When I was 41 weeks pregnant, I got a push notification on my Baby Center app that my little precious bundle had arrived. You’ve waited all this time and now she’s here! Congratulations! it cooed. She was not here. In fact, my daughter was showing zero interest in exiting my body. I was so upset and frustrated—and so insanely hormonal and hot and just over it—that I deleted the app and threw my phone across the room. Oops. There is a particular weirdness to waiting for a baby to be born. There is nothing quite like it, nothing that feels so utterly out of our control and so life-changing at once. Will it happen today? Tomorrow? Next week? Is it happening now? Now? Now? I did all the things I’d been told to do: acupuncture, long walks, climbing stairs (two-by-two), lots of sex, nipple stimulation. Finally, on day 10, I rubbed castor oil on my belly, and on day 11, I went into labor. Twelve (very, very, very long) days after my due date, my daughter arrived. Via c-section. After 28 hours of labor.
When can I induce labor?
“Between 37 weeks and 40 weeks + 6 days are safe times to have baby,” says Jocelyn Brown, LM, CPM, a certified midwife at GraceFull Birthing in Los Angeles. She says babies and mothers have good outcomes during that time frame. Between 41 weeks and 41 weeks + 6 days, the baby is considered late-term. After 42 weeks, the baby is post-term. After 41 weeks, the risks of stillbirth, c-section, and pelvic damage seems to become a little higher (although this is still statistically unclear). But at 42 weeks, the risk of stillbirth goes up enough that it is a true risk. One study shows that between 37 and 42 weeks, risk of stillbirth goes from 2.1 per 10,000 births to 10.8 per 10,000. Babies also tend to do worse in post-term labor and are sometimes badly positioned. If you’re hoping for a vaginal birth—especially one outside the hospital—you might not have that option after 42 weeks. It all depends on your state, so be sure to check with your midwife before you get close to delivery. “In California, I’m only licensed to deliver women until 42 weeks outside the hospital,” explains Brown. “So I have the induction conversation before a woman gets to her due date. She can’t be in my care forever until she has the baby. But the last thing I want to do is put pressure on her to give birth.”
I’m 38 weeks, but I want this baby out of me! Can I be induced?
Although the baby is technically full term, unless you are at high risk, there is no reason to rush things along. But this doesn’t mean that you shouldn’t start preparing for labor. “We talk about cervical ripening,” Brown explains, “not inducing.” This means working to soften the cervix before you’re 41 weeks along. In many midwife and OB-GYN practices, after 42 weeks, you have to go to the hospital (if you weren’t planning to already), where the likelihood of a medicalized induction is high. This is why cervical ripening can start earlier, between 35 and 37 weeks. Of when you’re ready to deliver, Brown says, “I want a nice, favorable cervix, so we are looking for a high Bishop score.” Here are a few things that can get your cervix ready to go:
First used over 3,000 years ago to induce labor, acupuncture is a very common part of the birth experience for many women, especially in China. But while it can increase your cervical ripening score (which helps lead to labor!), it might not shorten or induce labor. That said, it doesn’t seem to hurt, so you can start weekly or biweekly sessions around 35 or 36 weeks. “I recommend it to patients,” explains Rachel Graves, MD, who practices in Portland. “The data is not great, but there is some that says it may help women to not go significantly past their due date.” How does it work? “Acupuncture moves blood and qi [energy],” explains Kelly Smith, a licensed acupuncturist in the Twin Cities, “so I can bring blood to the uterus and move qi downward, using the right points on the right meridians. It also affects the sympathetic and parasympathetic nervous systems, which control hormone production.” Starting at 39 weeks + 5 days, Smith encourages her patients to come in daily. That’s when she begins working on the “forbidden” points—the points that can possibly induce labor and have hitherto been avoided.
Nipple Stimulation and Breast Pumping
One recent study showed that women who performed nipple stimulation had shorter “phases of birth” than women who did uterine stimulation or nothing at all. (In this study, none of the women who did nipple or uterine stimulation had c-sections.) This can be started at 37 or 38 weeks. It might do nothing, but it could shorten the pregnancy by 3 days. “It doesn’t seem like a lot,” says Brown, “but 41 weeks + 5 is better than 42 + 1.” (Ain’t that the truth?) Plus, it can be the difference between a hospital birth and one at home, if that’s your goal.
I’m 41 weeks, and I want this baby out! How can I induce labor?
All the tips above are really meant to ripen the cervix before it’s go-time, but once it’s safe to actually start labor, you can take more advanced steps. “We don’t freak out at 41 weeks,” says Brown, but the approach becomes a little more intensive. But keep in mind that if nothing happens and you are almost at 42 weeks, your next stop is probably the hospital. Here are some ways to move things along if you go past your due date:
Membrane stripping (or sweeping) is often done at 41 weeks, sometimes earlier. One caveat to this less-than-pleasant process: The cervix needs to be dilated enough for your midwife or OB to get her finger in. “I put my finger in a curve hook shape and sweep around. I’m trying to separate the amniotic sac from the sides of the uterus and soften the cervix,” Brown explains. Pros of Membrane Stripping:
- It could put you into labor.
