Nipple Stimulation for Labor Induction

Breast stimulation and nipple stimulation have historically been used to induce and speed up labor in many different cultures around the world. Let’s answer your questions on “can pumping induce labor,” how to do nipple stimulation for labor induction, and everything you need to know about the benefits and risks of nipple stimulation for labor induction.

How Does Labor Start?

When a baby is ready to be born, studies indicate that the baby’s lungs reach a point of maturation before releasing hormone signals into the amniotic fluid, which contributes to the initiation of labor at term [1].

In preparation for this, the mother’s uterus has grown oxytocin and melatonin receptors. Melatonin works synergistically with oxytocin and make contractions effective. Yes, this means one factor of having the safest and most effective labor possible includes being in darkness in addition to the other 4 key components of an optimal birth space which I go into in this post: The 5 Things You Need to Create a Calm Birth Space.

So, even with a natural labor induction method, I do not recommend it unless the baby needs help to be born sooner for medical reasons. If this is the case, I am all for trying natural induction methods before medical tools if desired.

However, another time women might use natural induction methods is when a mother cannot have her planned homebirth with a midwife if she goes past 41 weeks, which is, unfortunately, a regulation in some states in the U.S.

The Truth About Pregnancy After 40 Weeks

It is also noteworthy to add some babies just come a little earlier, and some come a little later. The medical model’s concern with births after 40 weeks is a risk of stillbirth. However, using information via kick counting and/or getting a non-stress test (NST) and a biophysical profile (BPP) can also be beneficial to check in with how your baby is doing to catch early warning signs of distress as you approach or pass your estimated due date.

Why Induce Labor Naturally?

There are various reasons some mamas may try to induce labor naturally. Recent data found almost half (47%) of mothers had providers who wanted to medically induce their labor, and more than a third of these attempts (37%) were elective [1].

This study also found that cesarean birth is more likely in the case of induction [1].

Even natural induction is still induction and an intervention straying from the normal labor and birth process, which can have adverse effects. But there are times and places for these tools!

If you genuinely feel a need to induce your labor, I’m excited to share options backed with research for you to take to your midwife or OB. However, if inducing your labor doesn’t feel right to you, and you are not at peace with it, do not let your provider pressure you into an induction.

Does Nipple Stimulation for Labor Induction Work?

Nipple stimulation is an effective method to induce labor in full-term pregnant women! This is because nipple and breast stimulation release oxytocin, the same hormone responsible for uterine contractions, which begin and continue throughout labor and birth.

In one systematic review (a study of multiple studies), all mothers performed self-breast and nipple stimulation, stimulating one breast at a time [2].

In three of these trials, it was done for three hours per day. To get the three hours a day, the participants did the stimulation one hour at a time, three times a day, alternating sides every 10 to 15 minutes.

In another trial included, the stimulation was done with a breast pump instead of hand massage, and the pump was set to a normal speed and suction strength. The mothers pumped alternating sides every 15 minutes until their contractions were three minutes apart.

The Results of Nipple Stimulation for Labor Induction

In five of these trials, 37% of the mothers who stimulated their nipples went into labor within 72 hours, compared to only 6% of those who did not use nipple stimulation [2]. Additionally, the results applied equally to first-time mothers and experienced mothers. Furthermore, even if a woman’s cervix wasn’t ripe at the beginning of the study, this also didn’t make a difference in the positive effects of nipple stimulation for inducing labor.

The researchers also found a major reduction in the rate of postpartum hemorrhage in the moms who used nipple stimulation [2]. The rate of postpartum hemorrhage was 0.7% in the breast stimulation group compared to 6% in the group that didn’t use nipple stimulation [2].

Within both groups, there were no differences in the rates of cesareans, meconium-stained amniotic fluid (when a baby has their first poop while still in-utero, which can be a sign of fetal distress), and there were no cases of uterine hyperstimulation which means that the uterus was not overstimulated [2].

Generally, uterine hyperstimulation is understood as more than 5 contractions per 10 minutes for at least 20 minutes, a contraction lasting two minutes, or fetal heart rate changes consistent with uterine hyperstimulation.

The uterus is a muscle. So, you can also think of uterine hyperstimulation as an overworked and tired uterus that cannot contract effectively. Maternal health experts know Pitocin, or artificial oxytocin, can increase the risks of cesarean sections and postpartum hemorrhage [7, 8].

So, considering that breast stimulation increases oxytocin levels higher than for most mothers who don’t use it to induce labor, it is reassuring that the researchers didn’t see an increase in uterine hyperstimulation. However, another study did find a case of uterine hyperstimulation from nipple stimulation.

Another Study on Nipple Stimulation for Labor Induction

benefits and risks of nipple stimulation

A randomized controlled trial from 2014 included 100 low-risk pregnant mothers and looked at whether breast stimulation could help these low-risk first-time mothers achieve spontaneous labor and vaginal birth [3].

However, I disagree with them calling this a “spontaneous labor“, because although breast stimulation is not a medical form of induction, it is still a form of induction. Stimulating your nipples for hours a day (if you weren’t already doing so with breastfeeding while pregnant) isn’t generally a physiologic event occurring towards the end of pregnancy.

Nevertheless, in this study, the mothers started self-breast stimulation at 38 weeks pregnant and were compared to a group of 100 other mothers who did not do breast stimulation.

So at 38 weeks gestation, half of the participants began massaging their breasts for 15 to 20 minutes on each side, three times a day, and the other half of the participants did nothing.

