Variations of Pregnancy
Postdate Pregnancy Guidelines
Postdates is defined as pregnancy which continues for more than 40 weeks from conception. Often this is a normal occurrence for some women and some pregnancies. Keep in mind, each woman and each pregnancy is unique. If conception date unknown, then more than 42 weeks from LMP (Last Menstrual Period) (when cycles are 28 days). There may be slightly different calculations made when normal menstrual cycles are less or more that 28 days. The length of the normal menstrual cycle will often determine the normal length of the pregnancy. Example: If a woman has a normal menstrual cycle of 35 days, the estimated due date (EDD) should be recalculated, or at least kept in mind, reflecting the longer cycle. This woman may go a week or more past her 28-day calculated EDD and still be “normal”.
The midwife should recheck calculations for errors in dating (e.g., fundal height, date of quickening, date FHT (Fetal Heart Tones) first auscultated).
If there is no error in dating, twice-weekly Non-Stress Testing (NST) may be initiated, beginning at 41 – 41.5 weeks. The midwife and client may decide to consult with client’s health care provider.
If NST is abnormal, or gestation is greater than 42 weeks, the midwife may decide to consult with client’s health care provider.
If a woman is postdates and the actual conception date or LMP is accurate with accurate calculations, there are natural holistic options to a pitocin (oxytocin) induction in a hospital setting. These options may include but may not be limited to these ideas:
Other forms of natural induction include the use of herbs. Black and blue cohosh both tone the uterus and can stimulate contractions. They can be used to start or augment labor. They are taken orally either as a liquid or capsule. Drawbacks include false labor, uncomfortable toning contractions, and may also cause a drop in blood pressure. Borage and flax seed oil, black current oil or evening primrose oil, 3-6 capsules, taken orally, every day and/or rubbed directly on the cervix if bag of waters is intact, after 37 weeks, can soften the cervix, tone the uterus and stimulate contractions.
Ripening Up of an Unripe Cervix
Before labor can begin, the cervix must “ripen”. It can be checked with the fingers by a feeling method. The unripe cervix will feel like the tip of the nose. As the cervix ripens, it will soften up. A ripe cervix will feel softer and more pliable, like the lips or the tongue.
If it is necessary to initiate labor and the cervix is not ripe, these two herbs and other suggestions which may help to hasten the ripening.
CAUTION: Do not put your fingers or anything else in the vagina if the membranes are not intact!
Evening Primrose Oil (EPO):
Taking three capsules daily for up to a week, may ripen the cervix.
Opening up capsules of EPO, squeezing oil out onto fingers and gently massage oil directly onto, around and into the cervical os (opening). This is helpful for after contractions have started and a rigid os is a problem. If this is the case, then the fingers should hold the os open through two or three contractions. Â
Red Raspberry Leaf and Evening Primrose
NOTE: Evening Primrose should NOT be used throughout pregnancy.
Red raspberry leaf tea has been used for thousands of years as a uterine tonic. Its use strengthens and tones the reproductive organs but does not stimulate uterine contractions, making it safe for use throughout pregnancy. Evening primrose, however, definitely plays a role in labor induction, as I have seen with women who use it as a vaginal suppository to soften the cervix and “get things going” during the last days of their pregnancies (do not insert anything into your vagina if your membranes have already ruptured, though!) Both herbs are safe and gentle to women when used with wisdom during pregnancy – red raspberry throughout, and primrose oil at the very end when both mother and baby are prepared for birth.
After 38 weeks of pregnancy, a recommended dosage of 2,500 mg tablets per day of evening primrose oil is taken orally to systemically soften all tissues (including cervix and perineum, especially if cervical scarring or previous perineal injury exists) along with 1 cup of red raspberry leaf tea from 28 weeks, increasing red raspberry leaf tea to 2 cups from 32 weeks and then increasing the dosage of red raspberry leaf tea to 3 cups from 36 weeks gestation, then as needed in labor to strengthen and tone the uterus.
Reprinted from Midwifery Today E-News (Vol 2 Issue 4, Jan 28, 2000)
To subscribe to the E-News write: firstname.lastname@example.org
For all other matters contact Midwifery Today:
P.O. Box 2672-940, Eugene OR 97402
541-344-7438, email@example.com, Midwifery Today
Black Cohosh Tincture:
Take 10 drops of tincture under the tongue hourly. This will have noticeable effect on the cervix in three or four hours. Continue until the cervix is fully soft and ripe.
Stimulation of the nipples is a very effective way for ripening the cervix and initiating labor. Have someone else suck continuously on the nipple, or roll the nipple between the thumb and finger. This may need to be continued for many hours to establish regular labor. It is fine to rest during a contraction and resume stimulation as it fades.
