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Castor Oil Safety and Effectiveness on Labour Induction and Neonatal Outcome

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Abstract

Castor oil is one of the most popular methods for labour induction. The use of castor oil to induce labor is controversial. The irregular, painful contractions of castor oil-induced labor can be stressful on the mother and fetus. The use of castor oil may stimulate passage of meconium, and thus, neonatal respiratory distress that may result from meconium aspiration. So, the aim of this study was to assess safety and effectiveness of castor oil on labour induction and neonatal outcome. Subjects and Methods: a quasiexperimental design was used. The study was conducted in a private hospital at Makkah Al Mukaramah. One hundred pregnant women who attended the hospital for giving birth was selected from the previously mentioned setting. The sample was divided as follow: 50 women already took castor oil and 50 women didn't take castor oil at the time of birth. Results: there were a lot of maternal complications that had been occurred among castor oil group in comparison with control group such as fatigue (12.0%), nausea & vomiting (20.0%) and excessive uterine activity (12.0%) compared to (8.0%, 4.0% ,4.0%) from the control group respectively. About one fifth 18 % of castor oil group had amniotic fluid mixed with meconium. In addition, a highly statistical significant difference was found between the two groups at the first minute APGAR score (t=2.65 at p=0.009). Conclusion: It can be concluded that, the probability of labour initiation increases during the first 24 hours after using castor oil. In addition, taking castor oil increases the chances of meconium stained amniotic fluid. Most side effects caused by taking castor oil are fatigue, nausea, vomiting and diarrhea. Also, castor oil affected newborn's APGOR score at the first minute. Key words: Castor oil, labour induction, neonatal outcome
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ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
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Castor Oil Safety and Effectiveness on Labour Induction and
Neonatal Outcome
Sahar Mansour Lamadah
1,4
, Hoda Abed El-Azim Mohamed
2,4
, Sahar Mahmood El-Khedr
3,4
1 Lecturer of Obstetric and Gynecological Nursing, Faculty of Nursing, Alexandria University,
Alexandria, Egypt
2 Assistance professor of Obstetric and Gynecological Nursing , Faculty of Nursing, El Minia University,
El Minia, Egypt
3 Assistance professor of Pediatric Nursing, Faculty of Nursing, Tanta University, Tanta, Egypt
4 Faculty of Nursing, Umm Al Qura University, Makkah Al- Mukarramah, KSA
E-mail of the corresponding author
: dr.saharlamadah@yahoo.com
Abstract:
Background: Castor oil is one of the most popular methods for labour induction. The use of castor oil to
induce labor is controversial. The irregular, painful contractions of castor oil-induced labor can be stressful on
the mother and fetus. The use of castor oil may stimulate passage of meconium, and thus, neonatal respiratory
distress that may result from meconium aspiration. So, the aim of this study was to assess safety and
effectiveness of castor oil on labour induction and neonatal outcome. Subjects and Methods: a quasi-
experimental design was used. The study was conducted in a private hospital at Makkah Al Mukaramah. One
hundred pregnant women who attended the hospital for giving birth was selected from the previously
mentioned setting. The sample was divided as follow: 50 women already took castor oil and 50 women didn't
take castor oil at the time of birth. Results: there were a lot of maternal complications that had been occurred
among castor oil group in comparison with control group such as fatigue (12.0%), nausea & vomiting (20.0%)
and excessive uterine activity (12.0%) compared to (8.0%, 4.0% ,4.0%) from the control group respectively.
About one fifth 18 % of castor oil group had amniotic fluid mixed with meconium. In addition, a highly
statistical significant difference was found between the two groups at the first minute APGAR score (t=2.65 at
p=0.009). Conclusion: It can be concluded that, the probability of labour initiation increases during the first 24
hours after using castor oil. In addition, taking castor oil increases the chances of meconium stained amniotic
fluid. Most side effects caused by taking castor oil are fatigue, nausea, vomiting and diarrhea. Also, castor oil
affected newborn's APGOR score at the first minute.
