Castor oil for labour induction

A study has looked at birthing outcomes of 323 women who used castor oil as part of an attempt to induce their labour, with interesting results. The study was carried out in the US where, in contrast to countries like the UK, Australia and New Zealand, castor oil is quite commonly used or recommended by midwives and women as a way of inducing labour.

Almost 91% of the women gave birth vaginally after this intervention, and the authors note that this is significantly higher than the national average. I applaud any attempt to look at alternative ways of helping women, because it is clear that the current system does not serve us well. But, as the authors themselves note, it is also important to understand that there are a number of things that this kind of study can’t tell us. This isn’t a randomised controlled trial, so we’ve got no way of comparing the women in this study to women who chose other paths, such as waiting for the onset of natural labour or opting for medical induction. We can’t know whether the outcomes were to do with the castor oil or some other factor, such as (for instance) the fact that the women were being cared for by nice midwives or that they lived in a particular part of the world. It is important to bear in mind that some of the women in this study also used other methods of induction, such as artificial rupture of membranes, so it is impossible to separate out and compare different methods.

One finding will be particularly helpful for those considering using castor oil though. A concern that some people have about the use of castor oil for this purpose is the possibility of experiencing unpleasant side effects such as nausea, vomiting and extreme diarrhoea. The findings of this study showed that 7% of the women in the study experienced such side effects, and this result raises a number of points which we might consider. The first is which is to note that, because castor oil is a laxative, some diarrhoea is probably inevitable. We might assume that all women in the study experienced some diarrhoea, but the results don’t tell us that and I must admit that I would have liked to know more about that aspect of the womens’ experiences, for the sake of being able to give good information to women considering this option.

For some women, having a 1 in 14 chance of such side effects may be OK, but for others it may be too high. If women are deciding between using castor oil for induction and using medical methods of induction, then the potential risks and side effects of the medical induction methods (and any change in birth setting) need to be considered as well, but there are so many factors involved and different people will feel differently about them. That’s why it is so important that we create spaces where women can decide what is right for them.

I do wish that people would stop describing methods of labour induction as ‘natural’, however. (I’ve ranted about this before, I know). I understand that castor oil is preferable to medical induction for many people, but the key thing to bear in mind is that it isn’t an alternative to induction. It is a form of induction, and the ‘natural’ alternative is to await spontaneous labour.

If you’re interested in issues relating to induction, you might like to look at my online course, Post-term pregnancy: exploring evidence, inspiring confidence.

 

DeMarie AL, Sundstrom B, Moxley GE (2017). Castor oil as a natural alternative to labor induction: A retrospective descriptive study. Women and Birth. https://doi.org/10.1016/j.wombi.2017.08.001
photo credit: Martin LaBar (going on hiatus) castor bean fruit via photopin (license)

6 comments for “Castor oil for labour induction

  1. Annabel Bryant
    November 9, 2017 at 11:33 am

    Hi Sara

    Thank you for sending out this research.

    You have written Almost 91% of the women gave birth vaginally after this intervention, and the authors note that this is significantly lower than the national average

    Did you mean to write “Almost 91% of the women gave birth vaginally after this intervention, and the authors note that this is significantly HIGHER than the national average”

    91% of women giving birth vaginally is phenomenal, how can that be lower than the national average or am I misunderstanding something.

    Best wishes

    Annabel

    • November 10, 2017 at 11:57 am

      Oh well spotted, thank you. You are correct, and we have remedied our error. Thanks for pointing it out 🙂

  2. Keeley Bryan
    November 9, 2017 at 8:29 pm

    What I find fascinating is when speaking to retired midwives they tell of an age where women who went over due were often given an enema prior to admittance to hospital for medical IOL and would then often return in established labour. Castor oil has the double effect of loose bowels and vomiting which appear to work for many women. Is it not therefore the action upon the bowel which can trigger things? Maybe a randomised trial of administering an enema at home before medical induction is commenced might be worth doing also. Just a thought x

  3. Nicky
    November 11, 2017 at 6:02 am

    On the 3 occasions women I’ve cared for have taken this at home there have been very precipitate births, one stillbirth and one placental abruption. I caution women there isn’t the evidence to say it’s safe and would be interested to know others experiences.

  4. Meghan
    November 13, 2017 at 2:37 pm

    I have heard Midwives discourage this form of induction as they have said it can lead to increased interventions. Their rational was thay castor oil also reaches the baby and can lead to increased bowel movement or diarrhoea in both Mum AND baby . This may lead to the presence of meconium in the waters and thus additional interventions based on the mistaken belief that the presence of meconium is due to distress in the baby rather than being due to having been administered a laxative shortly before birth. The presence of meconium likewise increases the risk of meconium aspiration which could cause care givers to want women to deliver more quickly. Therefore the Midwives I have spoken to over the years firmly discourage the use of castor oil as it can lead to a fairly direct cascade of interventions. Just because the study says the women gave birth vaginally that does not tell us whether there was any meconium present or whether there were further interventions involved with the vaginal delivery. Vaginal doesn’t necessarily equate to ‘good’, ‘normal’, ‘without injury,’ ‘without agumentation’, etc., etc. Would be very interesting to hear more about this aspect.

    • Meghan
      November 13, 2017 at 2:39 pm

      *rationale* Silly autocorrect!

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