Two Ways Not to Induce Labour: Blue Cohosh and
Castor Oil
From a review of the literature by Rachel
Westfall, 2001. For more on herbs- both helpful
and harmful- in pregnancy and childbirth, visit
Rachel's site.
See her links on BirthLove at the end of this
page as well.
Note: for more about Castor oil (not "Castrol"
motor oil, as is sometimes mistaken) as a negative
means of labor induction, go here.
I began this research with a positive outlook
on herbal medicine in general. However, it soon
became clear to me that women use herbs to induce
labours only because they were being told by their
maternity care providers that pregnancy is, as
a rule, 40 weeks long. Some choose to induce because
they are tired of being pregnant, whereas others
wish to avoid a 'medical' induction. Herbal inductions
have many of the same risk factors as medical
inductions: the possibility of a premature birth,
side effects of the medications, 'failure to progress',
and so on. Some of these concerns are reviewed
below.
Blue Cohosh
Summary:
Blue cohosh is a North American herb with a reputation
for both causing and preventing miscarriage (abortion),
but it is most widely known for its use in labour
induction.
There are some unpleasant side effects from blue
cohosh, including elevated blood pressure and
blood sugar levels, nausea, severe stomach pain,
and toxicity. There have been two case reports
where blue cohosh was blamed for severe cardiac
toxicity in infants whose mothers used the herb
to induce labour. In addition, the plant contains
a toxic compound which is known to cause birth
defects in cattle.
The long story:
Blue cohosh Caulophyllum thalictroides (L.)
Michx. grows in rich soil in the shady woodlands
of Eastern North America (USDA, NRCS, 1999). This
perennial plant is a member of the family Berberidaceae.
Blue cohosh roots and rhizomes have a long tradition
of use as medicine by North American First Peoples
(Belew, 1999; Duke, 1997; McFarlin et al., 1999;
Stelling, 1994). The fresh roots are gathered
in the spring (Weed, 1986). Blue cohosh tea is
consumed near the end of pregnancy to prepare
the uterus for childbirth and reduce uterine irritability
and false labour pains (Stelling, 1994). It is
used to prevent miscarriage and to assist difficult
labours (Belew, 1999).
The Eclectic Physicians adopted blue cohosh into
their materia medica in the 1800s. They found
it useful for speeding up labour when it is stalled
due to the mother’s weakness, fatigue, or
lack of uterine energy (Felter and Lloyd, 1992).
It was also used to ease pain in pregnancy and
labour, as well as afterpains (Felter and Lloyd,
1992). It was used as an anti-abortive, as it
relieved "the irritation in which the trouble
depends" (Felter and Lloyd, 1992).
Today, blue cohosh is valued as a uterine stimulant,
anti-spasmodic and emmenagogue (Bartram, 1998;
Beal, 1998; Burch and Sachs, 1997; Grieve, 1971).
It is believed to be one of the most powerful
natural inducers of labour. Its oxytocic effect
is apparently produced by the glycosides caulosaponin
and caulophyllosaponin (Duke, 1992b; Tyler, 1993).
It also contains the compound caulophylline, which
raises blood pressure and blood sugar levels (McFarlin
et al., 1999; Duke, 1992a).
Blue cohosh has a reputation as an abortifacient
(Weed, 1986). Paradoxically, the herb also has
a reputation for preventing miscarriage in susceptible
women, if it is used before conception to strengthen
the uterus (Bartram, 1998; Belew, 1999; Lipo,
1996). If used after conception, it can prevent
implantation of the fertilized egg (Lipo, 1996).
The safety of blue cohosh has come into question
in recent years. Midwives have noticed a rise
in fetal heart rates associated with its use (Weed,
1986).
"A number of direct-entry midwives (DEMs)
have stopped using blue cohosh, because they noticed
an increased incidence of meconium-stained fluid,
fetal tachycardia or fetal distress, and a high-pitched
or inconsolable neonatal cry associated with the
intrapartum use of blue cohosh (personal communication,
May 1998, Shannon Anton, DEM, Susan Claypool,
DEM, Lucero Dorado, DEM)" (Belew, 1999: 241-242).
Midwives and herbalists are coming to the realization
that blue cohosh should be used with discretion,
and only in the most difficult labours. According
to herbalist Karyn Saunders, "Blue cohosh
is thought to have a harsh effect on the spirit
of the baby (Karyn Saunders, personal communication,
May 1998)" (Belew, 1999).
There have been two recent case reports of health
problems in newborns associated with maternal
use of blue cohosh. In one case, reported by Gunn
and Wright (1996), the mother used an unspecified
amount of blue and black cohosh to induce labour.
