Updated October 2022

Important:  
Please note that this handout is for informational purposes only,
and should not be considered medical advice.  
Please use your own discretion before using any of this information
& by all means do further research of your own. 
Please consult with trusted health care professionals if you have any questions or concerns. 
This handout can be used as a discussion-starter with your primary (medical) caregiver.

Did you know only 3-5% of births happen on the "due date"? Due dates are just estimates, and the only person in the world who knows the perfect time for your baby to be born - - is your baby!  When your baby is ready to be born, they send a signal to your body that they're ready, and your body then begins the delicate and complex process of labour and birth. If you’re right on the edge of labour anyway, then some of these techniques might work for you.  If you and your baby aren’t ready though, no induction method - natural or medical - will work effectively. More and more evidence is coming out that inducing labour, even at term, and even “naturally”carries real and substantial risks for both mom and baby. 

**Please consider carefully the benefits, risks, and alternatives for each method of induction, and remember that not inducing, but allowing your labour to unfold on its own, is almost always a safe and legitimate choice. Sometimes the pros of induction outweigh the cons…. but not often!**
 
The Hormones of Labour
There are four main hormones involved in labour, and it is important to understand them when we start talking about induction. Prostaglandins are the hormone that soften your cervix. Oxytocin is nicknamed the ‘love hormone’, and it stimulates contractions. Endorphins are the ‘feel good’ hormones, and they are both calming and pain-relieving.  Finally, there is adrenaline, the “fight or flight/tend and befriend” hormone.  High levels of adrenaline cause your heart rate, breathing rate and blood pressure to increase.  While adrenaline has a healthy role at the end of labour, if your levels of adrenaline are high before labour and in early labour, this can prevent oxytocin and endorphins from working their natural magic. Your body interprets fear, worry, and anxiety as “danger”.  Your body then says (logically enough!) that if there is danger, then labour and birth should wait until you are safe.  So convince yourself that you are safe and well: Take a warm bath, eat a favorite meal, drink plenty of fluids and let nature take its course. The best things in life take their time.
 
FYI :

• the average pregnancy lasts 41 weeks and 1 day

• only -5% of pregnant people have their babies on their actual EDD

• 80% of pregnant people have their baby within 10 days of their EDD (either before or after)

• 8% of pregnant people have their baby between 20 & 36 weeks

• 7% of pregnant people have their baby later than 42 weeks.

 
 
RELAXATION TECHNIQUES & COMMONLY HEARD ‘DIY’ SUGGESTIONS

• Imagine your labour beginning in a way that is lovely and perfect for you. Visualize everything you’re hoping for, in detail.

• Try some of the relaxation techniques you may have learned about for use in labour if you’re feeling stressed or anxious.

• Blow up balloons (puts pressure on the cervix).

• Watch a tear jerker of a movie - sometimes you just need to “let it all out” for labour to start.

• Watch a really funny movie - sometimes a good laugh will go a long way!

• Play on a swingset.

• Dance to Holst’s “The Planets:Mars”
•  A bumpy car ride - if the baby is not in a good position, sitting (with knees below hips for optimal fetal positioning) and relaxing while being moved by the car over bumps might ‘jostle’ baby into position.

• Spicy food, especially hot curries - but if you are prone to heartburn from spices this may not be worth it.

• Eat or drink fresh pineapple, including the core (blood sugar issues notwithstanding).

• Walk on a curb - one foot on curb and one foot on street so you are lopsided. OR walk like a duck so your pelvis is nice and open.

• Walk up and down stairs

• Optimal Fetal Positioning.  Check out www.spinningbabies.com, to find out how you can help the baby shift into an optimal position for birth.
  
