One of the questions I get asked most often is “how can I avoid an induction?” Pregnant women are well versed about the risks of inductions and the “cascade of interventions” that can result from them. They know that inductions increase their chances of getting an epidural, an episiotomy, or a caesarean section, and they are motivated to avoid going down that route. And while it would be ideal to patiently let nature take its own course in getting labour started (while regularly monitoring mom, baby and placenta to ensure that are no associated risks), there is incredible pressure to induce labour medically, typically at 41+3 weeks (ten days “overdue”), even if there is no immediate medical indication to do so.
As I mentioned in my cheat sheet, given the pressure to give birth on a timeline, I regularly recommend a proactive approach, including:
- A weekly cervical ripening acupuncture protocol, starting at week 37 (including LI-4 and SP-6, which have been shown to shorten the time interval between the woman’s expected date of delivery and the actual time of delivery)
- A labour prep herbal tea given daily, starting at week 37 (this can be as simple as Red Raspberry leaf tea, a safe Category A herb in pregnancy)
- Weekly membrane sweeps by the patient’s MD, OB, or midwife, starting at week 40
When these three approaches are done together, I rarely have patients that require medical inductions. However, there are cases where a patient contacts me when she is already overdue, and has not done any treatments to prepare for the labour – she is facing an upcoming medical induction and wants to know what her options are. While I prefer a gradual, gentle, integrative approach to preparing the body for birth, I understand that many women only seek treatment once they are already overdue, and many more women do not have access to integrative labour-prep treatments where they live.
This past month, I attended a fly-in birth where this was the case – when I arrived, the patient had an induction scheduled that she was very committed to avoiding. In her first birth, she had been induced with Cervidil and had experienced a hyper-stimulation reaction, which was a scary experience for all involved. Upon my arrival for this second birth, we tried a number of “catch-up” treatments including acupuncture, homeopathic medicines and herbal medicine, but were unable to establish regular contractions. The clock was ticking, and we needed to make a decision about the use of castor oil – something I have avoided personally prescribing to date, but have seen used in many births when prescribed by midwives.
To be honest, I don’t like castor oil – it works by irritating the colon, which in turn (by virtue of proximity) irritates the uterus and causes contractions. And “irritating” is a bit of an understatement: the patient ends up with violent diarrhea and often vomiting too, which can leave her dangerously dehydrated and malnourished right as she is heading into the marathon effort of labour and delivery.
For this reason, I have a few conditions that must be met before I will consider castor oil:
- Other methods of gentler labour induction have been attempted – options include acupuncture, herbal labour tea, homeopathy, nipple stimulation, sex (if the water has not yet broken), and exercise
- The patient’s cervix must be “ripe” (soft and at least partially effaced) – taking castor oil on a hard/long cervix is, in my opinion, setting up the patient for failure, as there is likely a long early labour phase still to come. Using castor oil at this early stage runs the risk of having the patient depleted and unable to proceed with a long labour without medical interventions.
- The patient must be well nourished (food and fluids) in the day leading up to the treatment – getting those nutrients and fluid in will be imperative to the patient being able to sustain her energy throughout the labour
- Regular electrolyte replacement (Gatorade-type drink or homemade mix) must be given regularly (every few contractions) throughout the labour to reduce risk to the mom/baby
- (As with all treatments) Patient is informed of the benefits/risks of both castor oil and medical induction options (including Cervidil if her water has not broken, and Oxytocin)
In this case, we had only a few hours left before the scheduled induction and the patient opted to undertake the castor oil treatment. We mixed 2 oz castor oil with 4oz of orange juice, went to sleep, and then woke up two hours later with the patient experiencing hard, regular contractions, and of course, diarrhea. The diarrhea and vomiting lasted about an hour, and the contraction pattern remained strong and regular. The patient was admitted into the hospital, and despite being exhausted from the effects of castor oil, this amazing mom delivered a beautiful healthy baby hours later without complication or interventions. Mom and baby continue to do well, and the mom is very relieved to have avoided medical induction
In this patient’s context, castor oil was an appropriate option and led to a positive outcome for mom and baby. That said, I would still prefer to prepare for labour in a more gradual, gentle manner, whenever possible. I do not advocate for routine use of castor oil without medical supervision, and without considering mom’s nutritional/fluid status and the ripeness of her cervix.
I hope you have found this helpful – if you haven’t done so already, sign up for my free cheat sheet: 8 shortcuts to a healthy pregnancy – and stay up-to-date with more great information and announcements about the My Health Pregnancy Plan program.
In health,
Dr Jocelyn Land-Murphy, ND
Terra Life
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