Maternal Care: Naturopathic Labor Induction
The key indication for why a clinician would interfere with the natural process of cervical ripening is when a medical complication would compromise maternal or fetal health. In this circumstance, where cervical ripening must be hastened and the onset of labor encouraged, NDs have many tools at hand in addition to the traditional recommendations of nipple stimulation, orgasm, touching skin-to-skin with partner, walking, resting and sleeping. This article will focus primarily on the use of homeopathy as a tool for labor initiation.
For practitioners who are part of the birthing team, it is important to honor the natural process of late-stage pregnancy and the important changes that it brings for both mother and fetus. However, I have found more frequently that the most common reason a midwife will refer a client to my clinic is because the patient is post-dates and the midwife will soon be at the point where she will come up against hospital protocol and a drug induction will be recommended.
Naturopathic goals for treatment of a woman who prefers a “natural induction” are to avoid interventions such as prostaglandin gel, AROM (artificial rupture of membranes), oxytocin injection, etc. Although I will be discussing homeopathy, the benefits of the use of herbs and acupuncture are well documented, and include: avoiding a medical induction, reducing labor length, reducing epidural rates, reducing cesarean-section rates and increasing the rate of normal vaginal delivery.
When approaching the clinical scenario of a woman who needs to go into labor within a certain time period, the ND first must consider the woman’s emotional state, and have a conversation about anxiety and fear. Many women, especially first-time mothers, carry a burden of fear within them that often is fostered through modern media and the sharing of negative birth experiences from other women, and anxiety around an unknown experience. Often, a woman will carry the same fear with her through the entire pregnancy. These fears might center on being vulnerable or losing control during the process of giving birth. This fear and anxiety is best addressed directly and processed through talk therapy or art therapy. Meditation, visualization and hypnosis also are useful methods for dealing with fear and anxiety pre-birth.
Homeopathy and Labor
Recently, homeopathy has become a modality that midwives are comfortable using, as there is the perception that the choice of the incorrect remedy will do no harm and the choice of the correct remedy will be of great benefit. One of the reasons homeopathy is relatively accessible is that during birth there are a select few remedies that seem to recur with strong keynotes and are relatively straightforward to prescribe. There are common “preventive” protocols that pregnant women are told to follow to help them prepare for labor. Among the protocols, the remedies Caulophyllum, Cimicifuga and Arnica are included.
The essence of the art and practice of homeopathy is the clear identification of a complete symptom picture rather than identification of a few symptoms. Midwives and NDs attending a labor are in an ideal position to collect the information and symptomology that will lead to identification of the complete symptom picture. After years of attending births and prescribing homeopathic remedies, I have found that the most effective way to prescribe a homeopathic for a woman in labor is for the practitioner to find her own calm center, to open her senses and her heart as much as possible and to spend as much time as she can completely in the present, simply observing what is happening. Symptoms and signs from all levels of the laboring woman’s experience are important: mind, body and spirit. How is the laboring woman moving? What is she saying? What is the temperature of the room? How is she handling contractions? How does she indicate where her pain is and how it is manifesting? What is her thirst? What sounds is she making? How does the room smell? How is the woman feeling? Is she expressing fear, worry, frustration, confusion, exhaustion, or joy? How is her experience of labor manifesting? How does the prescriber feel?
These observations form the pieces of the puzzle that is the picture of the remedy the woman is inhabiting in the present moment. The case taken with keen observation – with the prescriber very careful to remain present and grounded and with growing experience of what symptoms are most important to note – will point in the direction of the correct remedy picture. Then the prescriber will be able to choose, from the remedies that she has studied, the correct remedy that the laboring woman needs at that particular moment in time. This is truly holistic and individualized medicine, directed at the true essence and experience of the laboring woman, as opposed to only one or two strong symptoms. The wonderful and challenging aspect of prescribing homeopathic remedies during labor is that this symptom picture may shift and change often during labor, and the prescriber must think on her feet, constantly anchor herself to the experience that is happening in the now, and be confident enough with the remedies available to choose and administer the correct remedy for what is indicated in the moment.
I have chosen the following remedies for their specific nature of assisting with induction of labor, or assisting with a labor that is slow and arduous, or has stalled. Some remedies tend to be prescribed with more mental/emotional symptoms, and some with more physical symptoms.
I would guess that Caulophyllum is the most prescribed and self-prescribed remedy for pregnant women. This remedy is often prescribed for women wishing to soften the cervix and initiate labor. The repertory tells us that this remedy is indicated in the woman who is having atonic or weak contractions and whose cervix remains rigid and undilated. Labor may be very slow in progressing when a woman is in a caulophyllum state. Contractions may also slow or stop once labor has been established. This remedy is also useful in cases where women become completely exhausted and their labors slow or stop. With these physical symptoms in mind, this remedy is best used when women are having very long and tiring prodromal labors, where the contractions are ineffective and the cervix remains uneffaced and undilated. She may describe a hot, stitching pain in her cervix. As a clinician who uses homeopathy frequently, my one concern with the prescription of this remedy across the board in a population of women who are post-dates is the idea of a homeopathic proving. In the case of Caulophyllum, if proved, you would see women who have slow labors, a slow to dilate cervix, atonic contractions, and labor that stalls and stops. Caulophyllum is a remedy that should be used when the clinician sees the clear picture of the remedy; it should not be the go-to induction remedy used in all cases.
