What you can do to naturally induce labor - What works and what doesn't

Last week, I was pondering the increasingly popular phenomenon of "membrane sweep", and I'm not entirely convinced that "membrane sweep" is in line with "science and proven experience". Perhaps "proven experience" to some extent, but not so much science.

There is no direct scientific evidence that "membrane sweep" actually helps to induce labor in pregnant women.

Now, onto this week's reflections. Can something else be done to naturally induce labor? As I mentioned before, many pregnant women come to the clinic. They are tired, experiencing pelvic pain, and eager to give birth. Ideally, right now. As a responsible doctor, naturally, one wants to help their patients. Is there anything that can be recommended apart from purely medical interventions? I wanted to delve into that.

What do the literature and science recommend to naturally induce labor?

Dates

Now you're probably wondering if I've gone crazy. The answer is no. Many years ago, when Södra BB (a maternity ward) existed at Södersjukhuset, the topic of dates came up. It turned out that dates were suddenly being served to women waiting in the ward's waiting room. We also had prenatal care at the clinic back then, so these women were not in labor.

One of the midwives had heard about the positive effects of dates.

When I discovered this, I started searching the literature. It has been several years since then, and I have now conducted a new, more recent search to find out if there is any scientific basis for the claim that consuming dates have a positive impact on initiating spontaneous labor. It has been reported that dates contain carbohydrates, fats, and proteins, as well as 15 different types of salts, minerals, and vitamins.

This means that dates are considered a very nutritious product for pregnant women.

Meta-analysis

If one looks for scientific evidence, there are approximately 10 different international articles discussing dates and labor initiation in some form. As usual, these studies are generally small and not very well-conducted, which lowers their level of evidence.

However, there is a meta-analysis on the subject as recent as 2021. Meta-analysis means that, according to a protocol, researchers search for articles that "meet the criteria" and compile and present the results from those studies.

The current meta-analysis included 4 studies. The results showed that women who consumed dates towards the end of their pregnancy generally had a more mature cervix when they arrived to give birth. They had a shorter latent phase, were less frequently induced, and required less oxytocin stimulation during labor.

However, there was no difference in the rate of cesarean sections between those who consumed dates and those who did not. It is believed that substances in dates interact with the oxytocin receptors in the uterus in a favorable way (?). However, the researchers concluded that larger randomized controlled trials are lacking and needed to provide a more definitive answer.

Advantages/Disadvantages

Regarding the studies' drawbacks, it should be noted that they generally do not specify the type of dates consumed in the study being reported. There are several different types of dates grown in different parts of the world, and their contents likely vary significantly.

It was also arbitrarily decided to have the women consume dates during the last 4 weeks before delivery (from week 36). The amount of dates were set at 6-7 per day.

At the same time, it is noted that this is approximately what a person from the Middle East (where dates are often part of the diet) typically consumes in one meal. However, it can be concluded that consuming dates is safe, even though the scientific evidence is fairly weak regarding its actual effect on labor initiation.

Raspberry Leaf Tea

Raspberry leaf tea is another product that has suddenly emerged in these discussions. It is said to prepare the uterus and shorten the duration of labor.

However, it can be concluded that the scientific evidence supporting the effectiveness of raspberry leaf tea is even lower than that of dates.

There is simply nothing to report on this matter! Nevertheless, there are several women who report consuming this tea towards the end of their pregnancy and claim that it works well.

Evening Primrose Oil

When it comes to evening primrose oil, the evidence is slightly better again. There is a meta-analysis conducted as recently as 2021. It included 6 studies that met the criteria and were included in the analysis.

Evening primrose oil can be taken orally as capsules or used vaginally. It contains something called gamma-linolenic acid (GLA), which is similar to the prostaglandins involved in labor initiation, as I described earlier.

One of the studies showed a more mature cervix and a shorter duration of labor in the group that consumed the oil. However, this finding could not be replicated in other studies. The summary is that the evidence for the effectiveness of evening primrose oil is fairly weak, and more randomized controlled trials are needed (of course!).

Labor Inducing Drink

I am strongly against this drink, mostly because I have witnessed cases where things have gone really wrong.

The labor-inducing drink contains castor oil, which is extracted from the seeds of the castor plant (Ricinus communis). Using castor oil to induce labor is not a new idea. It has been used for a long time, long before our influencers started drinking it on YouTube.

It is believed that the oil affects receptors in both the intestines and the uterus. This leads to diarrhea and, in the best case, contractions at the same time.

However, I have been in charge as a doctor when women have come in after taking castor oil at home. I have also been involved in performing emergency cesarean sections due to fetal distress. The woman has experienced what we call a "contraction storm." It means contraction after contraction without a break.

During labor, it is important for the uterus to have an adequate pause between contractions. This allows the baby to recover before the next contraction comes. If the contractions are too frequent, a contraction storm can occur, increasing the risk of fetal distress. And let's not forget the joy of having severe diarrhea during a significant portion of labor. Not exactly what one wishes for.

The "Final Kick"

"The final kick" refers to having sex to initiate labor.

Many times in my clinical practice, I have heard midwives tell women to go home when they are not fully in labor and say, "Go home, buy a pizza, and have sex. Then you'll be back soon."

Is it true? I had to check this scientifically as well.

I can immediately state that there is no published scientific evidence on this subject at all. The Cochrane Library conducted a review on this topic in 2001 and found only one study with 28 women included. They note that human semen contains the highest concentration of prostaglandins (which are important for labor initiation), and the idea is that this would have a positive effect on starting labor.

However, there is no scientific evidence to support this claim. It simply has not been studied. The next time I hear this in my clinical practice, I will have to protest. Of course, pizza and sex can be enjoyable, but it probably won't initiate labor.

So, what are my recommendations?

What are my recommendations for women who want to naturally induce labor?

My advice is to try to get as much rest as possible, eat well, and gather strength for the upcoming work of giving birth.

A marathon runner would never forgo sleep or food in the days leading up to a race. The same applies to a woman who is about to give birth. That is the most important thing, I believe!

To be continued,

Dr. Eva