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Encouragement of Sexual Intercourse and Breast Stimulation as

Nonmedical Labor Induction Methods

Elizabeth Mendoza

ENGL 1050

Instructor: Franny Kinslow Brewer

April 1, 2017


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

also be taken to respect personal beliefs or sensitivities in these situations.

Keywords: sexual intercourse, breast stimulation, labor induction, outpatient


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

location of implementation. These nonmedical methods should be considered as a viable primary

option for labor induction in nonemergent situations.

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

of complications like postpartum hemorrhage, breastfeeding challenges, postpartum mood

disorders, and maternal-infant bonding difficulties.

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

specifically prescribed by a healthcare provider. Similarly, per a 2001 study, nonmedical

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

why women might attempt nonmedical inductions.

Due to the safety concerns with inductions via medical means like oxytocin, artificial

rupture of membranes, or mechanical or pharmacological cervical ripening agents, it is

comprehensible why so many women turn to nonmedical or autonomous methods to try to start

labor. Commonly attempted nonprescribed induction methods include sexual intercourse

(Chaudhry et al., 2011) and breast or nipple stimulation (Kozhimanil, Johnson, Attanasio,

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.,

2011; Kozhimanil, et al., 2013).

Sexual intercourse is a common method that women self-administer to begin labor

(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

personal preference, doing so resulted in a 4.4-day reduction in pregnancy, a greater chance of

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

(Omar, Tan, Sabir, Yusop, & Omar, 2012).

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

comparing breast stimulation to no induction intervention, no significant differences were found

in rates of cesareans deliveries, meconium staining, or uterine hyperstimulation (Kavanagh,

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

stimulation was just as effective in starting labor as intravenous oxytocin with no higher rates of

cesareans or meconium staining (Kavanagh, 2005).

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

hormones as much as in an unfamiliar medical setting.

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

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

conversation regarding all aspects of medical or nonmedical inductions.

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.


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-

release prostaglandin-E2: Effectiveness and satisfaction. Journal of Obstetrics and

Gynaecology Canada, 25(1). 23-31.

Chaudhry, Z., Fischer, J., & Schaffir, J. (2011). Women's use of nonprescribed methods to

induce labor: A brief report. Birth, 38, 168171. doi: 10.1111/j.1523-536X.2010.00465.x

Declercq, E.R., Sakala, C., Corry, M.P., Applebaum. S., & Herrlich, A. (2013). Listening to

mothers III: Pregnancy and birth. New York: Childbirth Connection.

Dowswell, T., Kelly, A.J., Livio, S., Norman, J.E., & Alfirevic, Z. (2010). Different methods for

the induction of labour in outpatient settings. Cochrane Database of Systematic Reviews,

8. doi: 10.1002/14651858.CD007701.pub2

Kavanagh, J., Kelly, A.J., & Thomas, J. (2005). Breast stimulation for cervical ripening and

induction of labour. Cochrane Database of Systematic Reviews, 3. doi:


Kavanagh, J., Kelly, A.J., & Thomas, J. (2001). Sexual intercourse for cervical ripening and

induction of labour. Cochrane Database of Systematic Reviews, 2. doi:


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.

women. Birth, 40. doi: 10.1111/birt.12064


Moore, J.E., Low, L.K., Titler, M.G., Dalton, V.K., & Sampselle, C.M. (2014). Moving toward

patient-centered care: Women's decisions, perceptions, and experiences of the induction

of labor process. Birth, 41. doi: 10.1111/birt.12080

National Partnership for Women & Families. (2016). Quick facts about labor induction.

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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


Osterman, M. & Martin, J. (2014, June 18). Recent declines in induction of labor by gestational

age. Retrieved from

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,

134-140. doi: 10.1097/

Turnbull, D., Adelson, P., Oster, C., Bryce, R., Fereday, J., & Wilkinson, C. (2013).

Psychosocial outcomes of a randomized controlled trial of outpatient cervical priming for

induction of labor. Birth, 40. doi: 10.1111/birt.12035

World Health Organization, Department of Reproductive Health and Research. (2011). WHO

recommendations for induction of labour. Retrieved from