  
• Eat dates in your third trimester if blood sugar control isn’t a concern. 
• Things like a glass of wine, Tylenol* PM (*acetaminophen/parcetamol + diphenhydramine HCl), or Gravol alone (dimenhydrinate) are sometimes recommended to help you sleep in the early stage.  There is a growing body of knowledge which indicates that tylenol may interfere with early labour and it is already known to dull emotional responses as well as being the #1 cause of sudden liver failure in the US. While tylenol IS a common recommendation, it isn’t one I personally suggest at this time. I also do not recommend alcohol at any time or in any amount in pregnancy as we simply don't know how much is "safe" or how little could cause Fetal Alcohol Spectrum Disorder. 
  http://undercovermidwife.blogspot.ca/2015/03/paracetamol-and-labour.html

• Red Raspberry Leaf. Despite the hype, drinking RRL tea is NOT an induction method itself. It IS like yoga or walking for your uterus and has centuries of safe use in all stages of pregnancy. If you feel that drinking red raspberry leaf infusion makes your uterus irritable in pregnancy then by all means discontinue use, just as you would stop doing vigorous physical activity if it caused uterine irritability. But justlike walking or yoga won’t cause labour to begin out of nowhere in a healthy pregnancy, neither does red raspberry leaf. It is super nourishing to the body and some research shows drinking it throughout your pregnancy can decrease the length of your labour and reduce the risk of some interventions in labour. For those who feel comfortable using RRL, I generally recommend 1 cup/day in the first trimester, 2 in the second, 3 in the third, and as much as you want once 37 or 38 weeks. Ripe & Ready is my own Red Raspberry Leaf tea which includes just a touch of red rooibos, oatstraw, rosehips, chamomile, and ginger as well. You can learn more about the benefits of red raspberry leaf tea in this article from bellybelly

 
PROSTAGLANDINS
Prostaglandins are the hormone that softens the cervix, preparing it for birth. (It does not stimulate your uterus) A few ways to introduce prostaglandin are:
 

• Penis in Vagina Sexual Intercourse – no condom with your trusted penis-owning partner :). Don't get up right away, and elevate your hips so that the prostaglandin in the semen that helps to ripen the cervix, coats your cervix. Semen taken orally can help too, as prostaglandins are absorbed orally as well as vaginally. If there is any concern about disease/infections (sexually transmitted or otherwise), please do not engage in unprotected sexual activity as this may put the health of you and/or your baby at undue risk.

• Evening Primrose Oil  You can buy these at just about any health food/vitamin/herbal type store and they come in capsules that look like vitamin E. Specific timing and dosages vary widely between practitioners. Check with your health care provider to ensure that these options are not contraindicated for you and be sure to understand the risks and benefits.  You can learn more about Evening Primrose Oil here at Evidence Based Birth

• Castor Oil/Enemas. One of the very possible side effects of using castor oil or an enema is having bad diarrhea with cramps, and/or vomiting, that can lead to dehydration, which is why many caregivers suggest steering clear of it. Some believe it to be associated with a higher risk of the baby passing meconium before or during the birth though the available evidence at this time says it does not increase this risk. Castor oil works by stimulating the bowel (prostaglandins), which in turn stimulates the uterus because of their close proximity to each other internally. Metamucil is believed to work on a similar principle and may be easier to take but the same risks of dehydration etc apply. An enema works similarly to castor oil, but is invasive. Castor oil is often combined with something that makes it easier to swallow - ranging from ice-cream to soda-pop to scrambled eggs. Another popular option which apparently is from Germany involves mixing the castor oil with apricot nectar and lemon verbena tincture. If you choose this option make sure to take lemon verbena tincture NOT essential oil. It is usually recommended that the mom take 1 “dose”, then take a hot shower and then the second dose two hours after the first, and another hot shower if she feels like doing so. The shower has the relaxation effect that may be needed to help start labor. Some practitioners recommend vodka or a glass of wine instead of the hot shower. The recommendations on what constitutes “1 dose” vary widely.  Because of the potential side effects it is wise to consult with trusted healthcare professionals before using castor oil, any form of enema, or alcohol. (*Castor oil comes from a vegetable and is NOT to be confused with Castrol motor oil which is toxic!!)

 
 
 
OXYTOCIN AND EMMENAGOGUES
Oxytocin is the hormone that your body uses to stimulate uterine contractions during labour.  An emmenagogue stimulates menstruation. Be cautious in trying these methods. After trying one, wait several hours to see if it has worked. If it is used too much or too often labour may become too intense for you and baby. If you experience any side effects, discontinue immediately!
 

• Clitoral Stimulation/Orgasm. Orgasm is associated with the release of oxytocin.  Even if you don't have a partner to help with this, it can be one of the pleasanter methods! If your membranes have released remember not to insert anything vaginally.

