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Castor Oil for Starting Labor

Practice Variation in Cesarean Rates: Not Due to Maternal Complications
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”

Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients.  This analysis shows that:

    Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
    Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
    Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.

This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.

Tips for Choosing a Care Provider - great overview! from Henci Goer

Please note!

There is a vegetable oil called CASTOR Oil, made from castor beans, which is sometimes used to get labor going or for other medicinal purposes.  There is a petroleum product, i.e. motor oil, called Castrol Oil, which could be toxic.  Please do not confuse them!

Please also note - some of the recommendations here are for 4 oz. of castor oil.  This is 2 or 4 times the general recommended dose.  Some moms have tried it and had a riproaring really fast labor with lots and lots of diarrhea.  It probably makes more sense to figure out your body's ideal tolerance for castor oil by starting with a smaller amount, maybe one tablespoon, and working up to more each day.  Some women have found castor oil so untasty that they couldn't stomach it a second time, so there's a gamble here either way.  Good luck!

I've heard that you can purchase castor oil capsules.  Heh!  This is a huge win over trying to get it down in liquid form.  I haven't actually looked for them in stores yet, but if you're motivated . . .

If you're thinking about castor oil but not quite at that stage yet, you could try a general laxative agent.  Some options:

Try castor oil on the glove when you do a looooooong sloooooow cervical stretch. CO works only partly by causing intestinal cramps -- the other part of the effect is by stimulating prostaglandins. That's absorbed through mucus membranes -- including vaginal tissues.

Castor Oil Induction

[Effect of castor oil-diet on the initiation of labor of pregnant rat] - [Article in Chinese]
Gao J, Sun N, Wang F, Hao N.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao 1998 Oct;20(5):367-70

"Ricinoleic acid is likely the chief component to the induction of labor."

[Effects of castor oil-diet on the synthesis of prostaglandin E2 in pregnant rats] - [Article in Chinese]
Gao J, Sun N, Wang F.
Zhonghua Fu Chan Ke Za Zhi 1999 Mar;34(3):147-9

"CONCLUSION: The increased synthesis of PGE2 in the intrauterine tissues is a key of the initiation of labor induced by castor oil-diet, and ricinoleic acid in castor oil-diet might be the active component which induced the initiator of labor."

Use of castor oil in pregnancies at term.
Garry D, Figueroa R, Guillaume J, Cucco V.
Altern Ther Health Med 2000 Jan;6(1):77-9

 CONCLUSIONS: Women who receive castor oil have an increased likelihood of initiation of labor within 24 hours compared to women who
receive no treatment.

There is little in the chochrane database. There have been lots of tiny studies, very few controlled studies. Cochrane only came up with one which they felt was worth including -- and mainly says the subject needs more research, but that use apears harmless (no difference found in mec staining at any rate)

quote from cochrane ": In the one included study of 100 women, which compared a single dose of castor oil versus no treatment, no difference was found between caesarean section rates (relative risk (RR) 2.31, 95% CI 0.77, 6.87). No data were presented on neonatal or maternal mortality or morbidity. There was no difference between either the rate of meconium stained liquor (RR 0.77, 95% CI 0.25,2.36) or Apgar score < 7 at 5 minutes (RR 0.92, 95% CI 0.02,45.71) between the two groups. The number of participants was small hence only large differences in outcomes could have been detected. All women who ingested castor oil felt nauseous. REVIEWER'S CONCLUSIONS: The only trial included in this review attempts to address the role of castor oil as an induction agent. The trial was small and of poor methodological quality. Further research is needed to attempt to quantify the efficacy of castor oil as an induction agent."

I know of research done by obstetricians at Stuttgart Germany. I tried to obtain their results for an article on induction written for the Swiss midwives' journal, but they did not give them to me because of pending publication. They said they used a cocktail of castor oil, almond puree, apricot juice and vervain and spoke of "amazingly good results".

The actions of castor oil according to recent investigations are from prostaglandins and nitric oxide production, because agents that block these actions block the action of castor oil. they have been speculating on this since the 70's at least. its action can still be more complex than this but this is all they have narrowed down so far.  Still don't know which prostaglandins.

