By nine days past her baby's due date last October, Sarah Ikemire was anxious – and speed-walking daily around Sacramento, Calif.'s McKinley Park.
She wanted baby Mason to emerge on his own, without urging from drugs or, worse, a Caesarean section. She asked her doctor what she could do to encourage her baby to leave the comforts of the womb.
"Have sex, do a lot of walking, and just – think positive and you know, talk to your baby, and maybe he'll be ready to come out," she recalled. Hence the walking, relieving anxiety with speed.
In a survey of new moms at a Midwestern hospital, about 50 percent of respondents had tried at least one nonmedical technique to bring on labor in the week before childbirth, according to a report in the current issue of the medical journal Birth.
Walking was the most popular, and first-time moms the most likely to try to influence the onset of childbirth.
The report says, "Some women take it on themselves to hasten labor, merely to alleviate typical discomfort," but a number of Sacramento women interviewed by The Bee say they wanted to avoid the complications and medical interventions of an overlong pregnancy.
Sacramentan and first-time mom Natalie Miller, who worried that her big baby, Sam, would grow too big to exit by the natural route, tried everything, running down a list in a childbirth text: walking, spicy green curry, acupuncture, sex, and stimulation of her nipples.
Everything but drinking castor oil, that is. Her midwife at Kaiser Roseville said it was safe, but "in her experience it makes people more sick and doesn't actually induce labor. And the thought of being sick – that was not something I was into."
Nurse practitioner and midwife Ruth Cummings is owner and director of the Sacramento Birth Center, a clinic for women in low-risk pregnancies who want natural deliveries outside a hospital.
She said that for many of her clients, "It's important to them to get into labor because normal full term is 37 to 42 weeks. I can give a little fudge in my protocol to go a little earlier or a little bit later, but not much."
After 42 weeks, Cummings refers clients to a hospital, where doctors can induce labor and cope with emergent complications.
Many women believe that medical induction increases their chances of requiring a Caesarean, adding to the pressure to enter labor spontaneously. The connection is unclear in medical literature.
Popular "folk" methods for labor induction have not received much medical scrutiny. Most have not been shown to work in scientific studies – but haven't been conclusively shown not to work, either. Advice often rests on the speculation, or anecdotal experience, of practitioners.
Sex, for instance, has been hypothesized to hasten labor through the application of hormones in semen to the cervix.
"We use something called prostaglandins to induce labor, and we first isolated them from the prostate gland," said William Gilbert, an obstetrician at Sutter Davis Hospital and regional director for women's services at Sutter in the Sacramento region.
The muscle contractions of orgasm have also been proposed to bring on sympathetic contractions of labor.
Though the arguments for the labor-inducing properties of sex, spicy food, or castor oil rest on ideas, not evidence, stimulation of the nipples has had success in clinical trials.
The suckling sensation of a breast-feeding baby instructs the mother's brain to release the hormone oxytocin, which causes the breasts to release milk. Oxytocin also contributes to contractions and the opening of the cervix during labor. Stimulating the breasts before childbirth is believed to trigger this process.
Pitocin, a popular drug for labor induction, is synthetic oxytocin.
The study authors and Sacramento practitioners recommend that women walk, eat hot peppers, or have sex if they enjoy the activities and would do them anyway.
There's really not much you can do to hasten labor, said Gilbert. "In a normal pregnancy, being active, having intercourse and doing these things are good."
The onset of labor is a delicate conversation between maternal and fetal systems, and the signals that control it remain a mystery. If he knew what started labor, Gilbert said, "I'd have a Nobel Prize in medicine."
Cummings has a list of "gentle nudges for hesitant fetuses" but says the most important thing for her clients is to stay calm. She thinks state of mind affects the experience profoundly.
"If you're all worried that you're not going to have your baby in time, you've got this stress going on already. You've gotta give it up," she said. "If the baby's not ready to come out – short of being induced in the hospital with the aggressive medicines – babies won't come out. They really do come when they're ready."
Despite spicy food and vigorous walking, labor had still not begun for Ikemire when her water broke. Wary of infection, her doctor helped nature along with Pitocin. Ikemire soldiered through 37 hours of labor and four failed epidurals, stoically warding off doctors' suggestions of a C-section.
Things may not have gone according to plan, but in the end, she said, "I'm glad he's healthy. Period."