Key words: Castor oil, labour induction, neonatal outcome
1. Introduction:
Labor is a process through which the fetus moves from the intrauterine to the extra uterine environment. It is a
clinical diagnosis defined as the initiation and perpetuation of uterine contractions with the goal of producing
progressive cervical effacement and dilation (Pillitteri A 2010, Ricci S 2009, Josie l 2003). In an attempt to start
labor, some women will drink a mixture of castor oil and juice. The various recipes for this mixture are generally
called a "midwife cocktail." The recommended dosage of castor oil varies. It can be between 2 to 4 ounces.
Repeated doses may also be needed (Gao et al 1998). Because castor oil is unpalatable alone, it is mixed with
orange juice, grape juice, or tea. Some recipes encourage large volumes of juice to dull the flavor of the oil.
Other recipes use only equal amounts of oil and juice so the mother has less to drink. This is only one of several
non-medical techniques used to try to induce labor, and may be used in combination with other natural
techniques (Davis L 1984).
Castor oil has long been used throughout history. In some countries, castor oil is used to terminate pregnancy if it
is unwanted or unplanned. In Mexico, women eat the seeds of the castor bean in order to cause permanent
sterility. Women in India eat the seeds the day following birth in order to prevent pregnancy for the next nine
months. It was reportedly
used for medicinal
purposes in Ancient Egypt and in the early middle ages in
Europe. It was then regarded as a folk medicine (Leino, L 2009).
The United States Food and Drug Administration (FDA) has categorized castor oil as "generally recognized as
safe and effective" for over-the-counter use as a laxative, with its major site of action the small intestine
(Thomson M 2007) . Although it may be used for constipation, it is not a preferred treatment, because it can
produce painful cramps, fecal incontinence and explosive diarrhea. Its action can go on for hours, sometimes
unpredictably and powerfully causing an involuntary bowel movement at inconvenient locations and during
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sleep (Gana, A et al 2013). The use of castor oil to induce labor is controversial. One study showed that women
who received castor oil have an increased likelihood of initiation of labor within 24 hours compared to women
who did not receive. Following administration of castor oil, 30 of 52 women (57.7%) began active labor
compared to 2 of 48 (4.2%) receiving no treatment) (
Garry D
et al 2000). Castor oil, when ingested, triggers
cramping in the bowel, making it an effective laxative. Thus, it is intended that such cramping extends to the
uterus. One reason castor oil might work on the uterus to stimulate contractions, is its effect on the smooth
muscle tissue, of which the uterus is composed of. In an overdue pregnancy in which the mother's cervix is
already effacing and partially dilated, this cramping can lead to labor contractions (
Burdock GA et al
2006).
Significance of the study:
The irregular, painful contractions of castor oil-induced labor can be stressful on the mother and fetus. It also
leaves the laboring woman quite dehydrated as a result of the vomiting and diarrhea which result when the
recommended dose of castor oil for labor induction is taken, about 4 tbsp (Davis L 1984). This leaves mother
without access to the energy she could otherwise derive from food or drink throughout her labor process. In
addition, the use of castor oil to induce labor may stimulate passage of meconium, and thus, neonatal
respiratory distress that may result from meconium aspiration. Using castor oil for induction is not
recommended without consulting a medical practitioner and is not recommended in a complex pregnancy
(Sullivan M 2010).
2. Aim of the study:
The aim of this study was to assess safety and effectiveness of castor oil on labour induction and neonatal
outcome.
3. Hypothesis of the study:
Women who drink castor oil will have labour initiation within 24 h.
Women who drink castor oil will experience maternal and neonatal complications during labor than
those who do not drinking castor oil.
4. Subjects and Methods:
4.1 Research design:
Research design used for the study was a quasi-experimental design.
4.2 Research setting:
The study was conducted in a private hospital at Makkah Al Mukaramah.
