Coquelet & Punger Family Medicine P.A., Ft. Pierce, Florida

Herbal Labor Inductions: Are they Safe?
By Denise Punger MD FAAFP IBCLC

My third labor lasted easily over 12 hours giving me time to emotionally adjust to the escalating physical demands and surprise of my labor. Over and over, now that I am in private practice, I am hearing about intense labors that occur in two hours or less! Women often express delight about their miraculously quick labors (as if a quick labor were the goal)... But I don't sense an emotional, physical, or spiritual satisfaction accompanying these seemingly precipitous deliveries. The commonality I have noticed in these quick births -- is the use of herbals to bring on labor and augment contractions. Many women are attracted to the idea of using herbals to induce labor. I am all for the use of herbs in many conditions, but labor is not a condition and I can't support their use to hasten birth. Midwifery Today presented a question of the week that allows me to address my concerns over what seems to be a harmless intervention that some birth practitioners employ that I do not agree with (and some mothers actually initiate themselves without telling their birth care provider): Source: Midwifery Today E-News 'VBAC - Vaginal Birth after Cesarean'

Question of the Week

Q: I have used (alone and in a five-week preparation) blue cohosh in six of my ten births. Some of the babies were "in distress," but only one had meconium and all had good Apgar scores. I have read some bad press lately about blue cohosh as a "stressor" and possible heart compromiser. Has alternative medicine backed away from the use of this herb or is it still considered a good herb to use for preparation and in labor/delivery? My daughter is 21 weeks pregnant and would like to use the same five-week preparation that I used in my last birth, but she is hearing some pretty scary stories from my sister (also pregnant).

Dear Editor:

I am glad to see Midwifery Today addressing the safety of herbs for labor. I have several concerns.

I've wonder why anyone who promotes homebirth wants to routinely use herbs to induce or augment labor. When I refer to 'natural birth,' I literally mean natural - our womanly bodies birthing without intervention (including herbs taken internally). A homebirth does not equal a 'natural birth' if Blue and Black Cohosh are used to induce.

Having made that distinction, let's make sure when discussing safety we discuss route of administration, dosage and frequency. One birth provider might me swear that a cohosh tea is safe, but only share, 'Cohosh is a good tool in her practice.' Another provider might interpret that as meaning, 'A tincture or injection is just as safe.' Obviously they are not equally potent options.

In my Breastfeeding Medicine based-practice I am seeing babies whose mothers report to me that they received various forms of cohosh in labor: teas, tinctures, and injections (possibly even a cervical topical). I have noticed a trend with these babies: prematurity, cardiovascular distress, jaundice, meconium, failure to thrive, suck dysfunctions, and hospitalizations. The mothers report to me contractions on top of each other, very intense labors and hemorrhaging. Many of these women are taking these herbs prior to 38 weeks and deliver in the 37th week. I am suspicious that many homebirth transports and neonatal admissions could be explained by the side effects of the herbals.

I think the author of this weeks question answered her own question and observed in her own babies the same results I see. Distress and meconium are not necessarily routine problems of the neonatal period. In the author's case and in the cases I see they are iatrogenic and could have been prevented.

Incidentally, my own definition of prematurity is inclusive of all babies being induced prior to the onset of spontaneous labor even if it's an herbal induction.

How ironic it is that this question comes up in a VBAC (vaginal birth after cesarean) prevention issue of e-news. Most of your readers would educate clients not to take pitocin or cytotec if they attempt a VBAC to prevent uterine hyperstimulation. It is time to seriously consider the consequences of herbal induction and potential hyperstimulation and rupture in our VBAC clients.

Some midwives might rebuttal that use of these herbs is appropriate if a client is approaching 42 weeks, term rupture of membranes, or failure to progress. These herbs if used in these cases are probably safer than transport. But, I stress that if it comes to these situations then it is not just 'routine' use and the clients have a right to informed consent. The goal in using internal intervention in labor should be to use only what is needed and not more AND only if there is good reason.

As you see, I am very concerned about the use of the cohoshes. Let's not be to cavalier about there routine use.

If you enjoy this article, you will enjoy the book Permission to Mother which includes the updated version.