Sexual Activity & Intercourse:
Sexual activity acts in the same fashion as stimulation of the nipples, if not more intense. If sexual orgasm is achieved, this may actually initiate labor contractions through the release of hormones that cause uterine and pelvic contractions found in orgasm. If the woman’s partner is male, the semen contains a natural prostaglandin that will often soften the cervix and help with labor initiation. This semen may be applied directly to the cervical os. Some midwives have actually suggested that oral ingestion of seminal fluid may act just as well (not to mention relaxing the tense father-to-be!). Many a time a midwife has stepped out of the bedroom to allow the couple some “loving time” together in a slow or stalled labor and the wonderful acts of loving often end up producing a baby not too soon afterwards. It is wise to keep in mind that the act of loving put the baby there to begin with and it may be the remedy to helping the baby to be born as well.
These remedies will not work unless the cervix is ripe and ready to dilate. Some herbs, homeopathic remedies, and other suggestions are listed below:
CAUTION: Do not try to initiate labor unless the fetus is at least 37 weeks gestational age. It is best to attempt these things under the watchful guidance of your midwife.
Using imagery and visualizations can often start labor. This is done by “imagining” it is contracting. Don’t try to force or push the feeling, just let it arise by itself. If the mind worries or focuses on the problem, gently return the mind back to the solution by affirming that labor has begun and that it will be felt very soon. As with all visualizations, this one will work well with any of the following remedies.
This homeopathic remedy is reported to be a good labor initiator. The dose can be repeated every half-hour for two hours.
This can be done by the use of nipple stimulation or rubbing the belly softly and persistently (effleurage massage), with or without oil. Other suggestions may be to make an infusion of blue cohosh and use it as an enema and/or having sexual activity & orgasm. These methods are all safe and effective ways to encourage uterine contractions.
This has been a favorite remedy for birthing moms and midwives for a very long time. It is used internally and externally to stimulate the uterus, soften the cervix, and help initiate labor.
Rubbing castor oil on the belly and covering with a warm towel will help initiate labor if the cervix is ripe.
The use of castor oil as a stimulating purgative may be used. The dosage and procedure for starting labor with castor oil varies greatly with each midwife, but almost everyone uses some form or method of this treatment. Warning: The effects of taking castor oil internally can be intense. Forewarn your mothers as this will cause bowel cramping (which stimulates labor) and colon cleansing with diarrhea action and possibly nausea or vomiting. Be sure to keep the mother well hydrated and offer lots of support.
Various Castor Oil Suggestions:
1. Two ounces of castor oil, two ounces of vodka, and two or more ounces of orange juice. Follow with a hot shower. After an hour, the dose is repeated and an enema is given. Repeat the third dose after another hour, followed by a hot shower again. Labor will begin 3 to 5 hours after the last dose if all is well.
2. Two ounces of castor oil, 2 capsules of powdered blue cohosh. Take a hot shower. After an hour, the dose is repeated. Repeat the third dose after another hour, followed by a hot shower again. Labor will begin 3 to 5 hours after the last dose if all is well. This is the method I personally used with two of my own labors!
3. Two ounces of castor oil, 10 drops of blue cohosh tincture. Take a hot shower. After an hour, the dose is repeated. Repeat the third dose after another hour, followed by a hot shower again. Labor will begin 3 to 5 hours after the last dose if all is well.
Blue Cohosh Tincture:
3-8 drops in a glass of warm water or tea (red raspberry tea is good for a labor tea), is a very effective way in starting labor. Repeat every half hour for several hours until contractions are regular. If labor is not underway in four hours, use a dropperful of the tincture under the tongue every hour for up to four hours or until contractions are strong and consistent.
Labor Tincture (Susun Weed’s Wise Woman Herbal):
1/2 ounce dried Black Cohosh root
1/2 ounce dried Blue Cohosh root
1/4 ounce dried Ginger
1/4 ounce dried Birthroot
1 cup (8 fluid ounces) 100 proof vodka
Place dried herbs in a pint jar and add vodka. Label and cap. Let it all steep together for 6 weeks or longer. Decant tincture by running the mixture through a juice extractor or a salad spinner. If neither of these are available, pour the tincture and herbs onto a cotton cloth and wring by hand. Store decanted tincture in a cool, dark place in brown glass. Be sure to label it. The blue cohosh encourages the uterus to begin contractions and increases the force of the contraction. The black cohosh helps the uterus to contract in a coordinated and effective way, the ginger focuses the energy into the pelvic area and increases the energy available to the uterus. The birthroot (trillium) adds its influence on the uterus by speeding up the action of the cohoshes and joining with the ginger to energize the uterus. This tincture can be used to initiate labor, strengthen contractions, unstall and stimulate labor, deal with exhaustion during labor, expel the placenta and help to control postpartum hemorrhage.
Use the labor tincture hourly and homeopathic Caulophyllum 200x every half hour. This establishes a smooth labor within 5 hours. Contractions build slowly when a labor tincture is used. Do not discontinue use until the contractions become regular.
If you have any suggestions that you have used to initiate labor, please email me at firstname.lastname@example.org. I would be happy to include them on this page.