I include Chamomilla in this list because it is such a dramatic remedy when seen in labor. The essence of Chamomilla is irritation, restlessness and the very strong assertion that the woman cannot bear the pain of her contractions. I find this remedy interesting to work with, because this will be the woman who walks and walks and walks almost frantically between her contractions, but not with the sense of panic that the word “frantic” might bring. Then, this very restless, walking woman will be completely taken over by her contraction and often will loudly verbalize that she cannot do it, that she cannot bear the pain, that it’s too much for her. She also will not want anyone looking at her. However, as soon as the contraction passes, she will come back into herself and begin her walking or pacing again. She does not want to be touched, and is coping just fine with labor except for declaring that the pain is unbearable. Physically, Chamomile women may have a very rigid cervix and may experience the type of contractions described as “hourglass” – contractions that are not coordinated between all layers of muscle in the uterus, and thus are not very productive. Chamomile women will quickly become exhausted from the amount of energy they use due to the restlessness that they experience. This remedy acts very quickly and will help to ground the Chamomile woman, help her cope with her pain more productively and help her to avoid the use of pain medication. Often, one dose is all that is needed to help to get a woman out of this state.
Cimicifuga is another commonly prescribed remedy when preparing for labor and birth. It often is recommended to alternate with Caulophyllum. Again, concerns with proving the remedy are strong, especially with patients who are very sensitive. This remedy seems to have a specific affinity for the cervix. The classical way this remedy is prescribed is as follows: The cervix is rigid, tightly closed and fails to dilate. The pain of contractions can move from side to side and extend to the back, buttocks or thighs. Like Pulsatilla, the Cimicifuga woman’s contractions will stop and bleeding begin. Her hearing will be very acute and she will not be able to tolerate noise. The Cimicifuga woman may be very fearful and feel panicked about labor, especially after a previous negative birth experience. She will also feel that she is going to go insane during her labor and delivery.
The Gelsemium woman will be very fearful. She may describe herself as being paralyzed by fear. Her labor may be late or stalled due to anticipatory anxiety. She may seem heavy lidded, a bit spaced out or not present and timid. The Gelsemium woman’s cervix may be rigid post-dates and not softening, or it may be rigid even with contractions. The Gelsemium picture may also appear in a stalled labor when the cervix is opening wide but contractions simply stop for a long period of time. The Gelsemium woman will describe her contractions as moving from side to side or up her back. Her contractions may be ineffective, described in texts as “flabby” or “weak.” Her contractions may slow or stop in active labor. In very interesting cases, the Gelsemium woman will experience the tightening of her uterus but will describe her contractions as painless.
Other fearful remedies to study include Aconite, Arsenicum, Staphysagria and Phosphorus.
Pulsatilla tends to manifest as a shy type of person, with issues around people attending the birth who she does not want there, as well as fears around birthing alone. Pulsatilla labors may be slow and exhausting, and the Pulsatilla woman may weep from her state of exhaustion. Her contractions may alternate with bleeding, or the contractions may cease and bleeding begin. During pushing, her contractions lack expulsive power. The Pulsatilla woman’s symptoms can be very changeable. She will be hot one moment and cold the next. Pulsatilla women will also feel much better in the fresh, open air, and will be very thirsty. The prescriber will have a sense of the essence of Pulsatilla in the mental/emotional realm the most. Pulsatilla belongs to the sycotic miasm, and therefore needs the company of others for emotional strength. These women will constantly seek reassurance, will not want to be left alone, will require much encouragement and support, will constantly ask if they are doing alright and seek reassurance that they are cared about and supported. Pulsatilla patients can be indecisive, discouraged, weepy and needy, and will emotionally and physically drain those who are supporting them in birth. If you find that you are overwhelmed by how much the lovely, sweet, soft-spoken, shy woman you are supporting is emotionally or physically demanding of you, consider Pulsatilla. The remedy will help to center this woman and allow her to find her core strength.
Lisa Doran, ND believes that birth advocacy has an important role in health promotion and disease prevention. She has worked with birthing families for 18 years as an educator, advocate, doula and ND. Dr. Doran currently co-teaches obstetrics and pediatrics at CCNM, which is where she received her ND degree. She is a clinical supervisor at RSNC-CCNM, and she runs a private practice in Ajax, Ontario. In addition, Dr. Doran is the founder of the Association of Perinatal Naturopathic Doctors. She is the mother of three homebirthed sons, and balances her busy professional life with her joy in mothering, urban farming and celtic-fiddling and fiber arts. Visit www.barefootdoctor.org.