How long does nipple stimulation take

In the end, I went almost a week late—barely avoiding a medical induction—and only after having my membranes swept twice. At my 39 weeks appointment for my second pregnancy, my OB predicted that I would again go a week late. The only thing I was, it seemed, was deeply disappointed. But this time around I had done research on natural methods of inducing labor. That weekend, I pulled my breastpump out of the closet, sterilized my nipple shields, plopped them on, and sat down to pump for a couple of hours while watching a movie.

In my efforts to bring on labor, I am hardly alone. The grand irony here is that nipple stimulation, the least common approach, is the only one with solid scientific support. Using nipple stimulation to bring on labor has a long history. Midwives in the 18th and 19th centuries used the practice to speed up stalled labors. Nipple stimulation brings on labor by releasing oxytocin , the hormone that causes contractions. Hospitals use a synthetic version of the same hormone, pitocin, to induce or augment a stalled labor.

A meta-analysis of six randomized control trials the gold standard for medical studies found that nipple stimulation increases the likelihood of labor. A total of pregnant women at term were randomly assigned to stimulate their nipples for several hours or not. This difference, large in relative terms, was statistically significant.

Still, two-thirds of women failed to go into labor even after nipple stimulation—underscoring that the method is no guarantee of labor. Note to the do-it-yourselfers or those fearful of accidentally inducing labor: Nipple stimulation in these studies did not consist of a few random suckles, squeezes, or tugs. It was a serious, concerted effort. Women were instructed to gently stimulate one nipple for 10—15 minutes before switching to the other side, and to continue alternating between breasts for an hour, 3 times a day.

Using nipple stimulation for inducing labor would probably be a more widely known and recommended practice were there not concerns about its safety. One of the studies in the meta-analysis , conducted with high-risk women delivering at a hospital in India, was stopped early because of 4 fetal deaths: 3 in the nipple stimulation group, and 1 in the oxytocin induction group.

None of the other 5 studies reported any deaths. Because of this, the meta-analysis concludes:. The women in the Indian study were considered high risk because they had intrauterine growth retardation, high blood pressure, or were post-term. But the researchers failed to report which of these risk factors was associated with fetal death, or to provide any additional details about these deaths, other than to say one of fetuses lost did not appear to have any congenital abnormalities.

That nipple stimulation contributed to these deaths is certainly plausible. Nipple stimulation can result in uterine hyperstimulation —contractions that are too frequent or prolonged, and which can lead to fetal distress. This is why women are often told to alternate between breasts instead of stimulating both nipples simultaneously and to pause during contractions. Based on this, the authors caution against using nipple stimulation without medical supervision:. Due to the conflicting reports in the literature and because of the potential hazards involved, the use of nipple stimulation for the induction of uterine contractions can be advocated only in a controlled clinical setting.

Its application without medical supervision, as propagated in the lay press, is definitely contraindicated. In sum: nipple stimulation does increase the likelihood of going into labor. But because it can cause contractions that are too long or too intense, it is not recommended for women with high-risk pregnancies.

Below is a quick rundown on the evidence or really, lack thereof for other natural induction methods:. Walking is the most recommended and most commonly attempted method of inducing labor. It is true that in late pregnancy, walking seems to increase the frequency and strength of Braxton Hicks contractions.

There is no evidence, though, that walking speeds the onset of labor. Eating spicy foods. There is no evidence that spicy foods cause labor. Because of the inconsistent results and methods the type of acupuncture varied between studies , the reviewers felt no conclusions could be drawn without additional research. Sixteen low-risk pregnant women between 38 and 40 weeks of gestation with cephalic presentation participated. They performed breast stimulation for 3 days with an attendant midwife in a single maternity hospital.

Each breast was stimulated for 15 minutes for a total of 1 hour per day. Saliva was collected 10 minutes before the intervention and 15, 30, 60, 75, and 90 minutes after the intervention, yielding 18 samples per woman. Among a total of saliva samples from the 16 participants, OT level was measured in samples missing rate: The median OT level showed the highest values on day 3 of the breast stimulation, with a marked increase 30 min after the intervention.

In the mixed models after multiple imputation for missing data, the OT level on the first day of intervention was significantly lower than that on the third day of intervention. Uterine hyperstimulation was not observed. Following a 3-day breast stimulation protocol for spontaneous onset of labor, the mean OT level showed the highest values on day 3.

The breast stimulation intervention protocol showed good feasibility in terms of practicality and acceptability among the pregnant women. Oxytocin OT infusion is one of the most commonly used techniques for labor induction to avoid increased maternal and fetal risks beyond term [ 1 ]. However, labor induction is a relevant negative birth experience for women [ 2 , 3 ]. There is also speculation regarding the possible association between the use of synthetic OT and the development of autism, although no definite conclusion has been reached regarding the long-term adverse events of synthetic OT [ 4 , 5 ].

