Management of Protracted Active Labor with Nipple Stimulation: A Viable Tool for Midwives?

Ellen J. Razgaitis, CNM, MSN; Ashlee N. Lyvers, CNM, MSN

J Midwifery Womens Health. 2010;55(1):65-69.

Physiologic Mechanism of Nipple Stimulation

Nipple stimulation is predicated on the known mechanism of action of oxytocin. Mechanical stimulation of the nipple triggers the release of oxytocin from the posterior pituitary. Oxytocin binds to oxytocin receptors on the cell surfaces of uterine muscle. Once bound to these receptors, oxytocin activates the phospholipase C-inositol pathway, which results in the release of intracellular calcium. The increased intracellular calcium then acts to stimulate contraction of the myometrial cells, ultimately leading to organized uterine contractions. Oxytocin receptors increase in number by 100- to 300-fold at the time of parturition.^[8] Despite knowledge of how oxytocin acts physiologically, there is no documentation that nipple stimulation can cause sufficient oxytocin release to resolve protracted labor.

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Cite this: Management of Protracted Active Labor with Nipple Stimulation: A Viable Tool for Midwives? - Medscape - Jan 01, 2010.

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Abstract and Introduction
Background
Definitions
Physiologic Mechanism of Nipple Stimulation
Literature Review
Discussion
Implications for Midwifery Practice
References

Table 1. Nipple Stimulation in Cited Studies
Source	Nipple Stimulation Method	Method Timing	Total Stimulation Time	Definition of Method Failure
Curtis et al., 1999^[6] (N = 79)	Unilateral breast massage (one breast consistently or alternating between breasts). Performed by laboring woman, support person, or breast pump (lowest setting)	10 min of stimulation followed by 5 min rest. Cycle repeated 4 times.	60 min	No cervical change after 4 cycles (60 min) or contraction frequency less than 1 every 3 min after 4 cycles (60 min)
Stein et al., 1990^[18] (N = 84)	Unilateral stimulation (alternating between breasts) with electric breast pump at 150 mm Hg.	15 min of stimulation. No rest period specified. Cycle repeated with opposite breast.	30 min	Contraction frequency less than 1 every 3 min after 1 cycle (30 min)

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Management of Protracted Active Labor with Nipple Stimulation: A Viable Tool for Midwives?

Physiologic Mechanism of Nipple Stimulation

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References

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