Interestingly enough it seems that in the pre-eclamptic uterus the nitric oxide levels are very high. Also they have found not only COX 1 (which would be normal) but COX 2 in large amounts.  COX 2 usually increases rapidly in response to inflammation and immune response.

If you read the literature on the inflammatory response, you will learn that, in general, it is mediated by prostaglandins. The uterus sits against the intestines, so I would imagine that anything irritating the intestines would involve prostaglandins reaching the uterus.  We have another example of this kind of activity  in the well-known connection between urinary tract infections and preterm labor, also.

Castor oil tastes just fine scambled in 3 eggs.

I drank it with soda through a straw.  The straw enabled me to get it WAY back into my mouth avoiding most of the unpleasant taste.

Castor oil cocktail. Take one large glass of orange juice[good for you in many ways!] mix in three teaspoonful of castor oil and one teaspoon of baking soda. It gets nice and foamy. Almost like pop, and goes down much easier than[gag]swallowing castor oil by itself!! BTW, it works by stimulating the bowels, which in turn can stimulate the uterus, so metamucil works too and is much easier to take!!

My recipe includes vodka in the first dosage. It helps with the absorption of the castor oil. I've not heard of the baking soda variety.

One of the very possible side effects of using castor oil is the mom having bad diarrhea with cramps, which is why my midwife suggests steering clear of it! 

Castor oil is the most effective labor initiator I know of. If castor oil, properly administered, does not work, I don't believe she is ready. Once taken, I can almost set a timer to the contractions starting in 4-6 hours (usually 6) which is why I have them take it in the AM after a good night's sleep when possible.

I think castor oil almost always works if the cervix is ripe.

4 ounces, all at once -- any way you can get it down - If it doesn't work, 4 more ounces a few hours later. I have often seen it work within 24 hours, if it doesn't work instantly. I think it causes the intestines to release prostaglandins, which push the mom's hormonal level over the top. I have rarely seen it not work, in a woman who is truly due.

There are many who say you can get the same effect by rubbing the oil on mom's tummy -- that "the prostaglandins" are absorbed through the skin. I don't know if this is true or not-- but we hear it a lot. Does anyone know for certain?

I don't know how that could be true. After all, it's putatively not the castor oil itself that has the PG's, but that the irritation of the gut that it causes produces prostaglandins. Anyway, if that were so, why couldn't you rub it on, say, her arm?

One of my midwifery faculty claimed that the reason she figured it worked was the uterine stimulation caused by the massage. She said that the amount of effort that it takes to massage in castor oil (which is very heavy and viscous compared to, say, olive or almond oil) will rub up some whacking contractions. The "seal" created between the hands and the abdominal skin is quite considerable with castor oil, so she says. Never tried it or suggested it myself.

We tell ladies to put 2 oz. in 4oz. of root beer, place your hand over top of the glass tightly, shake it up, and immediately chug it down (remember doing "slammers" in our young and foolish days in college???). If no labor within 4 hours, may repeat x1.

The root beer "fizz" suspends the oil, so when you chug it down you don't notice the "gloppy" taste of the oil.

Tried it myself with one pregnancy, and if you immediately drink it, you truly can't sense the oil's presence.

I have a suggestion/tip for those who want to try the castor oil method of induction. First of all, let me say it worked wonderfully for me after my midwife stripped my membranes. I found the 2 and 4 oz recipes to be a little much, so started out with 2 tablespoons...then 3 hours later 2 more tablespoons. I tried the orange juice method to make it more palatable and ended up not being able to get it down as the "goopy" feeling of the oil gagged me. I wasted a whole bottle of the oil trying that way. LOL Then I decided to go for the root beer idea. I read on your page to shake up your mixture of rootbeer and oil, so I tried that only to spray rootbeer all over myself and make a sticky mess. So what I did was empty a 20 oz bottle of rootbeer into a cup, make my mixture of 2 tbsp of oil to about 2 oz of rootbeer, pour the mixture back into the bottle, put the lid on and shake. This not only prevents a sticky mess, but also shakes it well and suspends the oil long enough to get it down. I chugged it with no hint whatsoever of the oil, except for afterwards in my mouth and the hot wash cloth washed that right out. This might be a helpful tip to other mothers who have the weak gag reflexes I do.

