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Elizabeth Mendoza
ENGL 1050
April 1, 2017
NONMEDICAL LABOR INDUCTION METHODS 2
Abstract
In the United States, induction of labor is a commonly occurring medical intervention due to
various medical and nonmedical motives. Because of the significance of this intervention, it is
crucial that all women be educated and informed about the safety, effectiveness, and implications
for their choices for it. In-home nonmedical induction methods such as sexual intercourse and
breast/nipple stimulation are effective and viable options for labor induction. Since how
healthcare providers present a topic can have a significant impact on womens perinatal
decisions, maternity care providers should educate and counsel clients on these induction
methods as a possible first line approach to labor induction in nonemergent cases. Care should
A significant proportion of pregnancies carried to term in the United States end in labors
that are started via medically assisted artificial induction. Per the Center for Disease Control and
Preventions most recent birth certificate data (Osterman & Martin, 2014), 23.3% of labors begin
this way. Estimations from women themselves are higher with 41% of those with singleton
pregnancies reporting that healthcare providers attempted an induction, 74% of those successful
(Declercq, Sakala, Corry, Applebaum, & Herrlich, 2013). As alluded to in these rising numbers,
there are numerous medical and nonmedical motives behind attempting to artificially begin the
labor process, one of which is maternal desire (Declercq, et al., 2013). With these high numbers
of medical inductions and their associated risks, coupled with a maternal desire to start labor,
healthcare providers should counsel and advise clients on home-based induction strategies: their
effectiveness, relative safety, and associated levels of maternal satisfaction of the methods and
Labor inductions via medical means carry risks for both the mother and the fetus. Given
the high number of women who experience a labor with an induction intervention, it is crucial to
thoroughly examine the justification and safety of medical induction methods, weighing the
known associated risks against the intended benefit of the induction. The World Health
Organization expresses this sentiment as well, stating that inductions should be done only when
there is a clear medical indication for it and the expected benefits outweigh its potential harms
(2011, p.4). According to the nonpartisan nonprofit National Partnership for Women & Families
(2016), effects of inductions include a higher rate of cesarean delivery with an unfavorable
cervix, a higher rate of epidurals and other medical interventions, longer labors, and a higher rate
NONMEDICAL LABOR INDUCTION METHODS 4
There are medically necessary instances of induction when the life of the mother or fetus
are in jeopardy, but the rising rate of medical inductions since 1990 suggests that there are also
confounding or intervening variables relating to the decision to start an induction not solely
straightforward medical evidence. These factors are numerous and their ranking of importance
vary per individual. In Listening to Mothers III (Declercq et al., 2013), women report the major
factors in wanting an induction as the baby was full term or close to due date, wanting to get
the pregnancy over with, and wanting to control timing (p. XI). In fact, women are often so
motivated to begin labor that 29% (Declercq et al. 2013) to 50.7% (Chaudhry, Fischer, &
Schaffir, 2011) report attempting to induce labor on their own via methods that were not
induction methods are important and of great interest to women (Kavanagh, Kelly, & Thomas).
However, a desire or attempt to begin labor at home does not necessarily equate to a desire to
have an induction in a medical setting with medical means. A desire to complete the induction
process in their own home, a desire to avoid a more medically intensive induction, and a desire
to have more personal control or autonomy over the process are all possible and realistic reasons
Due to the safety concerns with inductions via medical means like oxytocin, artificial
comprehensible why so many women turn to nonmedical or autonomous methods to try to start
(Chaudhry et al., 2011) and breast or nipple stimulation (Kozhimanil, Johnson, Attanasio,
NONMEDICAL LABOR INDUCTION METHODS 5
Gjerdingen, & McGovern, 2013), among others. Overall these two nonmedical induction
methods are considered safe in healthy, low risk pregnancies at least at term gestation and do not
routinely cause an additional need for additional medical interventions in labor (Chaudhry et al.,
(Kozhimanil et al., 2013), is an important issue to women and their partners, and seemingly
effective at starting labor (Kavanagh et al., 2001). In a study where women with uncomplicated
pregnancies were reassured of the safety of coital acts and were encouraged to engage per
delivering before 41 weeks, and therefore less chance of needing a medical induction for a
postdate pregnancy (Tan, Andi, Azmi, & Noraihan, 2006). When sexual activity is safe and
consensual, this activity can generally be considered safer than medicalized induction methods
with less chance of potential of detrimental side effects or need for further medical interventions
Breast and/or nipple stimulation is also another commonly used nonmedical labor
induction method (Kozhimanil et al., 2013). According to Kavanagh, Kelly, and Thomas (2005),
