A study has looked at birthing outcomes of 323 women who used castor oil for labour induction, or at least 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 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 a midwife or birth worker who is interested in issues relating to induction, and the evidence that relates to it, you might like to look at my online course, Post-term pregnancy: exploring evidence, inspiring confidence.