- It could break your water (which can be a pro or a con). “If my messing with the amniotic sac easily breaks it, then probably that sac wasn’t long for this world,” says Brown. If your body is ready to go into labor, then that’s a pro, but if your little one isn’t quite ready to come out, membrane stripping could leave you and your baby at risk for infection.
Risks of Membrane Stripping:
- If you are Group B Strep positive, there is a small risk of infection, so Brown always waits until the last minute. In other words, she personally wouldn’t do it at 39 weeks, but at 41 weeks, when you’re looking at a hospital transport, it might be worth it to you.
- It’s painful. “It’s practice to labor—it’s intense, but labor is intense,” Brown says. “I always say the magic word is stop.”
- It could send you into labor—but with your baby in a bad position (i.e. if the baby isn’t really ready to come out yet).
Castor Oil Induction
Ah, the dreaded castor oil induction! We’ve all heard stories. Poop for days! The idea behind castor oil is that it has prostaglandins, hormones that soften the cervix. “If you take it, you poop your brains out. The laxative effect activates the prostaglandins and makes the uterus contract,” Brown says. “It’s the most powerful thing outside the hospital.” One study does show that it can induce labor. Brown advises women to begin at 41 + 3 days or 41 + 4 days. “Because we know we’ll need to go to hospital at 42 weeks, we back up the clock and induce before time is very pressing.” In other words, don’t start wait until 41 + 6 because nothing might happen for a day or two. Note: Do not—we repeat, do not!—do this without consulting your midwife or OB. Brown advises her patients to take up to 6 ounces of castor oil throughout the day. “There’s no evidence that it’s hard on babies, but if you want your baby monitored through early labor, then it’s best to go to the hospital.” A less intense step would be to simply put castor oil on your belly and go to sleep. If nothing happens, begin the drinking protocol. Brown suggests a castor oil smoothie: 2 ounces in a smoothie with an ice cream flavor that you like—but not your favorite “because it will ruin it forever.” Wait two hours, do it again, wait two hours, do it again. If you have heavy contractions, stop. But otherwise, you can take up to 6 ounces. Brown encourages her patients to not get too depressed. “If you drink that much castor oil and it doesn’t work, then maybe the baby needs more monitoring. I’m a big believer in things being meant to be.” Pros of Castor Oil Induction:
- You might actually go into labor!
Risks of Castor Oil Induction:
- Discomfort—you could have a lot of diarrhea for an extended period of time and experience nausea.
- A lot of pooping might lead to nothing—one study says castor oil is actually not all that effective in inducing labor.
- Very few studies have been done on castor oil induction.
Nipple Stimulation and Breast Pumping
Nipple stimulation creates an oxytocin response, which creates uterine contraction. It also helps you stop hemorrhaging, deliver the placenta, and bleed less. It also works to ripen the cervix before you’re full term, but if you’re closing in on 42 weeks with no sign of baby coming, you can go at this a little more intensely. Brown suggests trying 20 minutes on, 20 minutes off for two hours, then taking a break. Then try again. That said, don’t overdo it. Brown doesn’t want your nipples to be so sore by the time the baby is born that you can’t actually nurse!
Random Bonus Idea: Eating Dates
One study actually suggested that eating dates in the last four weeks of pregnancy can help induce labor, but the results were non-significant. Another study claimed that “date consumption reduced the need for labour augmentation with oxytocin but did not expedite the onset of labour.”
I’m desperate! What else can I try to start labor?
We’ve all heard myriad tales. Here are some common labor-inducing activities, and Brown’s thoughts on whether or not they work. Sex: Some women are so desperate they will try anything! “It’s thought that semen will induce labor because it has prostaglandins that touch the cervix,” says Brown, “and also that orgasm increases uterine activity in healthy pregnant women.” But there’s little evidence that it actually works. Walking: People sometimes think walking can make the baby “drop” or get contractions going, but this won’t help unless the cervix is already effaced, and contractions will likely stop once you stop walking. Or, as Brown puts it, “Walking is not going to make a baby come out.” Spicy Foods: Many women are convinced this will do it—and will even name particular foods (e.g., tacos with TONS of super spicy habanero sauce). This thinking is based on the idea that spicy foods might give you diarrhea (obviously not true for everyone). “This doesn’t work unless it gives you diarrhea,” Brown says. Evening Primrose Oil: There’s no evidence that this works, and studies have not shown that it is effective or safe during pregnancy, labor, or nursing. It might actually slow the labor or lead to a vacuum extraction of the baby, but again, there’s not enough evidence yet. Brown’s conclusion? “Doesn’t work and can make your water break prematurely.”
And if nothing works?
We know these last few weeks of pregnancy are impossibly hard. You feel huge and ready and scared. You have no idea when the baby will show up, and it’s incredibly anxiety provoking! Brown’s recommendation? “Go to the movies. Have a good week,” she says. “I’m very businesslike about it—either let’s really get that baby out, or just enjoy your last few days of pregnancy.” In the end, I tried to just lay low those last few weeks. I watched a lot of terrible movies and TV shows I would not have otherwise allowed myself (how many episodes of The Voice can one person watch?!). I read and napped and spent time with my husband. This time is also an opportunity—as crazy as it sounds—to just be in these last few moments of coupledom (or single kid-dom). This time won’t come again, so try as hard as you can to just take a deep breath and know all will change soon enough.