Is Herbal Induction or Natural Induction Safe?
Moms today are often on a timer – go into labor before a certain date “or else.” That “or else” could mean your midwife won't attend (or legally can't attend) your home birth, that you'll be “forced” to go through an induction with Pitocin, or perhaps even be told that your baby is in grave danger and you need an immediate cesarean surgery.
Many women are turning to evening primrose oil, blue cohosh, or other “natural” induction methods to get labor started and avoid these problems. But are those options safe for mamas and babies?
An Induction is Still an Induction
The first thing to make perfectly clear is that a natural induction is still an induction.
Induction always changes things. Labor follows blueprint, or a rhythm – it's meant to begin with certain signals from your body and your baby (and those are still not fully understood). Those signs begin a hormonal orchestra that is both complex and fine-tuned. Hormones, your uterus, you, and your baby all work together during birth. There's moving and turning done by your baby. Pressure from your baby activates feedback loops that build over time and are meant to function in a certain way. And all of that is meant to continue immediately after birth, as the levels of certain hormones skyrocket to lifetime highs to protect you and your baby (not to mention complete the birth process).
Forcing the start of labor can and does change those patterns.
I'm not saying that it's inevitable that someone will “mess up” labor if she chooses an herbal induction. And it's possible that a so-called “natural” induction doesn't have the scary side effects that a chemical induction might (such as intense contractions, uterine rupture, uterine atony [meaning the uterus won't contract], hemorrhage, etc.)
But labor is not a “mechanical” process that can just be switched on. It's a biological, physiological process that we only understand a small part of – and what we do understand is incredibly complex. We should never have the audacity to casually “jump start” labor with herbs or chemicals.
Carefully weigh every pro and con. Listen to your midwife (or doctor's) advice and reasoning, but make the choices for yourself. You weigh the pros and cons doing an induction, and the pros and cons of waiting. Or of trying other “traditionals” like walking, swimming, or sex. You decide, in the end, what's right for you – and for your precious baby.
View Herbs Like You View Medicines
You should view herbs just like you view a medication. Just because it's green and fuzzy, or brown and dried, or comes in a quaint-looking little bottle, doesn't make it safer than something in a syringe or IV line.
The takeaway from this is to research any herbs you're thinking of using. If your midwife recommends it, take a little time to look it up. If your doula recommends it, go figure out exactly what it is. Hey, if I recommend it, go do your due diligence!
This is true for medicines too. Or diet recommendations. Or anything in your pregnancy. Again, it comes down to you being knowledgeable and feeling confident this is the right choice for you. You can trust and value your advisers, but there's nothing wrong with doing a little research or getting a second opinion. You're an intelligent woman, and these decisions are for your health and your baby's health.
Commonly Suggested Methods to Think Twice About
So what are some common “natural” or herbal methods for inducing labor that you should reconsider? And why? Read on to find out:
Evening Primrose Oil
Evening Primrose oil (EPO) is frequently used in the last few weeks of pregnancy to help “ripen” or soften the cervix. It's purpose is similar to that of medical prostagladins often used to prepare a women for a Pitocin-induced labor.
It's thought that ripening or softening the cervix can help labor to begin “on time.” EPO is often cited as useful for various female issues (such as PMS symptoms, menopause, etc.). It's also taken to provide extra fatty acids in a person's diet.
Does EPO stand up to the tests of safety and efficacy? Though it's a “traditional” remedy used in midwifery, it doesn't have compelling evidence to help – and it may have side effects that hurt babies. Studies have associated evening primrose oil with prolonged rupture of membranes (water breaking well before labor begins, or early in a long labor), need for Pitocin, and vacuum extraction1. Some midwives have also reported increased incidence of tachycardia (fast heartrate) in babies after moms have used EPO2,3.
EPO has been well-studied for other purposes, but labor trials have been limited after initial poor results. Though the above-mentioned trials involved oral EPO, it's probably safe to assume that vaginally applied EPO would have the same or stronger effects, since mucus membranes in the vagina absorb so readily.
Castor oil has long been used for labor induction by midwives and mothers. It's also a strong bowel stimulant (and has traditionally been used for constipation or forcing scheduled bowel movements).
In general castor oil is viewed as both effective and safe4, though it has been associated with babies passing meconium during labor5.
The main problem with castor oil is that it doesn't always work, and even when it does, it generally leaves a mom running to the bathroom frequently. This is actually a normal thing for many moms early in labor (the body does this very well own its own, which is why most moms don't want an enema, either). But castor oil can also bring on intense bowel cramping, which saps away your energy and leaves you feeling pretty sick – not a good way to start labor.
As with all induction methods, castor oil tries to jump start something that may have a reason for not beginning, so it's good to weigh pros and cons.