I do something similar with the castor oil in my practice, use it only for women with a ripe cervix to and the same idea with the rootbeer shake. I have them put it in the blender and have a wet washcloth ready, when you stop the blender you drink right out of the pitcher and wipe your mouth out with the washcloth to avoid the oily feeling in your mouth.

I have had success with castor oil, but I agree with the consensus..... that the mom needs to really due/overdue, and very ripe. "Juicy" is the term that I use. I also have her take consecutive doses, because often one dose will get her going, but will fade out. If you take at least two doses several hours apart, the second dose's effects kick in before the first one is completely gone. I personally took it for my last kid. I used a form of castor oil that was "emulsified" and had a minty flavor. Ghaaaaaa! It worked though!

For moms who like peanut butter, it does a great job of covering up the taste and texture of the castor oil.  Just have a large spoonful of peanut butter ready to eat immediately after you drink the castor oil.

My castor oil recipe is 2 tablespoons, once. I suggest this and strip the membranes. I don't think more is better, or more often. You just start making miserable moms. If the cervix is ripe enough to strip, then I suggest the whole trip. And it works most of the time. They have to be ripe and ready to roll, then you get good results.

Castor oil, like EPO and many other plant oils, contains varying amounts of the essential fatty acids that the body uses to manufacture prostaglandins. I guess you could absorb some of them from topical administration...the Edgar Cayce people (are there any of you on this list?) have written a lot about using castor oil in many and various ways, including for perineal massage. (I read about this one long day spent browsing through a bookstore).

My understanding of how castor oil works t stimulate labor is that the intestinal contractions cause a reflex muscular contraction in the uterus, and if the cervix is primed and the baby ready, the reflex contractions gradually mellow into real labor contractions.

I had a lady a few years ago who had been prodroming for 2 or 3 days, not sleeping, getting crabbier and crabbier. When I checked her, I noticed a hard lump in the rectum...I suggested that she try to get some sleep (valerian, warm bath, etc.) and that then she should try a fleets enema for her own comfort. Well, she decided to forget about trying to sleep. did the fleets, and went into booming labor 2 hours later, gave birth about 6 hours after that. Since then, I have seriously been thinking about what role, if any, constipation plays in the prolonged latent/prodromal labor scenario. Routine enemas are one thing that I am glad is gone, and most moms naturally empty their bowels during the prelabor stages. But I do think there is a place for enemata or purges for the few moms who are miserable and both constipated and laboring.

If and when I use castor oil I have them put 4 ozs. in a glass of chocolate slim fast. It goes down without that after taste.

Although my experience is limited with this, my recommended dose is: 4 oz in whatever liquid preferred (usually with ice cream as a "milk shake" b/c the taste is pretty disguised this way) at the completion of the drink, start blue and black cohosh in water or tea, every 1/2 hour, alternating between the two herbs. I don't expect to see any contractions until about 4 hours. It takes at least that long before things kick in. Also, I like to wait until the mom is 10 days past her due date. If nothing starts by 5 hours, either dose again with 4 oz or wait another day and try again from the top.

I personally have used castor oil for two labors. One was PROM (during a hurricane low pressure) and the baby was born 8 hours later (40 +1) and the other was 41 +5 and labor started 5 hours from first dose with birth at 7 1/2 hours (2 1/2 hour labor, some of which was at the movie theater, but that is another story)

Success has been pretty good, but I think that it is the combination of the herbs, tea, post dates and the castor oil, as well as the expectation that this is ONLY A NUDGE toward labor, not an induction. IT WILL TAKE TIME, so the hope that one will drink the stuff and instantly start labor is a bit much. All that said, it does give a mom who wants to avoid the hospital and who is at home waiting, waiting, waiting, at bit of hope that we are trying something. Since we can only stay home until 42 weeks, it gives us a little time. I think that it is prudent to always monitor moms during these attempts, if even just for peace of mind. I am also going to use Goldenseal as discussed on the list.

This Web page is referenced from other pages containing related information about Non-Pharmaceutical Induction.


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