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One Midwife's Herbal Induction Protocol

Practice Variation in Cesarean Rates: Not Due to Maternal Complications
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”

Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients.  This analysis shows that:

    Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
    Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
    Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.

This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.

Tips for Choosing a Care Provider - great overview! from Henci Goer


1. All candidates for herbal induction must fall within the prescribed parameters for midwifery care, and/or be under the supervision of a physician.

2. Candidates must be at term (=/>37 weeks gestational age).

3. Inductions shall begin with candidates fully rested, and fully informed as to the protocols for induction.

4. If desired, candidates may begin Evening Primrose Oil (>500 mgs.) orally, one in the morning and one at bedtime, at 37-38 weeks.

5. One Evening Primrose Oil capsule shall also be applied to the cervix morning and evening, beginning at 38 weeks, and used as the lubricant for all cervical examinations.

6. On the morning of the planned induction, candidate will eat a normal breakfast, and have a ready supply of fluids to insure hydration. Eating and drinking during the induction shall be at the candidate’s preference.

7. Recommended dose of herbs:

First hour: 5 drops of Black Cohosh tincture, 5 drops of Blue Cohosh tincture every twenty minutes.
Second hour: 10 drops of Black Cohosh tincture, 10 drops of Blue Cohosh, and 5 drops of Pennyroyal tincture every twenty minutes.
Third hour: 15 drops of Black Cohosh tincture, 15 drops of Blue Cohosh tincture, and 10 drops of Pennyroyal tincture every twenty minutes.
Fourth hour: 20 drops of Black Cohosh tincture, 20 drops of Blue Cohosh tincture, and 15 drops of Pennyroyal tincture every twenty minutes.
Fifth hour: 1 full dropper of Black Cohosh tincture, and 1 full dropper of Blue Cohosh tincture, and ½ dropper of Pennyroyal tincture every twenty minutes.

Maintain fifth hour dose until contractions are 2 minutes apart and 60 seconds long, OR until cervix is 4 cms. dilated, then discontinue.
** Hold tincture mixture in your mouth for the count of 5, then swallow and rinse with water.

8. If, after 6-8 hours, a contraction pattern fails to become established, and/or cervical dilation has not reached 4 cms., herbs may be discontinued, and re-started the following day.

9. If membranes are already ruptured: monitor temperature every four hours; maintain hydration; and limit cervical examinations (using sterile gloves) to the minimum necessary.

This Web page is referenced from other pages containing related information about Herbs, and Hormones of Labor, and Non-Pharmaceutical Induction.


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