Black Cohosh and Blue Cohosh
Many “labor preparation” formulas contain black and/or blue cohosh, and these herbs have also been traditionally used to induce labor. Unfortunately these herbs have been studied and the results are enough to give you pause before taking any formula containing them.
Blue cohosh especially has been associated with negative outcomes for moms and babies: stroke, heart attack/heart failure and shock, and organ injury due to lack of oxygen6. There's also evidence that it can cause birth defects and miscarriage, but these are associated with use during early pregnancy7.
Black cohosh may not have the same intense effects as blue cohosh, but has still been shown to have potent hormonal effects8.
Based on documented an potential effects, using these herbs is risky. Few have been studied extensively9, and midwives using them frequently report issues with labor, moms, or babies after their use10. It's true that not all poor outcomes or complications may be associated with the herbs (especially when used in a hospital setting, there are many other interventions). But just a possible association is enough to give you pause to truly consider and research if the possible complications are worth getting labor going a little earlier.
Breaking Your Water
Breaking waters is another very common and “traditional” technique to start or speed up labor – used by both midwives and doctors liberally.
But again, even this technique changes the pattern of labor in massive ways, may not be effective, and may be dangerous.
Most mothers, especially those eating an excellent diet, will go through much of their birthing time before the waters release. An intact bag of waters provides cushioning for mother and baby, lessening the intensity of contractions. It also cushions the umbilical cord, keeping blood and oxygen flowing more freely to baby during labor.
The cord also has the bag of waters to float within. Breaking the waters early, before a baby's head is well-engaged in the cervix, dramatically increases the risk of cord prolapse – where the umbilical cord falls past baby's head into the birth canal. This is a life-threatening situation that almost always requires an emergency cesarean section to avoid baby suffocating. If the baby's head is well-engaged this is unlikely to happen, but it is always something to carefully consider.
Breaking the waters also requires gloved hands and something (usually a tool called an amnihook, which looks like a crochet need) to break the water entering the vagina/birth canal. Even sterile gloves and a sterile amnihook can and do trasmit infection, as well as move flora from the lower vagina up to the cervix. Broken waters in and of themselves also increase risk of infection to a mom and baby.
Breaking the waters introduces an artificial time limit on labor, since most midwives and doctors won't “let” a mother go past a certain number of hours with broken waters (because of the chance of infection). This puts stress and pressure on you, which transfers to baby and could be enough to stall labor or cause complications in and of itself.
How to Encourage Labor
So what do you do if you're getting close to your “due date” and you're worried that you'll go over?
First, realize that in almost all situations, your baby's timing is the right timing. I don't have space to examine all the evidence in this particular article, but in general, going “past dates” is perfectly safe. This is another situation where you'll want to research and understand what's best for you and your baby, of course. But generally, if labor hasn't started yet, it's for a reason.
It's also your choice, no matter how much a care provider tries to convince you otherwise. You make the decisions for you and your baby – after consulting with the experts you have on your team – but it's still your decision. You have the right to research, understand, and discuss your options (including “wait”). Always listen to your instincts, too 🙂
The best way to encourage labor to begin right on time for your baby is to encourage high levels of oxytocin in your life. Relaxing and enjoying the last days of pregnancy are a recipe for oxytocin (and perhaps a lesson in patience – when your baby comes it will feel like it went by in an instant!). Here are some specific ideas:
- Watch a good movie
- Read a good book
- Eat a delicious meal
- Spend time with friends
- Play with your older children
- Pet your dog or cat
- Make love
- Be out in nature
- Listen to music you enjoy
- Massage (very effective for one of my students!)
- Think about your baby
As you can see, there are a lot of things you can do to boost oxytocin levels, and high oxytocin levels are literally the recipe for effective labor contractions. Relaxing and enjoying the end of your pregnancy, and trusting in your baby's timing, is a great way to know that labor will begin at the right time.
Other suggestions that have worked well, and may also help with getting labor started are walking, swimming, climbing stairs, talking to your baby, visualizing labor starting, etc.
Your baby's timing is generally the right timing, and your labor pattern can be affected by even a “natural” induction. It's important to realize that “natural” does not always equal safe. It may be “safer” than something chemical – or it may not be. It's important to research and get the facts for yourself.
And remember, the baseline is always what would happen if you were healthy and undisturbed – if labor could begin on its own time, without anyone pressuring you about “due dates” or what local laws say they can or cannot “let” you do. Today we often measure labor (and when it begins) by standards that are not natural and that do not respect the body's own biomechanical and physiological systems. Birth is designed to work, and very rarely does it <em>not</em> work. Letting nature take its course is the gold standard, and any intervention onto that should be considered with utmost care for how it may disrupt what's going on – both seen and unseen.
- Will the REAL Oxytocin Please Stand Up
- What is Physiological Birth?
- What You Should Know About Chemical Induction
- Fetal Monitoring During Labor, Lecture by Gail Hart 05/21/2013