Issue link: http://cp.revolio.com/i/869597
the 42nd week of pregnancy. However, statistically, there is, considered to be a slightly increased risk of stillbirth after 40 weeks of pregnancy. According to Up to Date "Perinatal mortality increases as pregnancy extends beyond 39 to 40 weeks of gestation… The perinatal mortality rate at ≥42 weeks of gestation is twice the rate at term, increasing four- fold at 43 weeks, and five- to seven-fold at 44 weeks. However, the absolute risk of fetal or neonatal death is low. Nonetheless, this small risk represents a major legal concern for doctors who deliver babies. An obstetrician can expect to be sued 3 times in her career, is legally liable until a child turns 18 years old for any problems that can be attributed to a birth she attended, and the stakes of a lawsuit, in addition to the stress, can be financially and professionally devastating. Induction has become the answer addressing risks to baby. According to some researchers, however, the statistics may be overinflated and skewed in favor of induction. And I repeat, according to Up to Date, "the absolute risk of fetal or neonatal death is low." au naTuraL: whaT reaLLy works for sTimuLaTinG Labor? is any of iT safe? It is generally optimal to let labor commence on its own. When it does, the conditions are usually best for a natural labor and birth. The baby's head is in the right position, hormones are kicking in left and right, and the uterus has built up a nice repository of oxytocin receptors primed and ready to embrace your body's natural oxytocin, which will naturally stimulate contractions. Unfortunately, we don't all live in a perfect world where nature is respected and honored – thus sometimes, we need to make a choice between trying to get labor going naturally and getting it done in the hospital. Occasionally, too, nature does need a nudge. Fortunately, we have resources at our fingertips to help things along. There are a number of options for getting labor started. Few of these have strong evidence behind them and not all of them have been proven to be safe for baby. Nonetheless, many women find these to be a preferable alternative to the risks of medical induction methods and being in the hospital. Over the years in my own practice, I have found membrane stripping, nipple stimulation, the use of some herbs, and castor oil to be the most effective, particularly in combination. Of these, only membrane stripping and nipple stimulation, are considered to be safe. Here is a review of the most common approaches to getting things going: Membrane stripping This does not mean breaking the waters. It is a technique your doctor or midwife can do which involves sweeping her index finger around the inside of your cervix and "lifting" the membranes up off the inner cervix. It is easily performed in the office and has been shown to be both safe and effective in stimulating labor within 48 hours. It is estimated that one in eight women will successfully go into labor with no increased risk of infection as a result of the procedure. It may need to be repeated at an additional office visit on a subsequent day. According to Cochrane Collaboration review, sweeping of the membranes was associated with reduced duration of pregnancy and reduced frequency of pregnancy continuing beyond 41 weeks. Discomfort during vaginal examination, mild cervical bleeding, and irregular contractions are the main "side effects." Last time I did it was when my daughter-in-law was in her 41st week. She went into labor within the day… Nipple stimulation Pulling on the nipples very firmly in a motion intended to simulate a baby's suckling stimulates uterine contractions and has been used to induce labor (a breast pump is not usually recommended). It usually works within about 72 hours in women with favorable cervices on Bishop scoring (something Page 28| Abby's Magazine - www.AbbysMag.com