Author: Mary Sauer

What would you do to encourage labor in a pregnancy that has gone past your due date? Would you join your obstetrician in a dance he choreographed specifically to get things moving along?
As a mom who has always carried pregnancies past their expected due date, I understand the desperation that drives attempts to induce labor. I’ve walked miles a day during my last weeks of pregnancy; I’ve bounced endlessly on an exercise ball; during my last pregnancy, I even turned to the breast pump. And still, I carried late, leaving me doubting that there is any validity to labor-inducing methods.

During my last pregnancy, I found myself four days overdue and searching for options. Nothing I found was convincing, but that didn’t mean I wasn’t willing to try out the suggestions of friends and family (just so long as they weren’t risky). And believe me, there were plenty of anecdotes out there.

The Baby Dance

One obstetrician, Fernando Guedes da Cunha, has achieved internet fame for his unusual approach to encouraging labor—he’s choreographing dances for his patients. In August 2017, he posted a video to his social media featuring one of these dances. Soon after, he shared a picture of the mother with her brand new baby. Since then, his video has been shared hundreds of thousands of times.
https://www.instagram.com/p/BXgG3NfDEPN/?hl=en&taken-by=drfernandoguedescunha
I’m having a hard time imagining myself dancing during labor—and there is no proof it will actually induce labor—but keeping moving is can certainly be beneficial to labor and pregnancy.
“I am not aware of any scientific article or properly done research to show that walking in labor—or in this case, dancing—would stimulate labor to make it faster,” shares Daniel Roshan, OB-GYN, “However, I always tell my patients that in the absence of any high-risk issues, the best [option] is to keep moving and walking before they get admitted. I think it eases the pain of labor and prevents the complications that arise from staying in bed.”

Roshan explained that patients who get admitted in early labor will frequently request an epidural and spend a lot of their labor in bed. In some cases, these patients experience a drop of in their blood pressure or fetal heart deceleration.
In fact, it’s good to keep moving throughout the pregnancy, according to Roshan, who said that all women experiencing a complication-free pregnancy should stay home as long as possible and continue moving until they are in the active labor phase. Yet while these recommendations are great for a comfortable and healthy pregnancy and labor, they’re aren’t actually known to induce or encourage labor.

“A lot of times, a woman’s body can be already starting to move into it,” Bailey Gaddis, birth doula and childbirth preparation educator, tells HealthyWay. “The things you hear about food, walking, that can all definitely help…if your body and your baby are ready.”
This is where a lot of confusion exists, and it’s important to understand that encouraging and supporting your body once it is ready for labor is vastly different from trying to get labor started.

It’s difficult to declare the efficacy of one method over the other, simply because it’s difficult to determine if induction attempts really made a difference or if your body was simply ready to get things going. There are, however, a litany of methods that claim to help get things going.

Methods That (Might) Encourage Labor

When it comes down to it, the only scientifically supported method for inducing labor is a medical induction. This is why, when it is medically necessary, most Ob-Gyns fall back on the same song and dance.
The often use dinoprostone (brand name Cervidil), a cervical ripening agent, as a first effort to begin labor. In many cases, oxytocin is then administered after the cervix is ripe to encourage contractions. It is widely effective and safe, according to a survey published in the journal American Family Physician.

Not all mothers want to use medications to induce or encourage labor, and they’ll fall back on more “natural methods” to get things started. Unfortunately, there is a lot of contracting studies on the topic.
For instance, one method that is practiced intermittently by birth professionals is membrane sweeping. Using their gloved fingers, a birth provider gently separates the bag of waters from the uterus. Although this method is widely regarded as safe, there is some disagreement on its effectiveness.

One 2012 study published in The Journal of Clinical Gynecology and Obstetrics found a decreased need for medical induction in women who employed membrane sweeping compared to those who did not. However, ten years earlier, a study in The International Journal of Obstetrics and Gynecology declared the practice “safe but ineffective,” and in 2005, a study published by Cochrane did the same.