4.3 Research subjects:
One hundred pregnant women who attended the hospital for giving birth was selected
from the previously mentioned setting; the sample was divided as follow:
50 women already took castor oil
50 women didn't take castor oil at the time of birth.
The women were recruited for this study according to the following criteria:
Inclusion criteria:
Cephalic presentation.
No contraindications to vaginal delivery.
Not use other induction agents.
4.4 Tools of data collection:
Tools used for data collection consisted of:
An Interviewing Assessment Sheet: It was designed by the researchers and consisted of three parts:
Part I: is concerned with socio - demographic data such as age, level of education,
occupation and residence.
Part II: is concerned with obstetrical history. It consisted of closed ended questions
related to number of pregnancy, deliveries, abortions and previous delivery problems
if present.
Part III: is concerned with history of the present pregnancy, delivery and castor oil
intake and its effect on labour induction and neonatal outcome.
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Partograph: It is a standardized design done by WHO (1994) to help in the management of labor.
(12)
This Partograph is basically a graphic representation of the event of labor plotted against time. The fetus is
monitored closely on the Partograph by regular observation of the fetal heart rate and color of liquor. Uterine
contractions (intensity, duration and frequency in 10 minutes) and maternal vital signs are also assessed.
Apgar scoring: it is designed by Apgar (1966) for rapid evaluation of the infant's cardio respiratory
adaptation after birth and for evaluating the newborns' need for resuscitation.
(13)
This method (Apgar score)
consists of five variables (heart rate, muscles tone, respiratory effort, reflex irritability and color) are evaluated
at one and five minutes after birth.
Scoring of Apgar:
A score of 0, 1, 2, is assigned for each variable. A score of 10 indicates that the newborn in the best
possible condition and needs only brief oral and nasal suction to clear the airway. A score below 7
indicates that the infant requires immediate further attention by the physician usually a pediatrician.
4.5 Preparatory phase
Researchers reviewed the current local and international related literature using textbooks, articles, and
scientific magazines. This helped the researchers to be acquainted with the problem and guided them in the
process of tools designing.
4.6 Validity & Reliability:
To measure content validity of the tools, the researchers assure that items of an instrument adequately represent
what are supposed to measure by presented it to experts for revision and validation. Also, using partograph to
monitor maternal, fetal condition and progress of labor and using Apgar scoring system for evaluating the
newborns' need for resuscitation are considering a standard evidence that support validity of the tools.
To measure the stability of the responses from the same woman and is a form of test retest reliability, the
researchers make two separate assessment at two different times. These two data sets from the same woman are
then compared with each other using r value. In general r value consider good if they equal response.
4.7 Administrative design:
An official letter clarifying the purpose of the study was directed to the manager of the private hospital
requesting his approval for data collection to conduct the study.
4.8 Pilot Study:
A pilot study was conducted with a representative sample of ten women representing 10% of the total study
sample to assess the reliability and applicability of the tool. The results of the pilot study helped in the necessary
modifications of the tool in which omission of unneeded or repeated questions, adding missed questions was
done. The sample of the women who shared in the pilot study was excluded from the main study sample.
4.9 Field work:
The researchers attended the selected hospital two days per week, from 8.00 am. to 12.00 pm. The researchers
introduced themselves to the selected women and briefly explained the nature of the study. Then women's
consent was obtained. Each woman was interviewed to collect socio- demographic and obstetrical history. After
that, for women in castor oil group, the researchers asked them by using closed ended questions about castor oil
intake that were received at the time of birth. The researchers immediately recorded all women's answers and
expressions. Each interview took for 15-20 minutes with each woman in control and castor oil groups and then
women were observed throughout labor.
