Ways to Induce Labor Part 4: Nipple Stimulation

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Is nipple stimulation an effective way to induce labor? Or will it just give you sore breasts? What does the research say?

Disclaimer: None of these methods should be used unless recommended by your provider, not even the natural methods. “Natural” does not automatically mean risk free. Some common recommendations are evidence based; others are passed on as old wive’s tales and are ineffective or possibly harmful. Normal, low risk pregnancies should not be induced prior to 39 weeks, and ideally not before 41 weeks, without a medical indication. Healthy babies will come when they are ready; taking the baby too soon can result in breathing and feeding difficulties, as well as increase the risk of c-section. Being uncomfortable, having difficulty sleeping, multiple rounds of false labor, or excitement for the baby to come are NOT reasons to induce. That being said, there are times when induction is appropriate, and this decision should be made with your provider.

Nipple stimulation is thought to help induce labor by increasing prostaglandins, a hormone that aids in cervical ripening and helps the body get ready for labor, as well as increasing oxytocin, a hormone that causes uterine contractions and labor. There are not many recent, quality studies to base recommendations on, although it is a common suggestion to get labor started. I was able to find a 2005 Cochrane review of 6 studies on breast stimulation for cervical ripening.

When compared with expectant management, breast stimulation resulted in a significant increase in delivery within 72 hours. In the groups without nipple stimulation, only 6% of women were in labor within 72 hours. 37% of women in the treatment group with nipple stimulation were in labor within 72 hours. However, this only occurred in women with a favorable cervix. If the cervix was unfavorable, nipple stimulation made no difference in labor rates. Nipple stimulation did significantly decrease the risk of postpartum hemorrhage. There were no differences between groups in meconium fluid or c-section rates.

Discussion: Nipple stimulation appears to be an effective method of labor induction for low risk pregnancies. It seems to work a little over a third of the time in patients with a favorable cervix. If your cervix is still closed and thick, nipple stimulation is unlikely to work at inducing labor within 72 hours of starting. In low risk pregnancies, there were no increased risks of c-sections or meconium stained fluids. Nipple stimulation can cause uterine hyperstimulation (contractions that are too frequent) and can stress the baby, resulting in abnormal fetal heart rates that can potentially become an emergency. Because of this, nipple stimulation should only be used in low risk pregnancies, and be done under the supervision of a trained provider. Nipple stimulation is still considered a safe option by ACOG.

There is no standard technique for nipple stimulation. Varney’s, a midwifery textbook, recommends stimulation of 1 nipple for two minutes, resting for 5 minutes, then switching to the other nipple, and repeating. Stop stimulating before the two minutes is up if a contraction occurs, and wait 5 minutes to repeat on the other side. Stop if nipple stimulation has not been successful at causing regular contractions after 1 hour.

Because it is not well studied, and because of the potential for uterine hyperstimulation, please do not attempt nipple stimulation without the direction of your care provider.

One thought on “Ways to Induce Labor Part 4: Nipple Stimulation”

  1. I’m a doula in Chicago, and just last night I witnessed the judicious use of a breast pump to augment/ induce labor in a hospital setting. Patient was held for an induction at forty one weeks 2 days, after baby showed some decels during a check-up. A low dose of pitocin had gotten early labor started, but after a few hours it spaced out. The patient wanted to avoid increasing the dose, to protect her hopes for a physiologic birth with freedom of movement and minimum interventions. Amazing midwife team took her off the pitocin, let her rest, walk around and shower, and borrowed a breast pump from the postpartum unit. They tried ten minutes on each breast, once an hour, with continuious monitering for hyperstimulation. After the second round, labor began in ernest. Pitocin was not restarted, and after five hours of very mobile, instinctive, trance-like unmedicated labor, baby was born healthy and bright eyed and took to the breast. Thanks to all you midwives who safeguard mamas’ hopes for physiologic birth in hospitals!

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