Natural Induction Methods: Black Cohosh and How a Certified Doula Can Help

Black Cohosh for Induction of Labor

What it is:

Black Cohosh is another plant that has historically been used by midwives to help induce labor. It is made from the root and is available as a tincture, capsule or tea. Not much is known about how this herb works, but it is thought to behave like estrogen. Estrogen may help to coordinate the muscles during a contraction. They are also important in how our bodies make progesterone, which helps ripen the cervix.

What the research says:

Several studies have shown an increase in hormone levels, but others have shown no effect. A new theory proposes that it helps decrease pain, but that has not been studied. Other than that, not enough research has been done to determine whether black cohosh actually starts labor.

Dosage:

The amount of black cohosh to use during labor has not been studied much. I have found varying amounts of this herb used and would advise you to discuss it with your care provider.

Possible Benefits:

If the herb acts like estrogen, it may have some ability to induce labor or prepare the woman for labor.

Side Effects:

Black cohosh may cause stomach aces and cramping. it may also cause headaches and some vaginal bleeding. It should not be used during early pregnancy.

What the Doula can do when her client is using primrose oil

-Provide your client with as accurate information as possible

-Help the your client work through the pros and cons of this method

-Encourage your client to also take care of herself, as this helps the body work better regardless of what else the mom is doing

-Provide some ways to help decrease stress and anxiety as this inhibits labor and is often a part of women’s lives when they are feeling pressured(from themselves or a care provider) to have their baby soon

-Be prepared to help provide some pain relief ideas if the black cohosh is creating some cramping. Some ideas include warm compresses, hot bath, movement, and distraction. Remember that the moms basic needs still need to be cared for (ie eating, drinking, sleeping).

-Continue to remind them of the different ways their body is preparing to have this baby. So often we focus on dilation, but that is really one of the last ways your body prepares, and it’s overused as a method of judging when the baby is going to be born. Focus instead on the baby moving down, the cevix softening, any increases in contractions (even braxton hicks).

References:

http://www.webmd.com/vitamins-supplements/ingredientmono-857-BLACK%20COHOSH.aspx?

activeIngredientId=857&activeIngredientName=BLACK%20COHOSH

http://www.ncbi.nlm.nih.gov/pubmed/22504147

http://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/

http://herbs.lovetoknow.com/Black_and_Blue_Cohosh_to_Induce_Labor

http://courses.washington.edu/conj/bess/estandprog/estandprog.htm

Disclaimer: I am not a doctor and recommend that anything you should choose to do should be discussed with your care provider first.

doula skills, medical intervention, natural induction

Natural Induction Methods: Evening Primrose Oil and How a Certified Doula Can Help

January 17th, 2013 | Posted by Rachel in Doula Action | Medical Interventions - (0 Comments)

I am going to state upfront, that I do not like electivel inductions be it natural or not. We do not fully understand how and why labor starts and I don’t like to mess with that system:) So there’s my bias upfront, but I still feel like it’s important to present all information, so these posts are my attempt to do so.

In my doula certification course, methods of induction are presented so that the doula can help provide information to the birthing mother. The doula must be careful, though, not to advocate for a particular method. She must also make sure that her information is as accurate as possible. When it comes to non-medical methods of induction, there has not been a lot of research done to support or refute them. This should be conveyed to the mother if she is going to be able to assess her choices accurately.

Primrose Oil for Induction of Labor

What it is:

Evening primrose is a plant that was used by the Native Americans for various ailments, but it is also used by many midwives today to prepare the body for labor. It has chemicals that are part of the production of prostiglandins which are hormones that help soften the cervix. Some believe that taking primrose oil helps to release these prostiglandins, thus providing a way to soften the cervix earlier.

What the research says:

There is not a whole lot of research on evening primrose oil, and the research that I’ve seen shows no effect on the length of labor or starting labor. One small study also showed an increase in the bag of waters breaking when women took evening primrose oil.

Dosage:

There is no standard dosage, but 500-2000mg daily after 38 weeks has been suggested. The capsules can be taken orally or vaginally.

Possible Benefits:

The benefit appears to be in it’s ability to soften the cervix, thus preparing the body for labor. The idea is that it may keep the woman from going overdue, or help shorten the labor.

Side Effects:

May cause an upset stomach or nausea and vomiting. There is possibility of premature rupture of membranes (based off of one small study).

What the Doula can do when her client is using primrose oil

-Provide your client with as accurate information as possible

-Help the your client work through the pros and cons of this method

-Encourage your client to also take care of herself, as this helps the body work better regardless of what else the mom is doing

-Continue to remind them of the different ways their body is preparing to have this baby. So often we focus on dilation, but that is really one of the last ways your body prepares and it’s overused as a method of judging when the baby is going to be born. Focus instead on the baby moving down, the cevix softening, any increases in contractions (even braxton hicks).

References:

http://www.aafp.org/afp/2009/1215/p1405.html

http://www.webmd.com/vitamins-supplements/ingredientmono-1006-EVENING%20PRIMROSE%20OIL.aspx?activeIngredientId=1006&activeIngredientName=EVENING%20PRIMROSE%20OIL

Dove D, Johnson P.Oral evening primrose oil: its effect on length of pregnancy and selected intrapartum outcomes in low-risk nulliparous women. J Nurse Midwifery. 1999 May-Jun;44(3):320-4.

http://www.webmd.com/baby/inducing-labor-naturally-can-it-be-done?page=2

Disclaimer: I am not a doctor and recommend that anything you should choose to do should be discussed with your care provider first.

certified doula actions, natural induction

Defining Physiologic Birth

January 8th, 2013 | Posted by Rachel in Medical Interventions - (0 Comments)

In my writings, and perhaps those of others, you may have seen the term physiologic birth. In order to understand why I choose to use this term, I thought it might be helpful to discuss a few definitions.