The effect of castor oil intake on labor induction and neonatal outcome were assessed. The effectiveness of
castor oil to induce labour was expressed as time of beginning true uterine contractions after taking oil until
birth. Measures associated with safety monitored with a WHO Partograph included fetal distress, Meconium-
stained amniotic fluid, tachysystole (excessive uterine activity), abnormal maternal blood pressure during labour,
mode of delivery, APGAR score, neonatal resuscitation, post-partum hemorrhage and severe diarrhea. The fetal
heart rate is observed through electronic fetal monitoring. Fetal distress was defined as a fetal heart beat
repeatedly above 160 or below 120 beats per minute. Uterine tachysystole was defined as more than five
contractions within ten minutes. Maternal blood pressure was defined as abnormal when it is above 140/90, or
below 90/60 mmHg, and severe diarrhea as diarrhea necessitating intravenous fluid replacement. The researchers
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Vol.4, No.4, 2014
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observed complications that occurs during labor and recorded it and estimated duration of labor for both groups.
The field work lasted for six months. It started from January 2013 to June 2013.
4.10 Ethical consideration:
Obtaining the acceptance of women to participate in the study.
All women were informed that participation is voluntary and that the collected data would be only used for
purpose of the study, as well as for their benefit.
A code number was used for every woman to maintain confidentiality.
4.11 Statistical Design:
Data was collected, coded, tabulated and analyzed, using the SPSS computer application for statistical analysis.
Descriptive statistics was used to calculate percentages and frequencies. Significance test was used to estimate
the statistical significant differences. A significant P-value was considered when P- value less than 0.05 and it
was considered highly significant when P- value less than or equal 0.01.
5. Limitations of the study:
Little number of the researches related to the effectiveness of castor oil to induce labour so further extensive
and intensive researches is needed in this area.
6. Results:
6.1 Socio-demographic characteristics of the women:
As shown in table (1), the mean age of castor oil group was 27.52+5.856 compared to 30.2+5.806 of control
group. More than one half of both groups (56.0%) had primary, intermediate and /or secondary education. In
addition, most of the women from castor oil and control group (80.0%, 88.0%) respectively were housewives.
Moreover, more than three quarters of women from castor oil group (76.0%) lived in rural area compared to
64.0% of control group.
6.2 Obstetrical history:
As shown in figure (1), only (10%) of women from castor oil group delivered by cesarean section compared to
6.0% from control group. Furthermore, there were a lot of maternal complications that had been occurred
among castor oil group in comparison with control group such as fatigue (12.0%), nausea & vomiting (20.0%)
and excessive uterine activity (12.0%) compared to (8.0%, 4.0% ,4.0%) from the control group respectively. In
addition, 10.0 % of women from castor oil group suffered from severe diarrhea compared to none of the control
group (0.0%). As regards to neonatal complications, 16.0% of newborn from castor oil group suffered from
suffocation as compared to 8.0% from control group. In addition, 32.0 % of newborn from castor oil group
suffered from bluish coloration in all body compared to 12.0% from control group (Table 2).
6.3 Fetal condition:
As regards to fetal condition, the results of the study showed that the mean fetal heart rate among the castor oil
group were (139 +.13.7) as compared to (113.6 + 20.77) in the control group with statistically significant
differences between the two groups (t. =7.21 at p=0.000) while there is no statistically significant differences
between the two groups regarding to fetal movement. As regarding neonatal APGAR scores, the results of the
present study showed that highly statistical significant difference was found between the two groups at the first
minute APGAR score (t=2.65 at p=0.009). (Table 3)
6.4 Amniotic fluid condition:
Majority of the women in control group had transparent amniotic fluid (94%) as compared to (82%) in the
castor oil group. Only 6.0% in control group and 18 % of castor oil group had amniotic fluid mixed with
meconium. A highly statistical significant difference was found between the two groups (Z=2.41 at p=0.01).
(Figure 2)
6.5 Castor oil:
As shown in figure (3), the most common cause for taking castor oil was labour induction (35%) followed by
facilitating labour process (28%) while lubrication to empty the intestine (25%) and 12% of women received
castor oil after they became postdate. Table (4) illustrates castor oil intake, it can be observed that, the most
common person who prescribed castor oil were the relatives and friends (42.0%) followed by the physician
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(28.0%). Less than two thirds of women (60.0%) received castor oil after 40 weeks of gestation. In addition,
(74.0%) of women used 50 ml of the oil, most of them (82.0%) mixed it with juice. Uterine contractions began
after 2 hours from castor oil intake among (44.0%) of women.