Because of the safety of the procedure, some women may choose to take the gamble, but they should keep in mind that it is an uncomfortable process and this method has its limitations. It isn’t a good option for women who have an increased risk of infection. Also, a woman’s body still needs to be ready for labor for membrane sweeping to be an option.
“In order to do it, the cervix has to be dilated and effaced,” explains Roshan. “It could be a good choice for patients who had a vaginal birth before and will need to be induced due to their pregnancy conditions.”

Another method worth trying is nipple stimulation using a breast pump. Nipple stimulation is said to encourage contractions and is often used to attempt to speed up labor. A research survey published by the journal BMC Pregnancy and Childbirth found this practice to be safe. Additionally, they found that women who employed this method at full term were less likely to remain pregnant after 72 hours.

Methods That Don’t Work

Pregnancy is long enough without carrying past the expected due date, pushing many women (including myself!) to try any safe method for getting contractions started. Unfortunately, most of the common methods employed have very little grounding—including those recommended off the cuff by many doctors.
For instance, women are often instructed by their doctors, friends, and family to enjoy intercourse often to induce labor. This belief is based in the idea that semen contains prostaglandin, which is used in medical settings to induce labor. However, there is no research that indicates semen has the same effect on women.

A study published by the journal BMC Pregnancy and Childbirth concluded that, although perfectly safe in low-risk pregnancies, intercourse did nothing to speed things up. The following year, a study published in the journal BJOG found no difference in induction rates between women who were and weren’t advised to be physically intimate with their partners.
That being said, Roshan does believe that regular physical intimacy is beneficial to pregnant women, saying that frequency appears to lower the risk of lacerations and generally improve the labor experience.

There are a lot of anecdotes about specific labor-encouraging foods, but there isn’t any evidence to back up these claims. In fact, practices like indulging in spicy foods can only make mom miserable, causing heartburn and an upset stomach, according to Roshan.

Lastly, we have the famous suggestion of taking a small dose of castor oil to start contractions. This method may “work” in the sense that it can cause contractions, but that doesn’t make it a safe choice.
“[Ingesting castor oil] leads to bad diarrhea and dehydration and uterine contractions. I believe the contractions are mostly due to dehydration …  [This] method, although it will bring patients to hospital … does not cause real labor.”

The Truth About Inducing Labor

Ultimately, labor induction is something that moms should discuss with their care providers. Personally, by the time my third due date approached, I found myself resigned to the fact that carrying late was just something my body did.
I talked it through with my care provider, and they suggested I have something called a biophysical profile: a detailed evaluation that estimates the baby’s size and measures the fluid in the womb. After assessing the results, they scheduled a medical induction for the following week, but I went into labor after having my membranes swept. I found myself in the hospital with my amniotic sack leaking but needing oxytocin to get contractions started.

It was a hard labor and an experience I likely won’t repeat again. If there is another baby in my future, I’ll probably just let nature run its course.
If, like me, you find yourself experience a pregnancy that continues past 40 weeks, there is one thing Gaddis recommended you can do that will certainly help: Relax! Becoming consumed and anxious about giving birth can rob you of the joy of those final days with your partner and other children before your new baby arrives.

There really is nothing quite as joy-inducing as the sound of giggling toddlers, and there is no better way to burn off a little energy before bedtime than running around the house. For these reasons, it seems like every family has some version of “tickle monster” they play with their kids. They chase their kids around the house, tackle them, and then tickle them until they scream.
My family plays it, too. Honestly, it has never crossed my mind to question this tradition. My kids laugh ferociously every time we tickle them. Recently, however, I came across research on the science of tickling. 

The main findings of this research, which was conducted in 1997 by the University of California, San Diego (UCSD), is that humorous laughter and ticklish laughter share some similarities but don’t share the same psychological experience. Specifically, humorous laughter indicates enjoyment, and ticklish laughter does not.

Tickling: Fun or Torture?

