The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Philosophy and Technique of non-Pharmaceutical Induction

I've had several people ask me what my alternatives to castor oil induction were since I had said it wasn't my favorite way....so here goes:

First of all, I seldom induce labor. I find that induced labors are harder, whether you use castor oil, pitocin, ROM, etc. If the body isn't ready to go into labor on its own, then forcing it to go into labor is not going to be easy. I find it very hypocritical for a midwife to slam doctors for inducing labor with pitocin and ROM, which is usually painful but fast and then turn around and induce labor using ineffective methods like castor oil which are still painful but SLOW!!!

Reasons I don't like castor oil:

1. It's awful to get down. Most moms gag and/or vomit.
2. It's awful to get out. Having a red, burning butthole is not what I would want to deal with while trying to deliver a baby.
3. It's hard to control where the contaminated oil and loose feces coming from the anus goes during labor and while the baby is being born. I feel this is a very vital problem if there is PROM. I NEVER suggest castor oil if there is any question of ROM.
4. If it doesn't work, the mother still has to go through hours of serious cramping and discomfort. I always worry that if after the poor mom has gone through the whole day with cramps, contractions and sitting on the toilet, when she finally does go into labor and she is now too exhausted and wiped out to handle labor well.
5. If it doesn't work (and it frequently doesn't) the dad has taken a day off work and is a little upset about that and mentally the mom feels like a failure. She now feels like not only couldn't she get into labor on her own, but now she can't even do it with help.
6. As a midwife I dislike the extra time and energy that inducing takes. A doctor or hospital midwife (I know there are midwives who don't practice this way so please no hate mail!) can leave the induction and waiting to the hospital nurses, but OOH midwives need to be in very close contact with someone who is taking castor oil. I've seen castor oil start labor within a few hours and I've also seen it take over 24 hours and during that 24 hours the mom is miserable and needs a lot of attention. She is nervous, can't tell the difference between labor and cramping, and is afraid you won't make it because she won't be able to tell when it's real labor......so the midwife ends up going back and forth a few times to check her and reassure her. By the time the mother needs normal labor help the midwife and all the support people are exhausted.

I prefer that all inductions start early in the morning and stopped at bedtime...even if the mom has to take a bath or a glass of wine.

1. Stripping the membranes. I will do this more than once if needed.
2. Golden seal tincture and Matrigin. I have the mother take these alternately every 15 minutes for an hour and then every 30-60 minutes until labor is well established or bedtime. I have used Matrigin vaginally also with some success.
3. Nipple stimulation. I prefer that the women use an artificial means of stimulation such as a breast pump. Doing it to yourself or having your husband do it, just doesn't work as well.
4. If no sign of ROM, castor oil.
5. ROM. I only use this if the woman has had a previous normal labor and vaginal birth, and she is at least 4 cm dilated and desperate!!! I've only done this three times...twice on the same woman who had been 6-7 cm. for over a week and one woman who was 5 cm. and who felt she would only go into labor if I AROM’ed her like her doctor had always done at that point....she had the baby a couple of hours later!