Natural Birth: This term has come to mean different things to different people. To some it simply means a vaginal birth, to others it means a birth that was free from all medical intervention. It can even lie in between these two extremes: a birth that did not use pitocin, but used an epidural, for instance.

Normal Birth: Normal means to be average or typical. This term is used to describe lots of varying situations also. To some it means a birth that, again, uses no medical intervention. To others it can mean that you just followed the normal course of labor.

I dislike both these terms because they are vague and tend to evoke some sort of judgment with them. Because of this, I like to use the term physiologic.

Physiologic Birth: This is a birth defined, not by our choices, but by how our body functions. For instance, a physiologic birth is spontaneous. Our body will go into labor on its own due to a complex hormonal mother/baby response. It is just how our bodies were made. When we interfere with it, you are not good or bad, but you are interfering with your normal physiology which may have consequences for the rest of your labor. Sometimes, there are medical conditions that change our physiology so that it does not work right. This also will have consequences for the rest of our labor.

The care that women have today can be problematic in that it does not take into account our basic physiology. There are consequences of intervening when it it not necessary. There is also not enough support given to promote physiologic care.

What can we do to help our bodies function the way they were made to function.

1) As stated above, physiologic birth is spontaneous. Doing anything (natural or unnatural) to start labor when your body is not ready will disrupt your body’s process of giving birth.

2) Keep a calm, dim, peaceful environment. These things are important to how our own hormones are produced.

3) Do not worry about how much time labor takes. The time constraints opposed on most women during birth are artificial and unsupported by research.

4 )Eat and drink during labor (unless there is a medical reason not to). This helps provide your body with the nutrients it needs.

5) Medical pain control will interfere with your bodiy’s ability to function the way it needs to. That said, I also feel like pain can stop your body from functioning the way it needs to. This is an individual decision you and your care provider must come to to decide what may be the best way to work with your body.

6) There should be delayed cord clamping and mother and baby should be skin to skin as soon as possible after birth.

7) Fear and anxiety from any source must be dealt with.

For more information on why we should care about physiologic birth and how it may be better for both mom and baby check out this link: http://www.midwife.org/acnm/files/cclibraryfiles/filename/000000002179/physioloigical%20birth%20consensus%20statement-%20final%20may%2018%202012%20final.pdf

natural birth, normal birth, physiologic birth

Another reason not to do cervical checks…

February 13th, 2012 | Posted by Rachel in Medical Interventions - (0 Comments)

This video discusses this in the context of preventing gbs infections, but I think we need to look much broader than that. There are not a whole lot of reasons to check women so often before or during labor. Especially if infection is a risk.

cervical exams, medical intervention

Harm vs benefits of obstetric interventions

February 12th, 2012 | Posted by Rachel in Medical Interventions - (0 Comments)

I came across an article that said that ”Overuse of therapeutic procedures, diagnostic tests, and medications is an understudied problem that may account for as much as 30% of healthcare spending in the United States and result in harm to patients, according to a review published in the January 23 issue of the Archives of Internal Medicine.”

It did not specifically mention obstetrics, but I have a feeling that it would be the same sort of percentages.

From the article “Overuse was defined as interventions in which negative consequences, including unnecessary costs, outweighed the benefits of care.”

So what are some overused interventions in obstetrics….here’s the list that I came up with(these are just my thoughts, but based off of experience and reading):

1. Checking the cervix every hour or two…

Potential benefit…really it doesn’t do much except tell the doctor where you are right at that moment. It doesn’t tell you where you will be even 5m from that point.

Potential harm…introducing infection, increasing costs(in time and materials and treatment of infection), rushing birth, pain for mother, anxiety or stress for mother.

2. Early induction for non medical reasons

Potential benefits…. convenience, perhaps relieve some stress and anxiety.

Potential harms…increase the use of other interventions, more painful, need to be continuously monitored, increased c-section rate, increased fetal heart rate abnormalities(increased cost in time and materials).

3. Routine artificial rupture of membranes(not medically indicated)

Potential benefits…slightly faster birth

Potential harms….increased fetal heart rate abnormalities, increased risk of infection, increased pain, mother uncomfortable with continuous leaking, (increased cost in time and materials).

4. Routine continuous monitoring(not medically indicated)

Potential benefits…doctors and nurses feel more comfortable, doctors and nurses feel more legally comfortable, takes less of the doctors and nurses time to monitor the heart rate

Potential harm….increase in c-section has been associated with continuous monitoring, more uncomfortable for mother, usually confined to bed, unable to utilize many other options to move around and provide comfort(increased cost in materials).

5. Routine use of IV fluids(not medically indicated)

Potential benefits…can get fluids in as fast as possible if an epidural is needed or desired, can give fluids quickly to help with with low blood pressure.

Potential harm…fluid overload, not able to move around as freely or easily(increased cost in time and materials).

Just looking at this list, our medical community wastes a lot of money on interventions that are neither necessary nor desired. Of course, money is not the bottom line. But these interventions have the potential to do harm with not a lot of benefits. Just my humble opinion.

obstetric interventions