The effects of complementary and alternative medicine on labor induction are expected during membrane sweeping and breast stimulation [ 7 , 8 ]. In particular, breast stimulation has historically been used to induce and augment labor [ 9 ].

Breast stimulation for inducing labor has been studied by many researchers to date [ 10 — 16 ]. In the systematic review analysis of 6 trials consisting of women by Kavanagh et al. The number needed to treat was only 4, indicating that effective intervention can still be achieved even with small numbers. The minimum breast stimulation time to induce spontaneous labor was reported to be 1 hour each day for 3 days [ 10 ]. Several mechanisms underlie the onset of labor, which appears to be associated with different plural factors.

In particular, the underlying mechanism of breast simulation inducing the onset of labor is considered to be associated with the OT level. In the s, the most frequently investigated procedure for the contraction stress test CST was the induction of OT release by breast stimulation in pregnancy instead of the use of synthetic OT. CST is an examination method for determining the coping ability of the fetus with uterine contractions mainly for high-risk pregnancies.

It is one of the antepartum fetal surveillance assessment techniques. Amico et al. On the other hand, Ross et al. Thus far, the results obtained remain controversial, and little has been reported about OT levels following breast stimulation for 3 days to promote spontaneous onset of labor. The objectives of this preliminary study were to 1 determine the changes in the salivary OT level during breast stimulation for promoting the spontaneous onset of labor in low-risk term pregnancies, and 2 clarify the feasibility of the breast stimulation intervention protocol used in terms of its practicality and acceptability.

This trial used a quasi-experimental single-arm time series design. This research was a feasibility study. The sample size was based on previous research reporting on saliva OT level from 11 breastfeeding women [ 19 ].

Previous studies reporting on plasma OT level in pregnant women involved about 10 to 20 subjects [ 17 , 18 , 20 — 22 ]. The eligibility criteria were as follows: planned to give singleton birth by spontaneous cephalic delivery; between 38 and 40 weeks of gestation; Asian and can read and write Japanese; received permission from the obstetrician or midwife to participate.

A flowchart demonstrating the recruitment of the study participants is shown in Fig 1. When eligible pregnant women at 34 weeks of gestation visited the outpatient ward for a prenatal check-up, we verbally explained our research in a place without a nurse or an obstetrician. After obtaining consent, we decided with the participant the first intervention day after 38 weeks of gestation.

Women also received a refusal form at that time with an explanation that they can withdraw any time without any disadvantage. In the data collection facility of this study, pelvic examination is performed for all pregnant women after the 37 weeks check-up. Membrane sweeping may be performed at the discretion of an obstetrician after 39 gestational weeks.

The experiments were held in the hospital for 3 consecutive days. There were some subjects who had perinatal check-ups by obstetricians before and after the experiment. Data were collected at a single maternity hospital in Kanagawa, Japan between June and August The study protocol was approved by the Institutional Review Board of St. The breast stimulation intervention time was 3 days. The same time of the day was used to control for diurnal effects. Saliva was collected within the period from to hrs.

The participants were asked to refrain from sexual intercourse and drinking alcohol before the day of intervention. They were also instructed to finish their meal, brush their teeth, and not to smoke 1 hour before the intervention. They were also asked not to use a lipstick. The experiment was started 30 minutes after the intake of mL of water. At the start of the study, the cervix score was evaluated for cervical ripening Fig 2 ; cervical check using a modified Bishop Score.

Cervical ripening can be a possible option for evaluating the intervention in relation to the endpoint. The evaluators were composed of 3 midwives who have 10 years of experience to standardize the assessment. The participants performed breast stimulation for 3 days together with an attendant midwife in the hospital. To standardize the intervention technique, a midwife demonstrated how to perform breast stimulation for 10 minutes using a breast model prepared from wool and a pressure-measuring instrument Perineometer, OWOMED, Gyeonggido, South Korea.

The recommended stimulation pressure was between 20 and 50 mmHg, which is a gentle pressure and does not damage the nipple. To achieve a stimulation rhythm of 69 beats per minute, a lighting electric metronome SQ50V, Seiko Watch Corporation, Tokyo, Japan without a sound was used as guide. Each breast was stimulated for 15 minutes, beginning on the right, alternating between the breasts to prevent uterine hyperstimulation, for a total of 1 hour per day. Breast stimulation was performed by pinching the breast to a degree that did not hurt starting from the outer areola to the nipple using the thumb, forefinger, and middle finger.

Direct self-stimulation of the breast was performed using either the left or right hand with Pure Horse Oil Sonbahyu; Yakushido, Fukuoka, Japan. To address concerns or worries regarding the presence of others during breast stimulation, a nursing cover was used.