6.6 Labour duration:
As shown in table (5), the mean duration of first, second and third stage of labor in the castor oil
group was shorter than in the control group (5.16, 49.28 & 24.78) compared to (6.84, 60 & 30) respectively. A
statistically significant difference were found between the two groups in relation to first, third stages of labor
and the total duration of labor. (t. = -2.39 at p=.01), (t. =2.87 at p=.005) and (t. =2.93 at p=.004) respectively
6.7 Labor characteristics:
Regarding the relationship between amounts of castor oil taken and labor characteristics, table (6)
showed 10.0 % of women who drank 100 ml castor oil had amniotic fluid mixed with meconium and 8.0 % of
them delivered by cesarean section, this correlation was highly statistically significant (X
2
. =16.26 & p=.001)
and (X
2
=14.49 & p=.002) respectively. Moreover, 14.0 % of women who drank 100 ml castor oil had uterine
contractions began immediately after taking oil. However, the difference is statistically highly significant (X
2
=25.89 at p=.01).
Table (1): Distribution of the women by their socio-demographic characteristics
Socio-demographic characteristics
Castor oil group
(N = 50) Control group
(N = 50)
N. % N. %
Mean Age
Level of education:
Illiterate /Read and write
Primary/Intermediate/Secondary
University
Occupation :
Working
House wife
Residence
Urban
Rural
27.52+5.856
5
28
17
10
40
12
38
10.0
56.0
34.0
20.0
80.0
24.0
76.0
30.2+5.806
8
28
14
6
44
18
32
16.0
56.0
28.0
12.0
88.0
36.0
64.0
Figure (1): Distribution of the women according to mode of present delivery
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Table (2): Distribution of women according to their complications during labor
Items
Castor oil group
(N = 50) Control group
(N = 50)
N. % N. %
Maternal complications*
No complications
Prolonged labor
Bleeding
Fatigue
Nausea and vomiting
Excessive uterine activity
Hypertension
Cervical laceration
Severe diarrhea
Neonatal complications*
No complications
Suffocation
Bluish coloration in all body
Respiratory distress
20
4
1
6
10
6
2
2
5
34
8
16
5
40.0
8.0
2.0
12.0
20.0
12.0
4.0
4.0
10.0
68.0
16.0
32.0
10.0
30
7
3
4
2
2
1
2
0
40
4
6
1
60.0
14.0
6.0
8.0
4.0
4.0
2.0
4.0
0.0
80.0
8.0
12.0
2.0
*Multiple response questions
Table (3): Distribution of women according to fetal condition
Items
Castor oil group
(N = 50) Control group
(N = 50) t. P.
value
X +S.D X +S.D
Fetal heart rate
Fetal movement 139
3.38 13.7
1.17 113.6
3.84 20.77
2.15 7.21
1.32 *.000
.188
First minute Apgar score
Fifth minute Apgar score 7.32
8.26 .767
.650 7.66
8.48 .478
.677 2.65
1.53 *.009
.127
Figure (2): Distribution of women regarding condition of amniotic fluid
(Z=2.41 at p=0.01).
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Figure (3): Causes of taking castor oil as reported by the women
Table (4): Distribution of the women in relation to castor oil intake
Items
Castor oil group (n = 50)
N. %
Person who prescribe the castor oil
Physician
Relatives and friends
Nurses
Mothers
14
21
9
6
28.0
42.0
18.0
12.0
Time of tak
ing castor oil
After 37 weeks of gestation
After 40 weeks of gestation
With the beginning of labor pain.
