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non-invasive your midwife can calculate with a cervical exam). Breast stimulation causes the uterus to contract, likely through increased levels of the hormone oxytocin, which stimulates contractions. It is typically recommended to be done manually for about 30 minutes at a time on one or both nipples, repeated twice daily. There is little data on safety but it does not appear to be associated with any complications. Safety has not been evaluated in high-risk pregnancies. A plus is that nipple stimulation is associated with reduced postpartum hemorrhage. It's kind of difficult to do it firmly enough to yourself so having your partner or a close pal do it is more effective. It may be a little uncomfortable but don't let that worry you about breastfeeding, which can also be uncomfortable at first, but gets easy. Herbs Herbs, especially blue Cohosh and cotton root bark are popular amongst midwives, including certified nurse midwives, to stimulate labor. They are typically used in the form of alcohol extracts, taken in doses of several milliliters at a time, repeated up to 4 times/day, or more often under skilled guidance. While these herbs can be highly effective, and I have used them extensively in my practice over nearly 30 years, the use of blue cohosh has been implicated in serious complications in the newborn including heart attack and stroke at birth in three published case reports. Midwives also report increased risk of meconium in the baby and need for resuscitation, though this may be due to the factors that led to the use of the herbs, including the baby being overdue. While the existing adverse reports are unlikely due to the herb, the pharmacology of blue cohosh does not allow this association to be ignored. Thus, the use of herbs to induce labor should preferably be done under the guidance of a midwife or other reliable health professional skilled in the use botanical medicines in pregnancy. My extensive academic research on blue cohosh and herbs for labor induction is presented in the American Herbal Pharmacopoeia Blue Cohosh Monograph. Red raspberry leaf is a safe exception. It may be taken in a strong tea, prepared using ¼ oz. (about 4 grams) of the dried herb to 1 pint of water, steeped for 20 minutes, and several cupfuls taken daily until labor commences. It is not associated with causing preterm labor and has been associated with decreased complications at birth for the mother and baby. Abby's Magazine - Volume 5 Issue 5 | Page 29