We managed the time and notified the participants. Cardiotocography CTG readings were obtained during the intervention to record uterine activity and check the fetal heart rate. Adequate uterine contraction was defined as having at least 3 contractions lasting for 40 seconds each occurring within 10 minutes.

The frequency of uterine contraction can also be a possible option for evaluating the intervention in relation to the endpoint. The participants watched a prepared movie i. After the intervention, the participants answered a questionnaire on the feasibility of the experimental intervention. Cervical ripening was reassessed at the end of the intervention. The intervention was performed by 3 midwives consisting of the first author and 2 research assistants.

They had adequate CTG reading ability gained from their more than 5 years of clinical experience and over cases of conducting labor management for this feasibility study.

For the intervention standardization, the explanations for the participants and intervention details were unified. Moreover, the first author consistently participated in the experiments twice at the beginning to ensure that the research assistants can properly implement the intervention procedure.

Research assistant A was responsible for Salivary assays are relatively easy to perform and are minimally invasive for pregnant women. Saliva samples were collected 10 minutes before and 15, 30, 60, 75, and 90 minutes after the breast stimulation intervention for a total of 18 samples per participant.

To standardize the saliva collection procedure, the participants were asked to pool their saliva in their mouths for 3 minutes. Afterwards, the participants collected about 1. If this volume could not be collected after 3 minutes, the participants repeated the saliva collection procedure.

OT level was assayed using the method of Carter et al. OT receptor single nucleotide polymorphism has been reported to reduce sensitivity to OT [ 28 , 29 ]. In particular, women with GG homozygous types at OT receptor gene rs reportedly transitioned to late active labor.

In the present study, buccal mucosa samples were obtained for the analysis of 3 OT receptor gene polymorphisms i. We evaluated the feasibility of the breast stimulation intervention protocol in terms of practicality and acceptability [ 30 ].

For the practicality of the experimental method , the proportion of analyzable samples and the occurrence of adverse events were considered. For the acceptability of the experimental method , the dropout rate after the intervention was considered. The visual analog scale VAS , which is one of the most valid, reliable, and frequently used measurement tools for a self-report measure, was used in the present study to rate fatigue [ 31 ] and pain [ 32 ].

Considering the cultural background of East Asians tending to choose the midpoint [ 33 , 34 ], a 4-level Likert scale was used for the measurement of attitude to avoid ambiguity for these questions. In addition, the participants responded to questions about the environment where the intervention was carried out.

The means M , standard deviations SD , standard errors SE , and medians of all variables were calculated. We employed a linear mixed model using the AR 1 covariance structure with the OT level as the dependent variable and the day and time of intervention as the fixed effects. The main cause of the missing data was insufficient saliva volume and not missing data due to the OT value, thus the missing data in this study reflected missing completely at random MCAR.

Five imputed datasets were created. The data had a non-normal distribution. Written informed consent to participate in the study and publish the results was initially obtained from 34 pregnant women. Finally, 16 low-risk pregnant women mean age, 29 years; SD , 2. The participant flow diagram is shown in Fig 1. The demographic factors of the participants, outcomes in relation to the intervention period, and maternal and fetal outcomes are shown Table 1.

Values are expressed as mean [standard deviation] or number percentage of women. Among a total of saliva samples, OT level was measured in samples missing rate: Of the 16 women who participated in the intervention, only 3 women could complete the collection of all 18 saliva samples. After breast stimulation, the median level of salivary OT did not increase on day 1, increased only at 15 minutes on day 2.

In this article, we consider the research on nipple stimulation and also look at the other home remedies that some people use to try to induce labor. After a woman gives birth, stimulation of the nipples by a breast-feeding baby triggers the release of oxytocin.

Oxytocin is a hormone that triggers uterine contractions that help the uterus return to its pre-pregnancy size. As vaginal labor requires uterine contractions to move the baby down the birth canal, many women use nipple stimulation to try to encourage these contractions.

In a survey of postpartum women in the Midwestern United States, 7. A study in the journal PLoS One reports that 50 percent of women in Japan use nipple stimulation to help induce labor.

Researchers have conducted several studies regarding nipple stimulation and its effectiveness in inducing labor. These studies include the following:.

Low-risk pregnancies are those in which the women have no additional health risks. These health risks include high blood pressure , gestational diabetes , low or high amniotic fluid amounts, or other risks that could complicate the pregnancy. The theory behind nipple stimulation is that it mimics breast-feeding and causes sensory cells in the nipples to signal the brain to release oxytocin. Some women use a breast pump to stimulate the nipples.

Some women also use nipple stimulation during labor to reduce its duration. This may make contractions feel particularly strong. There are many other natural methods that people use to try to induce labor. Some of these techniques include:. Most methods to induce labor are either ineffective or pose the risk of unwanted side effects.

As a result, doctors do not usually recommend them.