When labour needs to start
*Updated Dec 2015
There are several situations when it is preferable that labour start sooner rather than later. These include-
- prolonged pregnancy (although the WHO recognises than normal human gestation at term is 38-42 weeks many women, especially older mothers have pressure put on them to accept induction from 40-40+10 days, due to a potential increased risk of stillbirth)
- Elevated blood pressure (gestational hypertension at term)
- Women with type 1 or 2 diabetes at term
- rupture of membranes at term without labour
Although some women are happy to accept induction, others would prefer labour to start naturally or are planning to birth at home so do not want o go into hospital for induction.
I have been offering a ‘Starting labour’ one to one session (in the North West and Wales, UK) for the past few years and have had good results (the majority of women going into labour within 24 hours) although some people have required one or two more sessions and two people have had two sessions and not gone into labour (one was induced, the other went into labour a week later at 43 weeks and had a physiological birth).
Disclaimer: You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you are worried about your babies movements please contact your midwife http://www.countthekicks.org.uk/
The session uses a variety of techniques to try to increase the chances of labour starting by looking at-
- baby position (there is evidence to suggest that prolonged pregnancy is associated with fetal malposition). This post suggests that baby position may effect bishop score http://wellroundedmama.blogspot.co.uk/2012/02/induction-math-importance-of-bishop.html
Starting labour session techniques
I usually start the session by talking to women about their pregnancy, any previous births (this can give clues about issues which may cause recurrent malposition) family history (some women just have longer gestations, if pregnancy is prolonged in each pregnancy and/or there is a family history or longer gestations) and do some belly mapping https://itaintthathard.wordpress.com/2012/10/02/belly-mapping-its-fun/ to see if we can work out if baby position might be affecting labour starting.
Women with too much waters (polyhydramnios) may want to avoid inversions (and anyone with severe high blood pressure)
This is my basic routine and I suggest you try to follow this both in sequence and frequency, without missing out bits if possible (some of it will need a birth partner to help) and can be done in early labour too
- 2 to 5 mins of rebozo sifting (manteada) with you kneeling forward resting your harms/head and shoulders onto a sofa/chair, you can use a sheet or a cotton throw if you don’t have a rebozo http://spinningbabies.com/techniques/activities-for-fetal-positioning/rebozo-sifting
- an inversion http://spinningbabies.com/techniques/the-inversion I would do this 3 times in a row (manteada followed by inversion), when you does the inversion you can wiggle your hips about.
These two techniques combined help the uterine ligaments relax and straighten, resulting in balance which will help baby be able to move into a position which allows engagement and rotation to fit down into the pelvis
*The first study to describe rebozo use for malposition was published in August 2015. There are currently no published studies looking spinning babies techniques (including inversion) in pregnancy or labour
After each rebozo session (or as one 5-10 min session afterwards) you can do some bottom/hip rebozo too and shaking the apples. (wrap the cloth around the bottom, holding the ends close to the body, facing the bottom and shake vigorously like you were shaking an apple tree to make the apples fall down https://www.youtube.com/watch?v=64IiA6N7Ldw then do rebozo lying on back http://www.homebirth.net.au/2008/03/rebozo-technique.html this is a great technique if baby is back to back or lying on the right if baby is on the right, try to use some extra pulls on the left side of the rebozo to gently encourage baby to make the short rotation from ROP/ROT/ROA to OA. This should hopefully encourage labour to start by helping the baby to present the smallest part of babies head into the pelvis, putting more even pressure on the cervix for a quicker and easier birth
If you know or suspect baby is OP (back to back) these techniques may be helpful
- 3-10 mins belly dancing, , if you know how, do fig 8s etc plus hip drops, camel walk and shimmy, if you don’t know then copy this video http://www.youtube.com/watch?v=vqVANMw99cQ
Bellydancing has been used for centuries to teach young women about movements that help in childbirth. Bellydancing is also fun and promotes laughter and relaxation which can produce oxytocin and encourage labour to start
- Gentle back and shoulder massage with a carrier oil and possibly some Clary sage/neroli/lavender and then foot massage with acupressure points http://acupuncture.rhizome.net.nz/Acupressure/induce.aspx
A 2013 Cochrane review found one study with statistically significant evidence of a change in cervical maturation for women receiving acupuncture compared with the sham control
- 20 mins of gentle breast massage with oil working all the way round and in towards the nipple 3 times a day.
A Cochrane review in 2010 found breast stimulation appeared beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates and a pilot study in 2015 found that breast stimulation in low-risk primigravidas helps in cervical ripening and increases chances of vaginal delivery.
- 10 mins of vigorous circles on the birth ball (up to 3 times a day)
Ball circles are great to help baby flex (tuck) their head to aid rotation and aid enagement in the pelvis.
A small clinical trial in 2015 found that performing birth ball exercises for 4-6 weeks at the end of pregnancy found that when descent and rotation of fetal head was assessed at the beginning of the active phase. Women who had participated in the birth ball exercises had significantly more babies with descent of fetal head into the pelvis (70%) than the control group (40%) and Complete rotation of the fetal head (OA) (63%0 versus control group (33%)
“After a very straightforward pregnancy, I developed high blood pressure in the last few weeks, and found myself booked in for an induction, something I hadn’t really considered and wanted to avoid if possible. I felt very alone and ill equipped to make decisions, and really felt the need for extra support. I contacted Selina very late in the day – 38+6 and 6 days before I was due to be induced! – and she got back to me immediately and came out to see us on the same day. I was so grateful for how quickly she came round, and it was so important to me to be able to do something constructive and helpful with Selina – it really helped me feel like I had a bit of control back. Her techniques and support were invaluable and enormously calming, and seeing her was a great relief for both me and my worried partner. She left us with lots of exercises to do to help get things moving and help with the baby’s position – after spending a day belly dancing, hula-hooping on my birth ball and using the rebozo she very kindly lent us, I went into labour the following evening and was able to give birth to our beautiful daughter naturally at 5 am the morning after. I’m positive that Selina’s techniques helped and the many tips she gave us made me feel calmer, more empowered and so much less alone. I am so glad I got in touch – thank you so much for everything!” (Anna and Ben Slater, Liverpool)
“After having a very medicalised and quite traumatic birth with my first child, I decided I wanted… to have a homebirth for my second. With the support and advice from Selina and the Liverpool Homebirth Support Group, I became convinced this was the right decision. However, after going five days overdue, I became concerned that if I reached ten days, medically I could be advised against a homebirth. Selina gave invaluable advice and offered my a range of treatments including aromatherapy massage, rebozo and belly dancing. The next evening, the first signs of labour began, the morning after that I gave birth to our beautiful son safely at home. I can’t thank Selina enough for all she did, not only practically but emotionally she got me through to what was ultimately my desired birth.”
“Selina was kind enough to help me when my envisioned homebirth was in danger of turning into a hospital birth with emergency induction. . She did rebozo sifting, which I feel made all the difference! And some acupressure, used some essential oils and we had fun doing some bellydancing moves to jiggle the baby down. I had been niggling for two nights, but nothing regular. Two hours later however, my contractions were every 5 minutes and I had my baby within a few hours”