BOTTOM LINE ON HERBS AND FOODS TO INDUCE LABOR
Overall, there is not a whole lot of reliable research out there on foods that can naturally help put women into labor. Most of the foods and herbal remedies we looked at are pretty understudied and there is definitely a need for more research in this area to be able to recommend them. If your mom, or sister, or colleague absolutely swears by something on our list that helped put them into labor, our advice is to go ahead and give it a try as long as there are no health risks that can potentially harm you or your little one. So by all means, sit back, relax, and sip on a pineapple smoothie, snack on some dates, or enjoy a nice warm cup of raspberry leaf tea. Even if your little babe doesn’t end-up making their their grand debut after doing these things, you still get to reap all their nutritious benefits! Sounds like a win-win to me.
Contribution By RD2B:
Enter the ARRIVE study.
Funded by the U.S. National Institutes of Health, the doctors in charge of the ARRIVE study (A Randomized Trial of Induction Versus Expectant Management) recently presented results on 6,000 first-time mothers from across the United States (U.S.). Participants were randomly assigned to elective induction at 39 weeks OR waiting for labor to start on its own (expectant management), up until 41 weeks. The researchers recently reached their recruitment goal of 6,000 people, and presented their initial findings at the annual Society for Maternal-Fetal Medicine (SMFM) conference in February 2018.
According to the study brochure, the goal of the study was “to find out whether coming to the hospital and having your labor started with medicine (induced) at 39 weeks of pregnancy can improve the baby’s health at birth when compared with waiting for labor to start on its own.”
The study brochure also says that “During labor induction, the same types of complications that can arise during spontaneous labor can occur.” Unfortunately, this statement is not quite true, because risks of inductions include hyper-stimulation of the uterus (where the uterus contracts too frequently, decreasing blood flow to the baby), the use of extra interventions such as continuous fetal monitoring and the need for additional pain relief, and a failed induction leading to a Cesarean (NICE Guidelines, 2008).
The researchers looked at the benefits and risks of elective induction at 39 weeks—including Cesarean rates, serious infant health problems, hospital costs, and patient satisfaction. Their goal was to find out if having everyone give birth by 39 weeks results in better newborn outcomes than letting people wait for spontaneous labor. They found that there was no difference between groups in their primary outcome– the overall health of newborns. They did find a slight decrease in the Cesarean rate among the 39 week induction group. To listen to our podcast explaining the results, check out EBB episode 10 here.
Limitations to the ARRIVE study
Since only 10% of people go into labor on their own by 39 weeks (Smith 2001; Jukic et al. 2013), what would happen if everyone was electively induced at 39 weeks? The ARRIVE study was not designed to look at the practical implications of inducing everyone at 39 weeks. For example, what might happen to someone who has a serious medical need for an induction, but can’t get on the schedule because all of the hospital beds are full of people being electively induced at 39 weeks?
One thing that the ARRIVE study could not tell us is whether or not induction at 39 weeks can decrease the risk of stillbirth or newborn death. They did not find any difference in stillbirth or newborn death between groups, but their study (even with 6,000 people) was too small to tell a difference in such a rare outcome. In earlier research, it took a sample size of at least 7,000 participants to tell whether elective induction at 41-42 weeks decreases the combined risk of stillbirth and newborn death (Hussain et al. 2011; Gulmezoglu et al. 2012). Since stillbirths and newborn deaths are even rarer at 39 and 40 weeks, the ARRIVE study (with 6,000 participants) was too small to tell if elective induction has an effect on this outcome.
What does it mean to be “full term?”
For many years, a baby was defined as being born at “term” if it was born between 37 weeks 0 days and 41 weeks 6 days. Anything before that 5-week period was considered “preterm,” and anything after those five weeks was “post-term.”
Over time, though, research began to show that health problems were more common at certain points during this 5-week “term” period. In particular, newborns are more likely to die (although the overall risk was still very low) if they are born before 39 weeks, or after 41 weeks.
The chance of a newborn having problems is lowest if he or she is born between 39 weeks and 0 days and 40 weeks and 6 days (Spong 2013).
In 2012, a group of experts came together to define “term” pregnancy. Based on their review of the research evidence, they broke the 5-week term period into separate groups (Spong 2013)
- “Early term” babies are born between 37 weeks 0 days and 38 weeks 6 days
- “Full term” babies are born between 39 weeks 0 days and 40 weeks 6 days.
- “Late term” babies are born between 41 weeks 0 days and 41 weeks 6 days
- “Post term” babies are born at 42 weeks and 0 days or later
How do you figure out your estimated due date?
Almost everyone—including doctors, midwives, and online due date calculators—uses Naegele’s rule (listen to the pronunciation here) to figure out an estimated due date (EDD).
Naegele’s rule assumes that you had a 28-day menstrual cycle, and that you ovulated exactly on the 14th day of your cycle (Note: some health care providers will adjust your due date for longer or shorter menstrual cycles).
To calculate your EDD according to Naegele’s rule, you add 7 days to the first day of your last period, and then count forward 9 months (or count backwards 3 months). This is equal to counting forward 280 days from the date of your last period.
For example, if your last menstrual period was on April 4 you would add seven days (April 11) and subtract 3 months = an estimated due date of January 11.
Another way to look at it is to say that your EDD is 40 weeks after the first day of your last period.
