Castor oil, bath and/or enema for cervical priming and induction of labour

Kelly AJ, Kavanagh J, Thomas J

Published Online:

May 16, 2012

More research is needed into the effects of castor oil to induce labour.

Sometimes it is necessary to bring on labour artificially. Castor oil has been widely used as a traditional method of inducing labour in midwifery practice. It can be taken by mouth or as an enema. The review of trials found there has not been enough research done to show the effects of castor oil on ripening the cervix or inducing labour or compare it to other methods of induction. The review found that all women who took castor oil by mouth felt nauseous. More research is needed.

Abstract (click to read)

Background:

Castor oil, a potent cathartic, is derived from the bean of the castor plant. Anecdotal reports, which date back to ancient Egypt have suggested the use of castor oil to stimulate labour. Castor oil has been widely used as a traditional method of initiating labour in midwifery practice. Its role in the initiation of labour is poorly understood and data examining its efficacy within a clinical trial are limited. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.

Objectives:

To determine the effects of castor oil or enemas for third trimester cervical ripening or induction of labour in comparison with other methods of cervical ripening or induction of labour.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2003) and bibliographies of relevant papers. We updated this search on 24 February 2012 and added the results to the awaiting classification section.

Selection criteria:

Clinical trials comparing castor oil, bath or enemas used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods.

Data collection and analysis:

A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction.

Main results:

In the one included study of 100 women, which compared a single dose of castor oil versus no treatment, no evidence of a difference was found between caesarean section rates (relative risk (RR) 2.31, 95% confidence interval (CI) 0.77, 6.87). No data were presented on neonatal or maternal mortality or morbidity. There was no evidence of a difference between either the rate of meconium stained liquor (RR 0.77, 95% CI 0.25 to 2.36) or Apgar score less than seven at five minutes (RR 0.92, 95% CI 0.02 to 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 (RR 97.08, 95% CI 6.16 to 1530.41).

Authors' 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.

[Note: The six citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

This record should be cited as:

Kelly AJ, Kavanagh J, Thomas J. Castor oil, bath and/or enema for cervical priming and induction of labour. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003099. DOI: 10.1002/14651858.CD003099

Assessed as up to date:

May 30, 2003

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Induction of labour > Techniques

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Castor oil, bath and/or enema for cervical priming and induction of labour

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