There are big differences between our experiences when we are exposed to something funny and when we are being tickled.
Let’s get the similarities out of the way. The UCSD study (where college-aged test subjects watched something mundane, something funny, and were tickled, all in various orders) found that laughing at humor and laughing at tickling have a positive correlation—people who laugh a lot at humor tend to be more ticklish. This, in part, is what the researchers were trying to find out.

Yet beyond that, the similarities stop. In this study, multiple tests were conducted to examine the relationship between tickling and humorous laughter. What was most interesting (or perhaps obvious) about the results was the revelation that laughing at tickling doesn’t mean the tickle-subject is enjoying the experience.
“Despite agreeing to participate in a tickle study and despite smiling and laughing, most reported that they did not find the experience at all positive,” the researchers wrote. One study participant said she felt like she was being tortured while being tickled, even though she laughed a lot.

The researchers proved this point by measuring the effect of being tickled on the participants’ response to humor. The idea was that, if tickling was truly enjoyable, the participants would laugh more at comedy after being tickled—research shows, after all, that people tend to laugh more at a new humor stimulus if they’ve recently been laughing. They’re already giddy; it’s like they’re primed to crack up at the next funny thing.
This wasn’t the effect tickling had on the participants, however. The people who had been tickled and then exposed to Saturday Night Live didn’t laugh any harder than those who had not been tickled.

“The present results are consistent with tickle and humour responses sharing a final common motor-response pathway, without sharing the same psychological state,” the researchers wrote.
When you really think about it, it makes sense that tickling isn’t all fun and games. It’s easy for laughter to turn into tears after just a few minutes of tickling. There are also stories of young kids enduring “tickle torture.” One mom wrote into The Washington Post asking how to deal with her young child who had begun to dread being alone with his cousins for that reason.

Since then, there hasn’t been a lot of additional research on tickling. Harris, one of the original researchers from the 1997 study, has published followup literature on the topic. Specifically, in 2012 he wrote about the differences between smiling and laughing when amused and smiling and laugh when tickled. Published in The Encyclopedia of Human Behavior, he noted that a smile doesn’t always indicate a positive affect. However, he did clarify that he believes there is evidence that tickling can be enjoyed based on the environment and the relationship between the tickler and the person being tickled.
This brings up interesting questions regarding the prevalence of tickling in parent and child relationships. Should parents banish the tickle monster from their home? Or, because of the trust in the relationship, is tickling fair game?

Picking Up on Your Kid’s Cues

The truth is, it probably isn’t necessary to ban tickling from your home. It is important, however, to think twice before engaging in tickle play. It’s easy to assume that everyone involved is having fun, but parents should pay close attention to their child’s cues. As Jennifer Lehr wrote in Scary Mommy, parents who tickle their kids need to have “ground rules” in place to guide this type of play.
“Follow your child’s lead,” suggests Fran Walfish, PsyD, a Beverly Hills-based family and relationship therapist. “Some kids enjoy tickling while others find it painful. Know your child individually and intimately. Always give affection so that it feels good to both of you, not just the loving parent.”

Children who aren’t enjoying being tickled may be laughing, but they’ll often say “Stop!” or try to escape your grasp. In our family, for instance, we have one little one who yells “Stop!” before coming back for more. In light of what I know now about tickling, we’ve started asking her if she really wants to be tickled before we play tickle monster again. Usually, she says yes. Sometimes, she says no. We honor what she says because we don’t want to risk sending the wrong message.

According to Harris’ research, “A combination of thrill-seeking and pleasure in tactile contact might lead children to seek out what is still an intrinsically aversive situation.” Communication will help you and your child determine just how thrilling—and aversive—tickling is.
In general, Mayra Mendez, PhD, a licensed marriage and family therapist at Providence Saint John’s Child and Family Development Center in Santa Monica, California, believes that parents should allow children to set their own boundaries.