• Nipple stimulation is a well-known method of stimulating oxytocin, which contracts your uterus. Used by midwives for centuries, it not only stimulates the uterus during labour, it is very beneficial after the birth to aid in expelling the placenta and thus avoiding hemorrhage. If nipple stimulation causes your uterus to contract too frequently or intensely – stop.

• Blue Cohosh and Black Cohosh are emmenagogues.  Don't use either if you are anemic or have a history of postpartum bleeding, high blood pressure, or excessive blood loss during birth. Use of these herbs should only be considered after genuine study, with due regard for their risks and benefits and in consultation with trusted professionals including your primary care provider as needed. Please seek advice from a qualified professional for specific dosage guidelines.

 
 
 
OTHER COMPLEMENTARY OPTIONS

• Homeopathics/Flower Remedies.  There are many different homeopathic and flower remedies which may be helpful in labour and birth.  Homeopathic remedies are considered very safe and effective by many, (though they are not an evidence-based modality) and are available over the counter from good natural health stores.  However, it can be a bit complicated to pick the right remedy for your exact situation, so consulting a homeopath with birth experience is usually simplest. You can also visit The Homeopathic Midwife and download her ebook “The  Vibrant Pregnancy” for $20. It contains a lot of specific and helpful information on the use of homeopathy in labour, as well as postpartum. Homeopathics are one of my preferred methods of supporting the body in pregnancy, labour, birth, and postpartum as they do not have a direct action on the body but work more subtly and energetically. They are not known to have negative side effects or risks like non-energetic remedies may.

• Aromatherapy.  The use of certain essential oils, such as clary sage, geranium, jasmine, and lavender, especially when combined with skilled massage,  acupressure, or reflexology may be helpful in encouraging labour. Essential oils are different than synthetic/fragrance oils, and both can cause harm when used incorrectly. Essential oils should NOT be used internally.  Please consult with a professional herbalist &/or aromatherapist to see if aromatherapy is an appropriate choice for you.  You can learn more here about the use of aromatherapy in labour here.
  
  

• Acupressure/Acupuncture. Acupressure and acupuncture may or may not cause a woman to go into labour, but some studies have shown that even when they do not cause labour to start, they can allow a woman's cervix to be more favorable for other induction methods.  Acupressure can be done yourself or with the help of a supportive partner.  Acupuncture requires professional assistance and you can learn more here.  

• Chiropractic Care.   Having an adjustment by a chiropractor skilled in working with pregnant women may be helpful.  If you do not already see a Chiropractor, talk with your local midwives and doulas to see who they recommend. This can be especially beneficial if baby is not optimally positioned for birth.
   
• Reflexology is a complementary healing therapy in which the reflexologist uses their hands to apply pressure to specific zones and reflex areas of the feet. Reflexology increases the flow of blood, lymph, and nerve signals in the areas/zones worked; evokes a profound relaxation response (soothing the sympathetic nervous system), and promotes homeostasis - a rest & repair state where the body can move into healthy balance (activates the parasympathetic nervous system). In other words, reflexology promotes optimal functioning of the body which can include encouraging the body into labour if body and baby are ready. Alongside homeopathics, reflexology is one of my favorite ways to support the body in the childbearing year. 

 
MEDICAL INDUCTION METHODS
 There are many methods of induction which your midwife or doctor can offer, depending on your circumstances.   The SOGC website <sogc.org>  provides a complete and thorough outline of these methods, which includes things such as: sweeping/stripping the membranes; artificial rupture of membranes (breaking your water); prostaglandin gels, vaginal inserts, oral tablets; foley catheter; synthetic oxytocin/pitocin.
 
 
REFERENCES, RESOURCES, & RECOMMENDED FURTHER READING

Inducing Labour - Better Childbirth Outcomes

How To Bring On Labour Naturally - Bellybelly
The Lowdown on Natural Induction - Aviva Romm
Natural Induction - Gentle Birth Archives

Childbirth Connection 
 
Thinking Woman’s Guide To Birth – Henci Goer
Gentle Birth, Gentle Mothering – Dr. Sarah J. Buckley