Come on, baby

When your pregnancy has reached term, but baby shows no sign of coming out, what can you do?

THE other day, I saw one of my patients, who was 40 weeks pregnant and nearing her due date. After examining her, I asked her how she was feeling.

“Well, doctor, this pregnancy thing is getting tiring. Is there any way to make the baby come out sooner?” she asked, half-joking.

She’s not the first pregnant woman to ask that question. By the 37th week, pregnancy has lost its glow and most women just want to be done with it so that there will be no more fatigue, swelling, leg cramps, backaches and sleep problems.

Some babies are ready to come out at 38 weeks, while others can stay in there until 42 weeks! Many first-time mothers deliver at 41 weeks.

Some patients have complained to me, “Shouldn’t doctors be able to accurately predict my due date?” The answer is yes and no. Due date prediction is not an exact science and it depends on many factors throughout pregnancy.

I always tell my patients that there is a reason the baby is staying in there just a bit longer. This is the time when the baby is developing, and forcing it to come out too early may interrupt his or her growth.

However, after week 40, there is no harm in trying to induce labour with natural methods. I will discuss a few of these methods in this article.

Stress and anxiety can suppress the flow of oxytocin, the hormone that stimulates contractions. Relaxing the body and mind may just encourage baby to come out. - Photo by Photos.com

Natural labour inducers

First of all, remember that you should never EVER try to induce labour before 38 weeks. You should also discuss any of these methods with your obstetrician before trying them. Some of these methods are merely primers – they are safe for almost all women at any time in the weeks before labour. Here are some of the common primers:

Relaxation – Stress and anxiety can suppress the flow of oxytocin, the hormone that stimulates contractions. Relaxing the body and mind may just encourage baby to come out. Try having a quiet day at home, taking a warm bath, getting a massage from your partner or listening to some soft music.

Sex – I don’t blame you if you’re not feeling too sexy at the moment, but this is actually not a bad idea. The semen contains prostaglandins, which help to ripen your cervix and prepare it for pregnancy. Orgasms can also trigger your contractions. Sex can also help you kill two birds with one stone – it is a stress reliever as well!

Walking – This is to help your baby move further into your pelvis for delivery. Other methods like bouncing or rocking on a birthing ball use similar principles of gravity to help the baby settle into the pelvis. If you have already started having contractions, walking will help to relieve the discomfort and encourage the process of labour.

Evening primrose oil – EPO contains the precursors to prostaglandins, which will help to ripen your cervix. You can take EPO supplements, but discuss the dosage with your doctor before starting. Some people may advise you to insert EPO into the vagina, but you should not do this because it could increase your risk of infection.

Raspberry leaf tea – It is believed that this can help make contractions more effective during labour. Raspberry leaf tea can be found at health food stores. You have to drink one to two cups a day starting any time during pregnancy. Don’t forget to drink water as well!

Then there are the inducers – these are the ones you should only try after 38 weeks. Most of these methods should only be done by your doctor or midwife, or under their supervision.

Nipple stimulation – Stimulating the nipples by hand or with a breast pump releases oxytocin, which can cause contractions. This should only be done with the approval or supervision of your doctor, so that you do not cause overly strong contractions that can cause your baby’s heart rate to slow down. Get your doctor’s advice on how to do this properly. But don’t worry, inadvertent nipple stimulation during foreplay or intercourse will not cause a problem.

Membrane stripping – This is a method of inserting a finger through the cervix and “sweeping” the membranes of the lower uterus to release the prostaglandins. Obviously, only your doctor should perform this – and there are risks involved with this procedure, so be sure to get all the facts before agreeing to it.

Acupressure – In traditional acupressure, it is believed that there are various points on the body that trigger labour. One point is located in the roof of your mouth, and sucking on a lollipop or your thumb may trigger that pressure point. The other point is four finger-widths up on your calf from the inside left ankle. Apply pressure for 15 seconds, release and repeat.

Inducers to be careful of

There are some methods that are passed on as traditional or cultural advice, but some of these do not hold water and may be dangerous for you and your baby. Castor oil is one method that is frequently cited, although I would not recommend it. Castor oil is actually a laxative and triggers spasms in your intestines. These spasms may irritate the uterus and cause contractions.

However, this side “benefit” of castor oil is not worth it – not only is castor oil smelly and foul-tasting, it will also cause painful diarrhoea and a risk of dehydration. Spicy foods are believed to work on the same principle, although they are more “gentle” in stimulating the bowels, compared to castor oil. Again, I would advise against using this method, because spicy food can cause painful heartburn.

Some people believe that certain herbs like blue and black cohosh can be used to induce labour. However, I would advise against it because there is not enough scientific evidence about the effectiveness and safety of these herbs. Blue cohosh may raise your blood pressure too much, damage your baby’s heart or cause uncontrollable haemorrhaging in the mother. Herbs aren’t always safe, even though they are touted as “natural”.

Finally, don’t stress yourself out about labour and delivery! Your baby will come out when he or she is ready, and your doctor is there to keep an eye on you. Use this time to relax, read, prepare yourself for impending motherhood and share your feelings with your partner. Soon, you’ll be a mum!

WOMEN'S WORLD By DR NOR ASHIKIN MOKHTAR, The Star, Sunday January 27, 2008

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). She is co chairman of Nur Sejahtera, Women & Family Healthcare Program, Ministry of Women, Family and Development. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.