Obstetrical History: Labor induction, Part 3

Induction of labor if the cervix is ripe and the baby mature can be relatively easy, but it was sonce believed that massage of uterus would work! Ulsamer and d'Outrepont in 1820 thought that massage of the uterus and breasts would work, are known as the oldest and most inefficient methods to induce labor. Actually breast massage, if done on the nipple can release a natural pituitary hormone that would work. Massage of the breasts was then championed by Friedrich 1839, but he didn't probably realize the techniques that would most efficiently be nipple stimulation. Breast stimulation activateswhat is called the milk ejection reflex, and it it what happens physiologically when babies breast feed. Stimulation of the nipple and areola causes sensory impulses to be relayed to the brain, actually the supraoptic and paraventricular nuclei in the hypothalamus. The impulses cause the release of natural oxytocin from the posterior pituitary. Oxytocin acts on the end organ, the breast, to cause milk letdown and is known to cause uterine contractions. We have yet to determine the exact physiology within the milk ducts and whether this is or is not similar to that which occurs in spontaneous labor. Since we have begun to understand that this does work many obstetricians and midwives will still use nipple stimulation to check on the baby's response to contractions and less often for labor induction.

By 1855, a more acceptable method of initiating labor was developed, the sponge tent. Sponge Tents in Cervix had been proposed by Brunninghausen 1820, but abandoned until later. Introduced into the cervix, these sponges, which were available in several sizes, were kept wet by introducing water into the vagina. Larger sponges were inserted as dilatation of the cervix proceeded, stretching open the cervical os according to Simpson in 1855.

Interest in improving the techniques of induction has never waned and Scholler tried a vaginal tampon in the mid 1800s,  and around the same time Dr. Kiwisch developed an injection stream of tepid water into the vagina and against the cervix so that the water entering the os would separate the surface of the fetal membranes from the uterine wall. This method usually required nine of these hot water vaginal douch applications, and labor commenced in five to six days. The procedure was a disatrous failure for many reasons and was soon abandoned because of associated maternal mortality caused by uterine rupture. Not to be detered the famous Dr. Scanzoni, who's name is still on the Scanzoni maneuver tried to improve the hot douches by making them out of a carobolic acid solution! This did not work any better and was also abandoned rapidly.
Midwives Chronicle & Nursing Notes; A History of Induction; 1978).

American Journal of Obstetrics and Gynecology; The Use of Breast Stimulation to Ripen the Cervix in Term Pregnancies; Elliott et al; 1983; page 536).


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