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Use of nonmedical methods of labor induction and pain management among u.s. Women

Kozhimannil KB, Johnson PJ, Attanasio LB, Gjerdingen DK, McGovern PM.

 Birth. 2013 Dec;40(4):227-36. doi: 10.1111/birt.12064.

Editor’s comment: Prof. Jim Thornton: Non-medical methods to induce labour are widely used
In this representative survey of 1,382 US women who experienced labour, nearly 30 percent reported using nonmedical methods to start it. These included nipple stimulation (12%), sexual intercourse (20%), castor oil (3.8%), herbal treatments (4.1%), and walking, exercise, or movement (23%). The methods were not always effective such that over half of women also reported using a medical method to induce labour. Only 10 percent of women reported using only a non-medical method.



There exists limited documentation of nonmedical methods of labor induction and pain management during childbirth in the United States. We estimated the prevalence of nonmedical interventions for induction and pain management and examined the association between medical and nonmedical care during labor.


We used a nationally representative survey of U.S. women who gave birth in 2005 (N = 1,382) to examine use of nonmedical methods of labor induction and pain management. Using logistic regression, we calculated odds of nonmedical and medical interventions to induce labor or mitigate pain, and the odds of medical induction and obstetric analgesia by whether nonmedical methods were reported.


Nearly 30 percent of women used nonmedical methods to start labor, and over 70 percent of women used nonmedical pain management. Doula support was the strongest predictor of nonmedical methods of labor induction (Adjusted Odds Ratio [AOR] = 3.0) and labor pain management (AOR = 5.7). Use of nonmedical pain management was significantly associated with decreased odds of medical pain management (OR = 0.65); this relationship was attenuated with covariate adjustment.


Nonmedical methods to induce labor and manage pain during childbirth are commonly used by U.S. women. Future research should examine effectiveness of these strategies and their influence on medical services use.


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Commentaries by Editor Prof. Jim Thornton