Study findings [3]:

The breast stimulation group:

Had higher bishop scores (looking at how “ready” the cervix is for labor)
Went into labor sooner
Gave birth at an average of 39 weeks and two days of pregnancy versus 39 weeks and five days in the group without breast stimulation
Had significantly fewer cesarean births; 8% versus 20%
Had one case of uterine hyperstimulation in the breast stimulation group.

Additionally, there was no significant difference in postpartum hemorrhage between the groups.

There were also no significant differences between the groups and the length of labor, meconium staining, or newborn outcomes.

Lastly, 92% of women in the breast stimulation group stated that they were satisfied with that induction method.

The Advantages of Nipple Stimulation for Labor Induction

Benefits of nipple stimulation for labor induction:

Reduced rate of postpartum hemorrhage [2]
One study found no difference in cesarean rates [2], while another found a significant decrease in cesarean rates [3, 4]
No difference in meconium-stained amniotic fluid rates [2, 3]
No differences in the length of labor [2], while one study found the women had shorter labors [4]
Less usage of Pitocin (artificial oxytocin- used to induce or speed up labor)[4]
No differences in newborn outcomes [3]

Risks of nipple stimulation for labor induction:

If the amount of oxytocin released is not controlled, there is a risk of overstimulating the uterus [3, 5]

Breastfeeding While Pregnant

Since nipple and breast stimulation in late pregnancy has been proposed as a method of inducing labor, some people are concerned that breastfeeding during pregnancy could induce a pre-term birth (birth before 37 weeks of pregnancy).

In 2017, a systematic review was conducted to identify outcomes related to breastfeeding during pregnancy [6].

After viewing seven studies that examined breastfeeding during pregnancy and rates of pre-term birth, none of the studies reported significant differences in the rate of pre-term birth between mothers who breastfed during pregnancy and those who did not [6].

The authors speculate that nipple stimulation may only induce labor in late pregnancy once the oxytocin receptors are fully present in the uterus. And there’s no evidence that breastfeeding is harmful earlier in pregnancy [6].

Can Pumping Induce Labor?

In only one of the studies included in a systematic review, a breast pump was used in the breast stimulation group. Pumping does stimulate the breasts and nipples and releases more oxytocin making it a form of nipple stimulation for labor induction.

However, there isn’t any research on if pumping or hands-on nipple stimulation is more effective for inducing labor.

Pumping for Labor Induction

To mimic the one study there is on pumping to induce labor:

Use a normal suction speed and strength
Pump for one hour at a time, three times a day, alternating sides every 15 minutes until your contractions are 3 minutes apart.

In most research studies women were taught to pause during a contraction and to stop breast stimulation if contractions are closer than three minutes apart or last longer than one minute.

How to do Nipple Stimulation for Labor Induction

How to use hands-on nipple stimulation for labor induction:

Stimulate one breast at a time using hand expression techniques and alternate sides every 15 minutes for 1 hour
Repeat this up to 3 times per day when you are full-term and with your practitioner’s guidance
Oil may be used to gently massage the breast starting at the outer areola and going around the nipple

Again, in most research studies women were taught to pause during a contraction and to stop breast stimulation if contractions are closer than three minutes apart or lasting longer than one minute.

Questions or Comments?

If you have any questions or comments, please leave them below👇🏻

Talk soon, mama!

– Katelyn Lauren

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References:

[1] Mendelson, C. R., Montalbano, A. P., & Gao, L. (2017). Fetal-to-maternal signaling in the timing of birth. The Journal of steroid biochemistry and molecular biology, 170, 19–27. https://doi.org/10.1016/j.jsbmb.2016.09.006

[2] Kavanagh, J., Kelly, A. J., & Thomas, J. (2005). Breast stimulation for cervical ripening and induction of labour. The Cochrane database of systematic reviews, 2005(3), CD003392. https://doi.org/10.1002/14651858.CD003392.pub2

[3] Singh, N., Tripathi, R., Mala, Y. M., & Yedla, N. (2014). Breast stimulation in low-risk primigravidas at term: does it aid in spontaneous onset of labour and vaginal delivery? A pilot study. BioMed research international, 2014, 695037. https://doi.org/10.1155/2014/695037

[4] Demirel, G., & Guler, H. (2015). The Effect of Uterine and Nipple Stimulation on Induction With Oxytocin and the Labor Process. Worldviews on evidence-based nursing, 12(5), 273–280. https://doi.org/10.1111/wvn.12116

[5] Narasimhulu, D. M., & Zhu, L. (2015). Uterine Tachysystole with Prolonged Deceleration Following Nipple Stimulation for Labor Augmentation. Kathmandu University medical journal (KUMJ), 13(51), 268–270. https://doi.org/10.3126/kumj.v13i3.16820

[6] López-Fernández, G., Barrios, M., Goberna-Tricas, J., & Gómez-Benito, J. (2017). Breastfeeding during pregnancy: A systematic review. Women and birth : journal of the Australian College of Midwives, 30(6), e292–e300. https://doi.org/10.1016/j.wombi.2017.05.008

[7] Dahlen, H. G., Thornton, C., Downe, S., de Jonge, A., Seijmonsbergen-Schermers, A., Tracy, S., Tracy, M., Bisits, A., & Peters, L. (2021). Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study. BMJ open, 11(6), e047040. https://doi.org/10.1136/bmjopen-2020-047040

more references:

[8] Espada-Trespalacios, X., Ojeda, F., Nebot Rodrigo, N., Rodriguez-Biosca, A., Rodriguez Coll, P., Martin-Arribas, A., & Escuriet, R. (2021). Induction of labour as compared with spontaneous labour in low-risk women: A multicenter study in Catalonia. Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, 29, 100648. https://doi.org/10.1016/j.srhc.2021.100648

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