Amount of castor oil taken
20 ml
50 ml
100ml
150 ml
Mixing castor oil with juice
Yes
No
Onset of uterine contractions after taking oil
Immediately
After 2 hours
After 4 hours
After 6 hours
After 8 hours
3
30
17
3
37
9
1
41
9
17
22
4
2
5
6.0
60.0
34.0
6.0
74.0
18.0
2.0
82.0
18.0
34.0
44.0
8.0
4.0
10.0
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Table (5): Comparison between castor oil group and control group in relation to labour duration
Items
Castor oil group
(N = 50) Control group
(N = 50) t. P.
value
X +S.D X +S.D
First stage (hrs)
Second stage (min)
Third stage (min)
Total duration of labor (hrs)
5.16
49.28
24.78
5.88
3.77
33,40
6.97
3.82
6.84
60
30
12.5
3.21
9,69
3.77
3.29
-2.39
.59
2.87
2.93
*.01
.55
*.005
*.004
Table (6): Relationship between amounts of castor oil intake and labor characteristics
Items
Amount of Castor oil (%) Total X
2
P. value
20ml 50ml 100ml 150ml
6.0% 74.0% 18.0% 2.0%
Condition of amniotic
membrane
Transparent
Mixed with meconium
6.0
0.0
68.0
6.0
8.0
10.0
0.0
2.0
82.0
18.0
16.26
*.001
Mode of delivery
Normal
Cesarean section
6.0
0.0
72.0
2.0
10.0
8.0
2.0
0.0
90.0
10.0
14.49
*.002
Time of beginning of
uterine contractions after
taking oil
Immediately
After 2 hours
After 4 hours
After 6 hours
After 8 hours
4.0
2.0
0.0
0.0
0.0
16.0
40.0
8.0
0.0
10.0
14.0
0.0
0.0
4.0
0.0
0.0
2.0
0.0
0.0
0.0
34.0
44.0
8.0
4.0
10.0
25.89
*.01
7. Discussion
The aim of the present study was to assess safety and effectiveness of castor oil on labour induction and neonatal
outcome. Results of the current study supported the following investigated hypothesis that women who drank
castor oil had labour initiation within 24 h and neonatal complications than those who did not drink castor oil.
Induction of labor is "the act of stimulating the uterus to begin labor", with the intent of bringing about the birth
of a woman's baby prior to spontaneous physiologic initiation of labor. A castor oil induction consists of taking
castor oil orally in an attempt to induce labor naturally (Knoche A et al 2008, Fraser D& Cooper M 2003).
As regards to the socio demographic characteristics of women, it was found that the mean age among the castor
oil and control groups was (27.52 and 30.2 years) respectively. As regards to the educational level, the results
showed that, more than one half of women from both groups had primary, intermediate and /or secondary
education. This may reflect women's cooperation during the study. As regards to their occupation, it also found
that, most of the women in both groups were house wives. Moreover, more than three quarters of women who
took castor oil were from rural area. Rural women seem to hold on to their traditions more strongly than their
urban counterparts. Modernization has brought with it medical dominance.
In relation to the mode of delivery, the current study referred that a minority from each group delivered by
cesarean section. These results are in line with the results of a study done by Kelly et al (2010) who reported that,
no evidence of a difference was found between caesarean section rates among the two groups. The results are
also congruent with the results of
Azhari S, et al (2006) who
stated that in the castor oil group, 79.2% of cases
and 52.2% of the control group had normal vaginal delivery, so there was no significant difference between
delivery methods in both groups according to chi-square test (p>0.05). However, the results of present study
contradicted with the results of a study done by Ravani et al (2006) who showed that there were nearly three
times as many caesarean sections in the control group (22.5%) compared to the castor oil group (7.5%).
Leino, L. (2009) reported that drinking castor oil that is supposed to induce labor can cause strong diarrhea and
vomiting in the mother. This result is accord with the result of the present study which indicated that one fifth of
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woman from castor oil group complained from nausea and vomiting while 10% of them had severe diarrhea.
