Q & A Video: Breast stimulation to naturally induce labor

Today’s video is all about the evidence on using breast stimulation to naturally induce labor. You can read our disclaimer and terms of use.

In this video, you will learn:

  • What studies have been done on breast stimulation as a cervical ripening and induction agent and if it was found to be effective
  • What studies have been done on breast stimulation as a means of augmenting labor and if it was found to be effective
  • If breast stimulation to start or augment labor is safe

Links and resources:

  • Adewole, I. F., et al. (1993). “Cervical ripening and induction of labour by breast stimulation.” Afr J Med Med Sci 22(4): 81-85.
  • Chayen, B., et al. (1986). “Induction of labor with an electric breast pump.” J Reprod Med 31(2): 116-118.
  • Curtis, P. (1999). “Breast stimulation to augment labor: history, mystery, and culture.” Birth 26(2): 123-126.
  • Curtis, P., et al. (1999). “A comparison of breast stimulation and intravenous oxytocin for the augmentation of labor.” Birth 26(2): 115-122.
  • Demirel, G. and H. Guler (2015). “The Effect of Uterine and Nipple Stimulation on Induction With Oxytocin and the Labor Process.” Worldviews Evid Based Nurs 12(5): 273-280.
  • Elliott, J. P. and J. F. Flaherty (1984). “The use of breast stimulation to prevent postdate pregnancy.” Am J Obstet Gynecol 149(6): 628-632.
  • Kavanagh, J., et al. (2005). “Breast stimulation for cervical ripening and induction of labour.” Cochrane Database Syst Rev(3): CD003392.
  • Narasimhulu, D. M. and L. Zhu (2015). “Uterine Tachysystole with Prolonged Deceleration Following Nipple Stimulation for Labor Augmentation.” Kathmandu Univ Med J (KUMJ) 13(51): 268-270.
  • Razgaitis, E. J. and A. N. Lyvers (2010). “Management of protracted active labor with nipple stimulation: a viable tool for midwives?” J Midwifery Womens Health 55(1): 65-69.
  • Salmon, Y. M., et al. (1986). “Cervical ripening by breast stimulation.” Obstet Gynecol 67(1): 21-24.
  • Schellpfeffer, M. A., et al. (1985). “Antepartal uterine hypercontractility secondary to nipple stimulation.” Obstet Gynecol 65(4): 588-591.
  • Singh, N., et al. (2014). “Breast stimulation in low-risk primigravidas at term: does it aid in spontaneous onset of labour and vaginal delivery? A pilot study.” Biomed Res Int 2014: 695037.
  • Stein, J. L., et al. (1990). “Nipple stimulation for labor augmentation.” J Reprod Med 35(7): 710-714.
  • Viegas, O. A., et al. (1984). “Nipple stimulation in late pregnancy causing uterine hyperstimulation and profound fetal bradycardia.” Br J Obstet Gynaecol 91(4): 364-366.
  • Enjoy the video on using breast stimulation to naturally induce labor, and I hope you find it helpful! Stay tuned for our next Q & A!

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Transcript

Hi, my name is Rebecca Dekker and I’m a nurse with my Ph.D. and the founder of Evidence Based Birth®. In today’s video, we’re going to talk about if breast stimulation is an effective way to naturally induce labor.

In today’s video, we’re going to talk about breast stimulation and if it can be used to naturally induce labor. Breast stimulation causes the release of the hormone oxytocin from the pituitary gland in your brain. This can lead to the ripening of the cervix and uterine contractions. The practice of breast stimulation to induce or augment or increase labor has been reported in the medical literature since the 1700s. There is no standard definition of breast stimulation, so the technique and timing varies from study to study.

In 2005, a Cochrane review looked at breast stimulation for cervical ripening and induction of labor. This induction method, they said, has the advantage of being inexpensive, non-medical and it gives women more control over the induction process. The review included six trials involving 719 people who were recommended for a labor induction. In every study, the women performed self breast and nipple stimulation, stimulating one breast at a time. The amount of time spent stimulating the breasts varied between studies. In one study, the stimulation was done with the use of a breast pump instead of hand massage. Within 72 hours, more people in the breast stimulation group had gone into labor compared to those who were assigned to not use breast stimulation. About 37% of the breast stimulation group was in labor within 72 hours, compared to only 6% of the group that did not receive breast stimulation. However, this result was not significant if you had an unripe or unfavorable cervix, so in other words, the intervention only seemed to work in women who already had a ripe cervix.