The infant showed signs of ill health at birth,
and was taken the hospital shortly afterwards
with seizures, kidney damage, and the need for
mechanical ventilation. The authors pointed out
that caulosaponin, a constituent of blue cohosh,
causes coronary blood vessel constriction and
myocardial toxicity. They speculate that caulosaponin
may have been responsible for the infant’s
ill health. Baillie and Rasmussen (1997) replied
to this article, pointing out that our understanding
of toxicity in these herbs comes from studies
of the effects of isolated constituents on animals,
often in unrealistic doses. In the case of caulosaponin,
laboratory animal experiments demonstrated a toxic
effect from an amount that was equivalent to a
human dose of 350g of the herb.
Jones and Lawson (1998) also published a case
report of some adverse effects of blue cohosh.
In this case, the mother was advised to take one
blue cohosh tablet daily for the last month of
her pregnancy. She chose to take three tablets
daily, and she gave birth after three weeks. The
amniotic fluid was slightly meconium stained,
and by 20 minutes of age, the infant required
mechanical ventilation. The infant was diagnosed
with profound congestive heart failure, and although
the child eventually recovered, left ventricular
function was still slightly impaired at two years
of age. The authors implicated the glycosides
caulosaponin and caulophyllosaponin as they are
known to have a toxic effect on cardiac muscle.
Blue cohosh has been known to cause nausea (Romm,
1997; Gardner, 1987), severe stomach pain, and
toxicity (Ferguson et al., 1954). The roots contain
the alkaloid anagyrine, which is held responsible
for the congenital deformity ‘crooked calf
disease’ (Keeler, 1984; McFarlin, 1999).
The disease does not appear to occur in other
species, but there is a case report of a similar
human congenital deformity which could have been
due to maternal consumption of anagyrine contaminated
goat’s milk in early pregnancy (Ortega et
al., 1987; McFarlin, 1999). With the evidence
stacking up against it, blue cohosh appears to
be a herb best left alone.
Castor Oil
Summary:
Castorbean Castorbean Ricinus communis (L.)
seeds, from which castor oil is pressed, contain
the toxic compound ricinic acid. The compound
is used medicinally in small, controlled doses
to cause abortion and female sterility; it is
a teratogen (causes birth defects).
Castor oil has been widely used to induce labour
for the past century, not just by women in their
homes (as we tend to think of it now) but by the
medical system. It appears to work only if the
cervix is ripe, meaning the woman must be physiologically
ready to have her baby already.
The safety of castor oil is being questioned
as reports come in of increased meconium staining
of amniotic fluid, something which is usually
interpreted as an indicator of fetal distress
(and will therefore precipitate further interventions).
In women, there have been reports of thrombosed
hemorrhoids, precipitous labour, nausea, vomiting,
diarrhea, and flatulence as a result of castor
oil.
The long story:
Castorbean is a large perennial plant in the
family Euphorbiaceae. It which grows as a tree
in tropical climates, a slender shrub in warm
temperate climates, and is cultivated as a shrubby
annual in cooler regions (Grieve, 1971). It is
believed to have originated in India (Phillips
and Foy, 1990), but it has been so widely cultivated
for thousands of years that its origins are disputed
(Scarpa, 1982).
Castorbean has been known since ancient times
as a medicine. Castorbean seeds were found in
Egyptian tombs, and Pliny the Elder and Dioscorides
both wrote of the oil’s use as a purgative
(Phillips and Foy, 1990). It appeared in the European
materia medica in 1764 when the English doctor
Peter Cavane published a dissertation on the oil
(Nabors, 1958). It has been widely used in European
medicine as a purgative since then.
The green leaves of castorbean have a wide range
of medicinal applications. The green leaves were
used in the folk medicine of ancient Greece to
treat tumours, including mammary tumours after
childbirth (which were probably blocked or infected
milk ducts) (Scarpa, 1982). Women of the Canary
Islands bind the green leaves to their breasts
to increase their production of milk (Bartram,
1998; Grieve, 1971), as do women in South Africa,
Cape Verde Islands, Madagascar, and Italy (Scarpa,
1982). In India and Pakistan, a decoction of the
leaves is used the same way (Scarpa, 1982). The
leaves are used to relieve engorged breasts in
New Caledonia (Scarpa, 1982). A decoction of the
leaves is used as an emmenagogue in Algeria, where
it is known to have caused permanent sterility
(Scarpa, 1982). The Thonga people of South Africa
wrap premature infants in the leaves of the castorbean
plant; the infant is then placed in a large pot
in the sun (Goldsmith, 1990).
Scarpa (1954) conducted clinical trials of the
application of the leaves or their juice in compresses
to lactating women’s breasts. The treatment
increased milk production considerably, as estimated
by the weight of the babies before and after suckling.
Castorbean seeds are extremely toxic, due to
the presence of the glycoprotein ricin (Scarpa,
1982), but they have been used in small doses
medicinally. They are considered to be a contraceptive
capable of bringing on a late period. Women in
India eat the seeds the day after childbirth to
prevent conception for the next nine months (Scarpa,
1982). In Mexico, the seeds are used to bring
about permanent sterility (Scarpa, 1982).
