Saturday, 5 March 2011

Due date and natural labour induction

36 weeks ago today I came home from Wales where I'd been on a dissertation writing retreat with my mum and the dog. I'd spent the week feeling very hormonal, really tired and craving fresh crab, constantly aware that my period was 2 weeks late. Despite mums reassurance that it was probably just stress from uni, and the fact I'd come off the pill a few months before hand so things were probably going to be a bit irregular, I wasn't convinced that her relaxed attitude was quite right. I had a pregnancy test in my drawer from another time I'd been late and decided to do it, just to put my mind at ease. I hadn't even started unpacking, as I'd decided on the route home I'd do it as soon as I got back. They say you're meant to do tests first thing in the morning when the concentration of pregnancy hormones is likely to be at its highest and I was so convinced the test was going to be negative that I stood and watched it, rather than leaving it and having the agonising wait. Within seconds, a plus was starting to creep across the display - I watched for another 5 minutes, feeling myself slowly start to shake as I realised it wasn't going to turn into a minus sign. I paced my kitchen, swearing A LOT and then took the test next door to my neighbours (our very best friends) where I waved it at them and burst into tears. We had a big cuddle, and their 2 and half year daughter came and cuddled me too which made me cry even more. After about half an hour though, I was fine. I'd got over the shock, I was ok with it, now all I had to do was tell Him and mum.

And now here we are today, our babies official due date, and I can't believe its actually here. Time went to slowly the first few months, then suddenly shot by and now it seems to be dragging again. I'm excited, he's excited, we're completely ready, crib and all, and we're just waiting for the baby to decide it wants to come out and meet us. As natural birth is very important to me, and I'm quite firmly against any kind of medical intervention along the way, I've made the decision that as long as baby and I are healthy and theres no complications, I will wait as long as takes for baby to be born. I have no intention of having membrane sweeps or inductions or any of that. Nobody is going to rush this baby out, even if the 'norm' is to be induced 2 weeks after the due date. I've read hundreds of stories of women who went to 43 or even 44 weeks and baby was absolutely fine - infact, baby showed no evidence of being 'overdue' (where the skin is more wrinkled, or the placenta is in less good condition) and many were born average weight (7ish lbs) with vernix still on the skin (a whitish substance that keeps the skin moist which usually disappears when babies are overdue).

My midwife is already pushing me to have a membrane sweep which I've refused - this is where she runs a finger round the edge of babies head (internally) to try and separate the membranes from the cervix to induce labour. There is a chance that this process can break the waters, which puts you under pressure for labour to begin spontaneously within 48 hours otherwise they will admit you to hospital for chemical induction as there is risk of infection to you or the baby. This is something I obviously want to avoid, which I have made clear to her.

Instead, I've opted to try natural methods of induction - many of which are old wives tales as nothing will actually have any effect unless baby is ready to come, and in any case theres no way of actually knowing whether its the technique you're trying or if baby was just going to come anyway, but even so, I'm prepared to have a go as lots of the techniques can be beneficial during actual labour. So heres a list of some of things I'm trying to help bring on labour, and a few others too....

1. Raspberry Leaf Extract - I've been taking this since 37 weeks in 400mg tablets. You can also drink it as a tea but it tastes pretty vile. A friend of mine suggested brewing some and leaving it to chill, and mixing it half and half with apple juice, so I'll try that later. Many people argue raspberry leaf helps to soften the cervix in the weeks leading up to labour, and others argue it actually causes contractions to start, as their labours have begun within hours of drinking a cup (or 2). The consensus is that actually raspberry leaf extract strengthens the uterus making it more efficient, particularly during the second stage of labour when you push the baby out. Lot of women therefore drink cups on it during the early stages of labour in an attempt to make later stages 'easier'. Who knows if its doing anything, but its completely natural and contains lots of Iron anyway, so it can't be doing anything bad.