when women had a favorable cervix prior to the stimulation, breast stimulation resulted in more
women in labor after 72 hours when compared to no induction intervention. Also when
2005). One noteworthy benefit was that the rate of postpartum hemorrhage was greatly reduced
when breast stimulation was used to begin labor and in this same systematic review, breast
NONMEDICAL LABOR INDUCTION METHODS 6
stimulation was just as effective in starting labor as intravenous oxytocin with no higher rates of
When at least a portion of the labor induction process can unfold in an outpatient setting
such as the womans home, Dowswell, Kelly, Livio, Norman, and Alfirevic (2010) suggest there
is less need for artificial oxytocin and no more interventions required including cesarean
deliveries. In these same conditions Biem, Turnell, Olatunbosun, Tauh, and Biem (2003) found
no greater incidences of adverse effects and a reduced time spent in labor overall. Moreover,
women report less anxiety and depression throughout the perinatal experience when they are able
to spend a portion of their induction at home (Turnbull, Adelson, Oster, Bryce, Fereday, &
Wilkinson, 2013). It can be assumed that these positive effects can be attributed at least in part to
the womens level of comfort in her own home and not impeding the natural progression of labor
Although research suggests that methods such as breast stimulation and coitus can be
effective at inducing labor and clients are generally more satisfied with outpatient settings, these
methods may not be the ideal choice for every client or situation. Both maternal and neonatal
safety is a large factor in deciding when to recommend them, but providing evidence-based
client education and supporting clients in the entire informed decision making process is crucial
to allow each client to make the most ideal choice for herself. For example, per Tan et al. (2006),
30% of study participants reported feeling that sexual intercourse was unsafe in pregnancy and
differences in rates of sexual acts could be attributed to certain ethnicities and age of her sexual
partner, which highlights the importance of both proper client education and sensitivity to
individual beliefs or preferences. Even though obtaining informed consent seems to be a central
issue to medical care, Moore, Low, Titler, Dalton, & Sampselle (2014) found that women are not
NONMEDICAL LABOR INDUCTION METHODS 7
fully aware of all aspects or risks associated with induction of labor even when they engage in
the process. However, healthcare providers framing of the issue was one of the most significant
factors in womens decisions about inductions. These findings illustrate the key role providers
play in these types of decisions and how essential it is to have an unbiased, evidence-based
Based on their reported motives for attempting to or asking to start labor, a significant
portion of women want a level of control over their birth experiences, specifically how it starts
and where it takes place. Even when not prescribed by a healthcare provider, many women
attempt to induce labor on their own or consider doing so. With this in consideration, women
should be fully educated and counseled on both medical and nonmedical induction techniques
with specific focus on the relative safety, effectiveness, and maternal satisfaction associated with
sexual intercourse, breast/nipple stimulation, and other home based induction approaches for
nonemergent situations. Women are inherently driven to make choices that they believe are
safest of themselves and their neonates and as such, should be provided with all possible options
and allowed to choose options that are most ideal for their own situations.
NONMEDICAL LABOR INDUCTION METHODS 8
References
Biem, S., Turnell, R.W., Olatunbosun, O., Tauh, M., & Biem, H.J. (2003). A randomized
controlled trial of outpatient versus inpatient labour induction with vaginal controlled-
Chaudhry, Z., Fischer, J., & Schaffir, J. (2011). Women's use of nonprescribed methods to
Declercq, E.R., Sakala, C., Corry, M.P., Applebaum. S., & Herrlich, A. (2013). Listening to
Dowswell, T., Kelly, A.J., Livio, S., Norman, J.E., & Alfirevic, Z. (2010). Different methods for
8. doi: 10.1002/14651858.CD007701.pub2
Kavanagh, J., Kelly, A.J., & Thomas, J. (2005). Breast stimulation for cervical ripening and
10.1002/14651858.CD003392.pub2
Kavanagh, J., Kelly, A.J., & Thomas, J. (2001). Sexual intercourse for cervical ripening and
10.1002/14651858.CD003093il
Kozhimanil, K.B., Johnson, P.J., Attanasio, L.B., Gjerdingen, D.K., & McGovern, P.M. (2013).
Use of non-medical methods of labor induction and pain management among U.S.
Moore, J.E., Low, L.K., Titler, M.G., Dalton, V.K., & Sampselle, C.M. (2014). Moving toward
National Partnership for Women & Families. (2016). Quick facts about labor induction.
health/quick-facts-about-labor-induction.pdf
Omar, N., Tan, P, Sabir, N., Yusop, E., & Omar, S. (2012). Coitus to expedite the onset of
labour: A randomised trial. British Journal of Obstetrics and Gynaecology, 120, 338
345.
Osterman, M. & Martin, J. (2014, June 18). Recent declines in induction of labor by gestational
Tan, P.C., Andi, A.M., Azmi, N.M., & Noraihan, M.N. (2006). Effect of coitus at term on length
of gestation, induction of labor, and mode of delivery. Obstetrics & Gynecology, 108,
Turnbull, D., Adelson, P., Oster, C., Bryce, R., Fereday, J., & Wilkinson, C. (2013).
World Health Organization, Department of Reproductive Health and Research. (2011). WHO
http://apps.who.int/iris/bitstream/10665/44531/1/9789241501156_eng.pdf