El Mauhoub et al. (1983) reported a case of an
infant with a series of birth defects that the
authors attributed to the mother’s consumption
of castor oil seeds for eight weeks after conception.
They imply that castorbean seeds are not a safe
contraceptive or abortifacient.
The oil pressed from the seeds of the castorbean
is widely used as a laxative, purgative, and uterine
stimulant for induction of labour. It is used
as a gentle laxative for pregnant women (Phillips
and Foy, 1990), although most herbalists would
not recommend it (or any laxative) as it might
cause premature births (Campion, 1996). It is
used as an emmenagogue and a galactagogue in Somalia
and as a galactagogue in Haiti (Scarpa, 1982).
Women in India and Pakistan smear the oil on their
breasts to relieve mastitis (Dastur, 1962). It
contains a mixture of triglycerides, of which
75-90% is ricinoleic acid, which stimulates the
motor activity of the bowel (United States Dispensatory,
1955).
Its usefulness for labour induction is thought
to be due to its profound effect on the intestinal
tract, which stimulates reflux of the uterus (McFarlin
et al., 1999). It is also absorbed systemically,
and it is not known whether it crosses the placental
barrier (McFarlin et al., 1999).
It was not until the 1920’s that castor
oil gained popularity among physicians for inducing
labour (Nabors, 1958). It remained popular until
the mid 1950’s, when it likely fell out of
favour as oxytocin was introduced and became widely
available (Davis, 1984). It still remains popular
as a folk remedy, and many nurses and midwives
still recommend it to their overdue clients (McFarlin
et al., 1999; Osborn, 1994). A questionnaire sent
to American Certified Nurse-Midwives revealed
that of those respondents who used herbal preparations
to stimulate labour in their practices, 93% used
castor oil. They generally felt most comfortable
using it over other herbal preparations, and they
considered it to be the most effective (McFarlin
et al., 1999).
Castor oil is believed to successfully induce
labour only when the cervix is ripe and the baby
is ready to be born (Campion, 1996; Summers, 1997).
Its ineffectiveness in inducing labour before
the cervix is ripe was reflected in the clinical
trial reported by Nabors (1958). Most of the women
in that study required induction because of complications
such as pre-eclampsia; under those circumstances,
castor oil was found to be less effective than
oxytocin. The author concluded that castor oil
is of no value in inducing labour, and is irritating
and dehydrating besides. In contrast, Mathie and
Dawson (1959) concluded that castor oil might
be useful for stimulating labour after demonstrating
that it caused an increase in uterine activity
in a laboratory setting.
Labour induction with castor oil has been the
subject of a number of scholarly papers in recent
years. Davis (1984) conducted a retrospective
study of the use of castor oil to stimulate labour
following premature rupture of the membranes.
Soon after the membranes have ruptured, the medical
system insists that labour must commence because
of the risk of infection. If labour does not commence
spontaneously within a specified timeframe (currently
24 hours), medical intervention is warranted.
This study demonstrated the effectiveness of castor
oil in inducing labour. Out of 107 women who used
castor oil, 75% went into labour shortly afterwards.
Of the 89 women who did not use castor oil, 58%
went into labour spontaneously. There were nearly
three times as many cesarean sections in the control
group.
Garry et al. (2000) conducted a clinical trial
of castor oil in a group of women whose babies
were overdue. Of the 52 women who used castor
oil, 30 (57.7%) went into labour within 24 hours,
as compared to 2 (4.2%) of the 48 women who received
no treatment.
With regards to the use of castor oil for the
induction of labour, some safety concerns have
arisen in recent years. Mitri et al. (1987) found
in a survey of 498 South African women whose babies
were overdue that meconium passage was found more
commonly in those who had recently taken castor
oil or a herbal preparation called ‘sihlambezo’.
Steingrub et al. (1988) published a case report
of amniotic fluid embolism, associated temporally
with the mother’s ingestion of castor oil;
it is conceivable that the woman’s contractions
were strong enough to result in an embolism. In
a survey sent by McFarlin et al. (1999) to Certified
American Nurse-Midwives, some respondents reported
adverse effects of castor oil including thrombosed
hemorrhoids, precipitous labour, nausea, vomiting,
diarrhea, and flatulence were reported. Two midwives
reported an increase in meconium stained amniotic
fluid- a classic indicator of fetal distress.
The inconsistencies in the level of success of
labour induction with castor oil may come in part
from the huge variations in dosage. McFarlin et
al. (1999) reported dosages from 5 mL to 120 mL
in the practices of American Certified Nurse-Midwives.
Susun Weed (1986) suggests using two ounces (four
tablespoons) of castor oil, two ounces of vodka,
and two or more ounces of orange juice, followed
by a hot shower. The dose is repeated after an
hour, and an enema is given. The dose is repeated
again an hour later, and another hot shower is
taken. Labour should begin three to five hours
after the last dose. I would personally not wish
to have my baby under the effects of 6 ounces
of vodka!
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Also by Rachel:
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