“Smiling or laughing because you’re getting tickled doesn’t mean you’re enjoying it,” she says. “These are sensorial reactions that may not be matching the emotional experience.”
This applies to games like tickle monster, says Mendez, but also to any situation that involves touch, including affectionate actions like hugs and kisses.

This is why it is important for parents to be watching for subtle cues from their children. Some children may ask you to stop or pull away, but others might not be so obvious. Flinching at your touch or grimacing between laughs are examples of more subtle cues that they’re not enjoying the tickling, says Mendez.

Are parents sending kids a mixed message?

In light of recent events, the topic of consent is getting a lot of attention in our culture. Now more than ever, parents are concerned with making sure their children understand that they are in charge of their body and can say no. They’re also having conversations about respecting consent, trying to teach their children to respect any no they hear from friends or family members.
In our family, we’ve been considering how important it is that our actions align with the things we say. We can tell our kids, “It’s your body,” but what message are we sending if we tickle them after they’ve said stop? Or if we pull them in for a hug or kiss when they try to wiggle away? We want to be certain we aren’t just preaching consent. We want to model it at home, too.

As parents, it’s easy to feel like we are the exception to rules about consent. It’s easy to feel that, as their mother or father, we get to smother them with kisses or tickle them whenever we please—that we don’t need our child’s permission to show them affection. The fact of the matter is that this mindset sends mixed messages to our children, says Mendez, who believes that parents need to consider how their actions align with their lessons about boundaries to their kids.
“Parents or caregivers as a whole have a tremendous power over young children,” she says. “Young children rely on learning about social cues, … what is acceptable, and … how to react to social messages from their caregivers.”

Because of this, she says it’s important that parents act in a way that is consistent with what they say to their children. Children will learn more from their emotional experiences than the words their parents say. Pushing, tickling, or hugging resistant children only sends the message that they can’t trust their own instincts. It communicates to children that they can’t trust themselves to decide what they do and don’t feel comfortable with.

What happens at home matters.

It’s important for parents to remember that their children trust them more than anyone. The way parents behave will ultimately influence how they respond to their friends or to strangers.
“If a child really isn’t comfortable with something, and the parent is still doing this action, that is sending the message that it’s okay,” says Mendez. This is confusing, and kids can’t discriminate between a parent who doesn’t respect their boundaries and a family member or stranger who pushes them to do something they’re not comfortable with.

These experiences that children have early in life have a huge impact on how they interact with others and the boundaries they set for themselves. Ultimately, parents need to respect those boundaries. They need to teach their children that they can trust themselves to decide what they are and aren’t okay with; they need to teach them that it’s okay to say no to the things they don’t enjoy. The lessons we teach our children will become the foundations for their interactions later in life.

The first time someone in my family suggested I should give my second baby a bottle, I took it personally. My baby wasn’t sleeping much at night, so I found myself breastfeeding around the clock. I had brought it up not because I was looking for advice, but because I just wanted to vent about how desperately tired I was.
“Maybe she’s hungry,” they suggested to me casually. My stomach dropped when they said it. How dare they suggest I’m not doing a good job feeding my baby. I, somewhat shortly, told them I didn’t see any reason to switch to formula and ended the conversation.
Since then, I’ve heard that advice more times than I can count. Although I have come to accept that my babies just don’t seem to sleep soundly, there have been people in my life who have felt like it was breastfeeding that was the problem. They seemed to believe that if I really wanted to get more sleep, I needed to give up on breastfeeding altogether.
Breastfeeding is an interesting experience in that it is so different from mom to mom, child to child. Despite the ample amount of information on the internet, there are a lot of misconceptions about the practice that are still hanging on for dear life. Some believe that breastfeeding moms don’t sleep, while others believe that breastfeeding is the only option. Let’s clear up these myths once and for all.

Myth: Breastfed babies don’t sleep.

