Care from midwives can very greatly. A certified nurse midwife working in a hospital with an obstetrician will use medically minded induction methods, such as Pitocin, artificial rupture of the membranes and vaginal prostaglandin preparations. But a certified nurse midwife, licensed midwife, or lay midwife who attends births at a freestanding birth center or in homes will have a different outlook on induction.
Evening Primrose Oil
A midwife might recommend evening primrose oil late in pregnancy to help a woman's body prepare for labor. This is taken orally and inserted vaginally, next to the cervix. While evening primrose oil will not start contractions or induce labor, it will help the cervix ripen, soften and dilate. This can help to speed spontaneous labor or help an induction proceed more smoothly.
Black and Blue Cohosh
Black and blue cohosh tinctures or capsules are often used under the supervision of midwives to help stimulate labor. Drops of the powerful herbs are diluted with water or juice and are taken orally, or the root of the herb is taken in capsule form. They are powerful herbs and should be used onlyunder the guidance of a trained midwife or naturopath. When taken together, these herbs help to coordinate late-term uterine contractions and strengthen them to bring on active labor.
Castor oil is commonly used to encourage labor. Once taken orally, it works by stimulating the intestinal tract, and thus stimulating the uterus through sympathetic contractions. Because it primarily works on the intestines, side effects include vomiting, diarrhea, cramping and dehydration. Because the side effects are so severe, some midwives are hesitant to use this method, because it depletes the mother's nutrient and hydration stores that are vital for a successful labor.
Although this is a medical procedure, it is one of the more gentle medical methods of labor induction, and thus midwives often use it to encourage labor. During a pelvic exam, the midwife will use her finger to separate the bag of waters from the cervix, breaking the threads of tissue that hold it in place. This action releases prostaglandins that soften the cervix and cause uterine contractions. If this method will work, labor will generally start within 24 hours.
Acupressure and Acupuncture
Several pressure points and energy channels on a pregnant woman's body will encourage labor contractions when stimulated. Acupressure and acupuncture by trained practioners can stimulate contractions and help to bring about labor.
Encouraging Natural Hormone Production
There are also methods that a midwife will encourage a pregnant woman to try on her own to bring about labor. Sexual intercourse is one of the most effective. Semen contains high levels of prostaglandins, which soften the cervix and encourage uterine contractions. In addition, when a woman orgasms, the naturally occurring labor hormone oxytocin floods her system, causing a strengthening of labor contractions.
Nipple stimulation is also recommended as a way to release oxytocin. A mother can use manual or oral stimulation, a breast pump, a nursing toddler or a stream of warm water to encourage contractions and bring about labor.
A midwife helping to bring about labor will also encourage a pregnant mother to spend a good deal of time walking. Long strides and the bouncing impact of a quick pace encourage the baby's head to press on the cervix, causing it to ripen and soften.