Also Kelly et al (2010) concluded that all women who ingested castor oil felt nauseous. Moreover, The expected
maternal side effects of castor oil, which includes watery stools and nausea, did occur in almost patient in the
study done by Ravani M ( 2006).
The present study revealed that there is a highly statistically significant difference between the two groups as
regards to first minute APGAR score while no significant difference were detected between two groups at five
minute APGAR score, this may be due to the effect of castor oil which may cause neonatal suffocation and
respiratory distress immediately after birth. This result is in agreement with the results of a study done by Ravani
M., (2006) who reported that all newborn neonates had a 5- minute APGAR score greater than 7 .
About one fifth of women from castor oil group had meconium stained amniotic fluid compared to a minority
from control group. A highly statistical significant difference was found between the two groups. This result is in
line with the result of a study carried out by gelderen et al (1987) who found that meconium passage was more
common in women who had recently taken castor oil . These results are contradicted with the results of the study
done by
Azhari et al (2006),
who reported that the incidence of meconium-stained amniotic fluid was 3 times
more common in the control group (13%) than in the castor oil group (4.3%), but the difference was not
significant according to the Fisher’s exact test (p>0.05). In addition, Garry et al (2000) did not detect a
significant difference between the incidence of meconium stained amniotic fluid in castor oil and control group.
Also, Boel et al (2009)
concluded that no harmful effects for the mother or neonate following the use of castor
oil to induce labour were observed. Moreover, a 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. 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 or Apgar score less than seven at five minutes between the two groups
(Kelly et al 2010).
The results of present study show that more than two fifths of woman who drank castor oil had labour initiation
after two hours. However, these results are supported by a study done by Garry
et al
. (2000) which indicated that
57.7% of women who received castor oil began active labor compared to 4.2% receiving no treatment. The
bowel stimulation by the castor oil induction triggers the production of prostaglandins, which are hormones that
contracts the smooth muscles of bowls and uterus. While
Azhari S, etal (2006) concluded that
there was no
hyper stimulation of uterus in the castor oil group. Also, Boel et al (2009) reported that castor oil for induction of
labour had no effect on time of birth nor were there any harmful effects observed in this large series.
The present study indicated that, a statistically significant difference were found between the two groups in
relation to the duration of first, third stages and the total duration of labor. the mean duration of first, second and
third stage of labor in the castor oil group was shorter than in the control group These results are contradicted
with the results of another study done by Boel et al (2009), who reported that castor oil treatment was not
associated with a shorter time of birth when compared to women who had not used castor oil.
8. Conclusion:
It can be concluded that, the most common cause for taking castor oil was for labour induction. The probability
of labour initiation increases during the first 24 hours after using castor oil. It is associated with a shorter time of
birth when compared to women who had not used castor oil. In addition, taking castor oil increases the chances
of meconium stained amniotic fluid. Most side effects caused by taking castor oil are fatigue, nausea, vomiting
and diarrhea. Also, castor oil affected newborn's APGOR score at the first minute.
9. Recommendations:
Based on the findings of the present study, the following recommendations are suggested:
Choosing to take castor oil to induce labor is a decision that should not be made lightly.
Different health education methods should be available to increase awareness of the pregnant women
about not consuming any substances without doctor's order
It is very important that women get the appropriate dosage from midwife or obstetrician before trying
any castor oil induction
For further research
Further studies should be carried out on a large number of women to examine the relationship between
castor oil intake and fetal distress.
Journal of Biology, Agriculture and Healthcare www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.4, No.4, 2014
10
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Nearly fifteen years after the Apgar score was introduced, Apgar reflected on its usefulness for increasing newborn survival, and noted that there were still methodological problems with using it for neonatal research.
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Susan Ricci's 3rd edition of Essentials of Maternity, Newborn, and Women's Health Nursing helps busy students learn what they need to pass the NCLEX-RN and safely practice maternity nursing. Using a nursing process focus, the author helps students go from concept to application by building on previously mastered knowledge. Content covers a broad scope of topics emphasizing common issues to maternity-specific information. A variety of learning features ensure student retention, such as Threaded Case Studies and Comparison Charts, as well NCLEX-Style Student Review questions (more than twice as many questions from last edition). Plus, this book includes a companion website that provides numerous resources for both students and instructors. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. All rights reserved.