As it turns out, this commonly-held belief about breastfeeding is a big misunderstanding. Moms who choose to nurse their baby don’t actually sleep a lot less—they actually sleep more than moms who formula-feed, according to a study published in The Journal of Perinatal & Neonatal Nursing.
“Breast milk is perfectly designed for our babies,” explains Angela Dietrich-Kusch, MD, pediatric hospitalist with Riley Children’s Health. “Because it is more easily digested, it does tend to pass through their system more quickly.”

Additionally, breastfed babies are less likely to overeat since it takes more effort to drink milk from a breast than it does a bottle. However, Dietrich-Kusch was quick to express that a soundly sleeping baby is overvalued in our culture.
“The issue there is that we know from the research on sudden infant death syndrome that sleeping more soundly does not equal sleeping safely,” she explains, referring to the numerous studies that have found an increased risk of SIDS associated with formula-feeding babies, as shown in a review published in Reviews in Obstetrics & Gynecology.

Myth: Breastfeeding comes naturally.

While it may be true that breastfeeding is “natural,” that doesn’t mean it just comes naturally to new moms and their babies. When I ask my friends about their breastfeeding experience, I hear the same answer from four different moms. They all tell me it was so much harder than they expected.

“Do not deny that breastfeeding is difficult and try to sell ‘easy’. Embrace the difficult – show women the personal pride and sense of accomplishment that comes from breastfeeding, just like running a marathon or scaling a mountain.” @iamKSealsAllers

— Emma Pickett (@makesmilk) February 25, 2018

“I was shell-shocked by how hard it was the first time,” shares Becky Wilson Berezoski, mom of four. “How completely dependent my baby was going to be on me, how overwhelmed I would feel being his only source of food, and how physically and emotionally taxing it would be.”
According to Rachel Borton, MSN, FNP-BC, the director of the Family Nurse Practitioner program in the Bradley University Department of Nursing, it’s uncommon for a new mom to breastfeed without facing a single challenge. Most moms experience some discomfort, their baby has difficulty latching, or mom feels like her milk is slow to come in.
“It’s not insurmountable,” she says. “You have to consistently try the same things everyday; you’re breastfeeding every three to four hours, it’s a lot of work.”

Myth: Breast size matters.

Some women may find themselves concerned that their small breasts will prevent them from producing enough milk for the baby. Breast size doesn’t influence milk production, according to Dietrich-Kusch, who said she does hear this concern from new moms in her clinical work.

“They may worry about whether or not they’re going to have the ability to make breastmilk,” she says. “Our mammary glands are not dependent on the overall size of our breasts, so that’s kind of an individual thing.”
Although it is true that milk storage capacity varies from mom to mom, storage capacity doesn’t determine if a mom is able to breastfeed. Instead, it may simply influence how often she breastfeeds, according to breastfeeding resource KellyMom.

Myth: There’s a magic pill to increase milk supply.

When a baby is depending on you as their source of food, it is easy to get caught up in concerns that you are not making enough milk. Because of this, it is fairly common for moms to search social media support groups looking for a magic pill or simple strategy for increasing their milk supply.
The issue with this is that there isn’t any clear research that there is any one thing you can eat or drink that will help you produce more milk. In fact, there simply isn’t research at all.

“Studies like that are hard to do. You’re exposing the infant to something they wouldn’t otherwise be exposed to. It’s hard to convince people to buy into doing studies like it,” explains Dietrich-Kusch. “Certainly, we know that things like fenugreek, the supplements they sell, they’re not harmful to babies.”
https://twitter.com/morganburby/status/965794469458067457
Outside of knowing they’re not harmful, Dietrich-Kusch simply doesn’t believe there is enough information out there to determine if milk-boosting supplements will work. One review published by The Annals of Pharmacotherapy confirmed her assertion, saying that evidence is lacking on the topic of galactogogues and breast milk production.
https://twitter.com/heartsleeve/status/969617571728281601
Although she doesn’t discourage her patients from trying, she always advises them to rely on the one method that is proven to work—breastfeeding more often and for longer periods of time. Breast milk production is a supply and demand relationship, the more a baby stimulates the breast, the more milk the mother will produce.