In cases where the date of conception is known precisely, such as with in vitro fetilization or fertility tracking where people know their ovulation day, the EDD is calculated by adding 266 days to the date of conception (or subtracting 7 days and adding 9 months). This increases the accuracy of the EDD because it no longer assumes a 28-day cycle with ovulation occurring on Day 14.
But where did Naegele’s rule come from?
In 1744, a professor from the Netherlands named Hermann Boerhaave explained how to calculate an estimated due date. Based on the records of 100 pregnant women, Boerhaave figured out the estimated due date by adding 7 days to the last period, and then adding nine months (Baskett & Nagele 2000).
However, Boerhaave never explained whether you should add 7 days to the beginning of the last period, or to the last day of the last period.
In 1812, a professor from Germany named Carl Naegele quoted Professor Boerhaave, and added some of his own thoughts. (This is how Naegele’s rule got its name!) However, Naegele, like Boerhaave, did not say when you should start counting—from the beginning of the last period, or the last day of the last period.
His text can be interpreted one of two ways: either you add 7 days to the first day of the last period, or you add 7 days to the last day of the last period.
As the 1800s went on, different doctors interpreted Naegele’s rule in different ways. Most added 7 days to the last day of the last period.
However, by the 1900s, for some unknown reason, American textbooks adopted a form of Naegele’s rule that added 7 days to the first day of the last period (Baskett & Nagele 2000).
And so this brings us to today, where almost all doctors use a form of Naegele’s rule that adds 7 days to the first day of your last period, and then counts forward 9 months—a rule that is not based on any current evidence, and may not have even been intended by Naegele.
Why is LMP less accurate than using ultrasound?
There are several reasons why the LMP is usually less accurate than an ultrasound (Savitz et al. 2002; Jukic et al. 2013; ACOG 2014). LMP is less accurate because it can have these problems:
- People can have irregular menstrual cycles, or cycles that are not 28 days
- People may be uncertain about the date of their LMP
- Many people do not ovulate on the 14th day of their cycle
- The embryo may take longer to implant in the uterus for some people
- Research indicates that some people are more likely to recall a date that includes the number 5, or even numbers, so they may inaccurately recall that the first day of their LMP has one of these numbers in it
What about the risk of stillbirth?
In this section, we will talk about how the risk of stillbirth increases towards the end of pregnancy.
There are two very important things for you to understand when learning about stillbirth rates in post-term pregnancies.
First, there is a difference between absolute risk and relative risk.
Absolute risk is the actual risk of something happening to you. For example, if the absolute risk of having a stillbirth at 41 weeks was 0.4 out of 1,000, then that means that 0.4 mothers out of 1,000 (or 4 out of 10,000) will experience a stillbirth.
Relative risk is the risk of something happening to you in comparison to somebody else. If someone said that the risk of having a stillbirth at 42 weeks compared to 41 weeks is 50% higher, then that sounds like a lot. But the actual (or absolute) risk would still be low—0.6 per 1,000 versus 0.4 per 1,000.
Yes—0.6 is 50% higher than 0.4, if you do the math! So, while it is a true statement to say “the risk of stillbirth increases by 50%,” it can be a little misleading if you are not looking at the actual numbers behind it.
The second important thing that you need to understand is that there are different ways of measuring stillbirth rates. Depending on how the rate is calculated, you can end up with different rates.
So what is the risk of stillbirth as you go past your due date?
Since the late 1980’s, there have been at least 12 large studies that looked at the risk of stillbirth during each week of pregnancy. Some of the researchers used open-ended stillbirth rates, and some of them used actual stillbirth rates.
All of the researchers found a relative increase in the risk of stillbirth as pregnancy advanced.
To get an accurate picture of stillbirth in people who go past their due date, it would be best to look at studies that took place in more recent times. I’ve chosen 3 of the most recent studies to show you from Norway, Germany, and the U.S. To see all of the other studies, click to view the entire table here.
All 3 of these studies used the actual stillbirth rate—not the open-ended stillbirth rate. Two studies used ultrasound to calculate gestational age, and one study used the LMP.
Although most researchers have found an increase in stillbirth rates in the late term and post term period, the “absolute” increase in risk is small until about 42 weeks, after which it reaches about 1 out of 1,000.
Based on their data, Rosenstein et al. (2012) calculated that in order to prevent 1 stillbirth or infant death, there would need to be at least 2,442 people electively induced at 39 weeks. They also estimated that 1,476 people would need to be electively induced at 41 weeks in order to prevent one stillbirth or infant death. This is called the “number needed to treat.” In other research that we are going to talk about later on this article, the number needed to treat was much lower.
Who Shouldn’t Use Exercise to Induce Labor?
Regular exercise is safe for the majority of pregnant women. However, there are some instances where exercises may not be the safest option for trying to induce labor.
If you have any of the following conditions, it’s best to speak with your care provider before performing any exercise.
- Prescribed bed rest.
- Severely high or low amniotic fluid.
- Placenta previa, or any other condition involving the placenta.
- History of premature labor.
- Gestational hypertension.
- Short cervix.
If you’re past due and trying to get things moving, then you need to start moving. Try some of these 8 simple exercises to help jump-start your labor:
- Climbing stairs.
- Butterfly stretch.
- Birthing ball exercises.
- Pelvic tilts.
But remember, while exercise can be quite useful for opening the pelvis and getting baby into a good position, try not to overdo it, as you’ll need plenty of energy for when you’re in labor.
Did you try to induce your labor naturally? What methods worked for you?
Share your experiences with us in the comments and be sure to share this post with all your pregnant mama friends.