favorite is one who has a strong desire to serve new mothers, who has experience with pregnancy, who uses craniosacral therapies, and who will be gentle with adjustments (not just “crack and pop”, but using pressure, range of motion, and lower-impact techniques).
  2. Acupuncture treatment. This adjusts hormone levels and helps to remove any stress factors which may be inhibiting the mother from allowing her body to go into labor. Some acupuncture treatments are more “forceful” than others, and some may be used to actually induce contractions, but I wanted to include it early in the list so that mothers knew it was an option for less-invasive induction, so long as they make it clear to the practitioner that they don’t want to force baby out; just get their body primed for labor.
  3. Activity. Sometimes activity can help bring labor on–walking is a popular one. And once in early labor, walking or dancing can help bring baby down, open up the pelvis, keep the muscles warm and stretchy, and keep the joints loose and flexible. There is a chance, however, that walking (or doing any other activity) excessively may lead to the mother’s exhaustion later in labor. Exhaustion can bring on complications, stall labor, and lead to a variety of interventions. It’s important that she save her energy as much as possible for the “main event”, and only walk as she feels the urge to do so, or at least take frequent breaks.
  4. Moxibustion. Admittedly, I don’t know as much about this as I do other inducers, but I have only heard positive results from this method. It is gentle enough to only work if you are truly ready, but still effective. The idea is that applying heat, via a burning piece of paper or herb, applied to a specific acupressure point, will activate that pressure point and start labor. This one may seem a little too new-agey, even for natural-minded folks, but it may be something to consider.
  5. Acupressure. I mostly use acupressure on clients who are already in labor and just need a little boost, but theoretically, it can be used to start up labor. But, like moxibustion, it should only work if your body is ready.
  6. Oxytocin boosts. Oxytocin is the “love hormone” and is responsible for causing the uterus to contract. Its synthetic form, Pitocin, is one of the more commonly used means of inducing chemically. But you can produce oxytocin naturally by staying close to your partner–kissing, holding, touching. Even more effective is intercourse which includes semen. Semen has prostaglandins which soften the cervix, making it easier to dilate. The synthetic form of prostaglandins is Cervidil. Vaginal intercourse of any kind is contraindicated when membranes have ruptured. Nipple stimulation also produces oxytocin, but most care providers will want to at least be advised if you are using it. There are individual risks to each of these methods, which most depend on your particular situation–whether membranes are ruptured, if you’re already in early labor, and so on. But for the most part, these are simple ways to encourage the body to start labor, but generally don’t start true (lasting) labor until the body and baby are ready. Mothers may experience contractions after intercourse whether baby is ready to come or not, but if it goes away after resting, hydrating, and eating, it most likely was not the start of true labor.
  7. Herbal remedies. Before I go on, please know that I am not an herbalist, and there is actually a bit of debate among midwives (and OBs who use herbs) about the safety and efficacy of these herbs. I cannot come to a conclusion on these, and so I urge you to take the subject up with your care provider, and make the decision that is right for your particular birth.Having given that disclaimer, I will briefly mention a few herbs that have been encouraged over the years to help labor along. First, the cohoshes (blue and black). I took these during my first labor (and they didn’t seem to do anything), but had no major complications stemming from them. Upon mentioning it to a different midwife (who I had for my second birth), she cringed and said she never recommends blue cohosh because, “Blue cohosh for a blue baby.” In other words, there is a risk of causing respiratory distress. Other herbs in my research are listed as inducers, but there is not much information on them as far as safety or efficacy, and don’t seem to be used by lay-people without the help of an herbalist or midwife, so I will leave it at this short list.
    A note here about herbal “toners”, which are NOT inducers. There is a myth running around that Red Raspberry Leaf Tea is an inducer and may not be safe until the due window in low-risk pregnancies. This is false. RRLT tones and prepares the uterus, but it does not cause contractions. It makes contractions more effective (which is why it IS contraindicated for mothers at risk for Preterm Labor) so that labor is shorter and less tiring. Dates (the fruit) are also said to be helpful in shortening labor and making contractions more effective. The recommendation is 1/4 to 1/2 cup daily in your third trimester. Another toner is Evening Primrose Oil. Like RRLT, this does NOT induce labor when taken orally. Taking EPO by mouth in the third trimester helps keep the cervix soft and flexible, so that when the hormones which tell the cervix to efface and dilate are released, your cervix will do so easily. It does not cause contractions. Like all herbs and supplements, however, it is imperative to check with your care provider before beginning any of these regimens, to ensure that they will be safe for your particular pregnancy. Women at risk for PROM or Preterm Labor may need to be more careful about cervical softeners and uterine toners.
  8. Castor oil. Having tried this myself, I can tell you that this is not a pleasant route to take. Castor oil works by irritating the gut and causing the abdominal muscles to contract. Because it works by irritating and forcing abdominal cramping, it also causes vomiting and diarrhea. This side effect can also be passed along to the baby, causing them to expel meconium, creating the risk of meconium aspiration upon birth. It works well for some women, who are willing to put up with the unpleasantness, and for whom is actually works. However my personal view is that it makes labor more difficult, causes painful cramping along with the vomiting and diarrhea, and poses a risk to the baby, making it my least favorite method of home-based induction. As with all things, discuss it with your care provider and make an informed decision for yourself.
  9. Foley catheter. This is only to be done under the direct care of a licensed care provider. I’m including it on this list not because it’s something you could do on your own at home, but because it is non-chemical and is a good alternative for those going to the hospital, or facing a possible risk-out of care due to later dates. A foley catheter is an inflatable tube which expands into a bulb and can be inflated to a specific size, depending on need. The tube will be inserted into the vagina and through the cervix, then inflated when placed on the inside of the cervix. The pressure from the bulb will help the cervix to stretch, especially when the mother stays upright and active (walking and dancing are especially good for this). The nurse or midwife who is caring for you may pull on the catheter to provide even more pressure. When the cervix is stretched to the size of the bulb, it can be easily pulled out. Any time you insert something into the vagina, there is a risk of infection, but being under the care of a licensed provider who uses sterile equipment keeps that risk at a minimum. This is often used in early labor if there has been a long early labor phase (called prodromal labor) or as the first step in a hospital-based induction when the mother wants to avoid pharmaceutical induction.
  10. Membrane sweep. Like the catheter, this is only to be done by a licensed care provider–specifically, a midwife or OB. There are tiny adhesions which “glue” the cervix to the amniotic sac. In a membrane sweep, the provider uses their finger, or sometimes a small rubber tool on the end of their finger, to break those adhesions and separate the amniotic sac from the cervix. This is meant to encourage the cervix to dilate. There are a number of risks involved, in addition to the general risk of infection (which is present in any cervical check, even with sterile equipment). The most concerning risk is that membranes will rupture before labor, which will force the mother into additional induction and intervention. Nearly all care providers (including homebirth midwives) are limited to a certain time frame when it comes to ruptured membranes. In some states, they require the mother to be in active labor within 24 hours; other states allow up to 48 hours. The reason for that standard of care is that there is a much higher risk of infection after membranes have ruptured (even without cervical checks). It’s important to understand the full extent of this risk prior to consenting to a membranes sweep.

There are many ways to induce naturally, and you can weigh your options with your care provider to decide what’s right for you. However, the biggest question remains, “Why do you want to induce?” and “Is this necessary, or will the risks and associated stress outweigh the benefits?” These are important to consider, and no one can categorically say what is the right choice for all women and all births.

Have you been induced naturally? What were your experiences? Would you do it again?

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