Myth: Breastfeeding always hurts.

When it comes to [linkbuilder id=”3228″ text=”breastfeeding myths”] that won’t go away, this just might be the most difficult-to-dispel myth out there. Nearly every mom I asked about their breastfeeding experience says she experienced a lot of pain. I hear it described as “toe-curling,” while other moms say they were in tears every time their baby nursed.

But when I follow up with experts, they say this type of pain shouldn’t be seen as normal. What is normal is to feel some discomfort during the first couple of weeks.
“That has to to do with the latch,” explains G. Thomas Ruiz, MD, OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. “If the baby is latched properly, initially you might get uncomfortable because your nipple is not used to the breastfeeding … so you kind of get a lot of nipple chafing and dryness.”

I breastfed Mia for about a year and 4 months and she had plenty of teeth and it was never painful… I know what people are going to think, every kid is different, but believe me it is NOT supposed to hurt.

— Jfabstyles (@jfabstyles) February 6, 2018

Most moms will also experience pressure when their breasts become engorged, according to Borton, who clarifies that it is a tight pressure in both breasts that can be relieved by breastfeeding, not a stabbing pain.
On the other hand, if the mother is actually in severe pain, her nipples are bleeding or scabbing, or she has very localized pain, something isn’t right.
https://twitter.com/lizfrmtheles/status/954370920767991808
“As opposed to pain, which can either be pain from the baby latching improperly versus pain that can occur from infection due to mastitis,” says Ruiz, who advises moms experiencing redness, pain, or tenderness to see a lactation consultant for advice.

Myth: Bottle feeding causes nipple confusion.

Many moms hold off on introducing a bottle or a pacifier because of the fear of nipple confusion. It isn’t quite accurate to call this is myth since it is more of a misunderstanding.
First and foremost, it’s important to understand just how difficult it is to provide a black and white answer to this concern.

“Every single baby and mom are different,” explains Dietrich-Kusch. “We know that there are some babies that can go seamlessly between artificial nipples and breastfeeding without seemingly any issue, while others will prefer one over the other.”
Secondly, it is important to know that bottle feeding and breastfeeding don’t have to be mutually exclusive. Moms just need to be smart about how they proceed. Artificial nipples can allow babies to eat with less effort, since the milk flows more quickly. International Board Certified Lactation Consultant Leigh Anne O’Connor advises moms who would like to introduce a bottle to make sure the breast is still being stimulated often to encourage continued milk production. Additionally, she suggests using bottles that have a slow flow nipple, which is typically clearly labeled on the bottle packaging.

“You’re unable to predict by looking at a baby what that baby’s preference is going to be,” says Dietrich-Kusch. “Certainly, waiting to introduce artificial nipples until breastfeeding is established seems to be the key. Once breastfeeding is established, typically anywhere between three to six weeks of life, it’s okay to at least try to see how they will do.”

Myth: Breastfeeding is the only option.

“I had to supplement early on with all my babies because they lost too much weight and were at risk of failure to thrive,” mom of four Katie Fazio shares with HealthWay. “It broke my heart, and I felt like failure as a woman and like I didn’t deserve my babies.”
Fazio’s story is a common one: Mom tries to breastfeed, mom can’t breastfeed either because she has a low milk supply or because she isn’t able to maintain her milk supply because of her lifestyle, and then mom feels really, really guilty. Although it is certainly true that breastfeeding is perfectly designed nutrition for babies, it is not the only acceptable option for babies.

It is important that moms don’t get too caught up in the myth that formula is not an acceptable alternative to breastfeeding.
Newer research published in Maternal & Child Nutrition focused on formula-feeding mothers found that, because of negative emotions associated with formula feeding, many mothers who make this choice experience decreased emotional well-being.

Ultimately, it is most important that the baby is well-fed and the mother is taken care of, making it incredibly important that mothers are supported in their decision to breastfeed or formula-feed and that they are given the information needed to dispel the most common myths about infant feeding.
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