The Cochrane reviewers also found a major decrease in the rate of postpartum hemorrhage. Only 0.7% of the breast stimulation group had a postpartum hemorrhage compared to 6% of the group that received no intervention. There were no differences between groups in the rate of Cesareans or meconium staining and no cases of uterine hyperstimulation. Uterine hyperstimulation is when the uterus contracts too frequently or too long, which can lead to a decreased blood supply to the baby. When the Cochrane reviewers compared breast stimulation to pitocin or oxytocin by itself, they did not detect any differences in the Cesarean rate and the number of people who went into labor within 72 hours or meconium staining.

The authors concluded that breast stimulation seems beneficial at inducing labor in women at term who have a favorable or ripe cervix, and it also seems to be beneficial at reducing the rate of postpartum hemorrhage. However, they recommended that it should not be used in high risk women until safety in that population has been further studied.

Since that Cochrane review was published, there have been at least two more randomized trials where they randomly assigned women to either breast stimulation or not. There was one randomized trial in India where they looked to see if breast stimulation could help first time moms who are low risk achieve spontaneous labor and vaginal births. 100 participants were shown a video and advised to perform breast massage starting at 38 weeks, and the other 100 participants did not get this intervention. They looked at the ripeness of the cervix at 38 weeks and at 39 weeks and they found that the Bishop’s score that measures cervical ripeness changed significantly after one week in the breast stimulation group but not in the control group. The breast stimulation group also went into labor and had fewer Cesareans. Their Cesarean rate was 8% versus 20%. They also reported that 92% of women in the breast stimulation group reported satisfaction with this induction method.

In 2015, researchers from Turkey published results from a randomized trial that they did where they assigned 390 people in labor to either nipple stimulation, which happened for about 45 minutes, once every 30 minutes during early labor or uterine stimulation, where they kind of use the hand to kind of let you rub the abdomen or control group that got nothing. They found that both the nipple stimulation group and the uterine stimulation group had shorter labors than the control group. There’s also a significant decrease in the Cesarean rate with none of the people in the nipple stimulation having a Cesarean versus 8.5% of people in the control group.

The control group was also more likely to need augmentation with Pitocin.

I was able to find at least three case reports that talked about the potential harms of using breast stimulation during labor or to induce labor. We talked a little bit earlier about uterine hyperstimulation. There have been several case studies where people who are pregnant and were doing this nipple stimulation to induce labor or to induce contractions had problems with the fetal heart rate after their uterus contracted too frequently or for too long.

Researchers think that because the amount of oxytocin that is released when you stimulate the breast is not controlled, there is a risk of overstimulating the uterus, which could decrease the blood supply to the baby. In summary, the available evidence does support breast stimulation as a non-medicine or a non-pharmacological way to improve the ripening of your cervix, start labor and reduce rates of postpartum hemorrhage, and in the large randomized trials, we did not see any adverse effects. However, there are some case reports that did warn of uterine hyperstimulation after breast stimulation and women should be counseled of this risk by their healthcare providers if their providers are recommending breast stimulation.

If a mother is using breast stimulation to augment labor, it is probably best if the laboring person is with a care provider who can monitor the uterine activity and look out for any potential fetal heart rate problems as needed. A variety of techniques are described in the research evidence but researchers consistently recommend that women focus only on one breast at a time and include rest intervals. Researchers seem to agree that people who have high risk pregnancies should not use breast stimulation to induce labor until there’s more evidence that it’s safe in this population. Since this seems to be a pretty effective way to induce labor, it seems only right that someone should probably be talking with their care provider about if they’re going to be doing this so that they can get their care provider’s advice for their specific situation.

That’s it for this video. Thanks, I’ll see you another time.

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