The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
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
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
of castor oil-diet on the initiation of labor of pregnant rat] - [Article
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."
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
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.
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