2. Evening Primrose Oil - this contains Prostaglandins, which are crucial to stimulating the cervix to dilate and are supposed to be one of the hormones that stimulate labour. Medics argue it is prostaglandins which are released during a membrane sweep, hence why they argue this is the most 'natural' way of kick starting labour fi you prefer not to have chemical induction. You can take EPO orally, several times a day, or (using a sterile needle) make a couple of holes in the tablet and (with clean hands) insert it into the vagina as close to the cervix as possible. I'm sticking to oral methods for the time being. Applying the oil directly to the cervix is the best method, but this relies on a partner who is prepared to do it for you. Its also suggested that you can use EPO for perineal massage (which helps prevent tearing during birth) but again, this really requires a willing partner.

3. Pulsatilla - This is a homeopathic remedy which is supposed to stimulate the uterus to begin contracting, or if you are already in early labour, can help to strengthen and regulate contractions. It is also given to women to help with PMT so whether it has any effect during labour is unknown (but some would argue that no homeopathic remedy works anyway...)

4. Clary sage and Lavender aromatherapy oils - both of these are not recommended for use before 40 weeks of pregnancy because of the supposed inducing effect they can have. I've been having lavender baths for the last 3 weeks though and I'm not in labour yet! Lavenders best use is for relaxation, and I plan to use it during labour to help keep me calm and focused. Clary sage is one of those things that can help stimulate contractions as it helps strengthen the uterus, but it also has an effect similar to gas and air so is often used during labour as a method of pain relief. I will probably have lavender in an oil burner, and have clary sage on a flannel or tissue to inhale during contractions. I'm yet to try clary sage in the bath, but will start alternating it with lavender baths from now on.

5. Walking and bouncing - midwives argue one of the best ways of helping baby in the right direction is to take long walks, to walk up and down the stairs and to bounce up and down gently on a birth ball, as well as rocking the pelvis while sitting on it. The rocking action involved in all of these is supposed to help move the babys head downwards encouraging it to engage into the pelvis ready for birth, and to get it in the right position. Some of my friends went for 5 mile countryside walks and after a nap found they were in labour. I've ben walking every day, bounce on my ball every evening and go up&down the stairs as much as I can but am yet to go into labour - the babys head is almost fully engaged though so it might be doing something!

6. Sex and nipple stimulation - these two are good for dads so they can feel like they're playing a role in helping baby to come. Sex is good for several reasons - sperm contains prostaglandins which can help stimulate labour, as can the regular contracting of orgasms and the release of oxytocin which occurs during sex. Oxytocin is produced exponentially during labour and has a natural anaesthetic effect on the body. When you are induced chemically, it is a synthetic form of oxytocin that they give you - so the more sex you have, the better!!
Linked to this is nipple stimulation - when you deliver the baby, you are encouraged to attempt to breast feed as soon as possible as this stimulate the uterus to contract and helps deliver the placenta, thus nipple stimulation is encouraged for the same reason (and it releases oxytocin). It can be done by the partner, or alternatively, hand expressing is recommended as this mimics the natural effects of feeding. I've been expressing for about a week now (successfully) and am looking into donating what I do express for premature babies, however the local hospital doesn't offer the facility so I may have to look further afield.

7. Accupressure - there are 2 pressure points on the body which are supposed to be directly linked to the reproductive system and can therefore be used to induce labour The first is the webbing between the thumb and forefinger, which when pinched firmly and rubbed in a circular motion is supposed to stimulate contractions. Alternatively, a spot 4 finger widths up from the ankle bone on the inside of the ankle is directly linked to the uterus promoting contractions and thinning of the cervix. Again, pressure needs to be applied in a small circular motion.

8. Eating curry - one of the most common old wives tales is that spicy food is supposed to stimulate labour. Its argued that the capsicum compounds contained in peppers and spices often stimulate the bowel and this can lead to the uterus having sympathetic contractions too. For some women it works, for others not so much. I guess it depends on how familiar your body is to spicy foods, and how strong the actual curry is!

Although any forum you read will be full of anecdotal evidence of women who've tried these methods and then been in labour a few hours later, the most important thing to bear in mind is that these will only have any kind of effect if baby is actually ready to be born - if at all - they're not called old wives tales for nothing! And, as much research has shown, even chemical indiction is unsuccessful when baby is not ready, often leading to c-sections which could have been avoided if everyone just waited a bit longer.

Hopefully, the next time I write will be to announce the arrival of our baby, so keep your fingers crossed and I'll see you on the other side of my pile of herbal pills and aromatherapy oils!

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