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The possibility exists that the vehicle for 17-alpha-hydroxyprogesterone caproate, castor oil, exerts an effect on human uterine contractility. The aim of this study was to evaluate its effects on contractility of myometrial preparations that were obtained during pregnancy. Myometrial strips were suspended under isometric conditions. Contractility was induced with oxytocin. Strips were incubated in castor oil or physiologic salt solution and suspended for a further oxytocin challenge. Contractile integrals were compared between both groups. Strips that were exposed to castor oil demonstrated increased contractile activity that was elicited by oxytocin (mean contractility value, 165.53%+/-17.03%; n=8; P=.004), compared with control strips (mean contractility value, 72.57%+/-7.48%; n=8; P=.003). There was a significant increase in contractile activity of the castor oil-exposed strips, compared with those that were exposed to physiologic salt solution (n=8; P<.001). Exposure of human myometrial preparations to castor oil results in enhanced oxytocin-induced contractility.
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Castor oil is one of the most popular drugs for induction of labour in a non-medical setting; however, published data on safety and effectiveness of this compound to induce labour remain sparse. To assess the safety and effectiveness of castor oil for induction of labour in pregnancies with an ultrasound estimated gestational at birth of more than 40 weeks. Data were extracted from hospital-based records of all pregnant women who attended antenatal clinics on the Thai-Burmese border and who were more than 40 weeks pregnant. The effectiveness of castor oil to induce labour was expressed as time to birth and analysed with a Cox proportional hazards regression model. Measures associated with safety were fetal distress, meconium-stained amniotic fluid, tachysystole of the uterus, uterine rupture, abnormal maternal blood pressure during labour, Apgar scores, neonatal resuscitation, stillbirth, post-partum haemorrhage, severe diarrhoea and maternal death. Proportions were compared using Fisher's exact test. Of 612 women with a gestation of more than 40 weeks, 205 received castor oil for induction and 407 did not. The time to birth was not significantly different between the two groups (hazard ratio 0.99 (95% confidence interval: 0.81 to 1.20; n = 509)). Castor oil use was not associated with any harmful effects on the mother or fetus. Castor oil for induction of labour had no effect on time to birth nor were there any harmful effects observed in this large series. Our findings leave no justification for recommending castor oil for this purpose.
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Prior to artificial rupture of membranes, 498 women were questioned about obstetric and social factors including self-medication during pregnancy. Caesarean section (P less than 0,01) and low Apgar scores (P less than 0,001) were significantly more common in pregnancies complicated by fetal meconium passage. Meconium passage was more common in women who had recently taken castor oil (P less than 0,01) and possibly herbal substances called 'sihlambezo' (trend P less than 0,2). Use of laxatives or enemas and other obstetric risk factors were not associated with meconium passage.
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Induction of labor is often necessary in patients with premature rupture of membranes. While the effect of oxytocin to stimulate labor is well established, it is potentially hazardous to both the mother and infant. In this study, castor oil was evaluated as a method to induce labor in uncomplicated patients at term gestation with premature rupture of membranes. A total of 196 patients with premature rupture of membranes was studied retrospectively. Of 107 patients who received castor oil, 75% went into labor as compared to 58% of 89 control patients who went into labor spontaneously (P < 0.02). On the basis of these results, it is concluded that castor oil, which is more economical and convenient than oxytocin, can be used safely and effectively to stimulate labor.
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To induce labour successfully, a good cervical status and favorable obstetrical conditions are necessary. If these conditions are not present, cervical ripening must take place before induction of labour. Cervical ripening is only justified when a pathology (maternal or foetal) indicates termination of pregnancy. Intracervical or intravaginal administration of prostaglandin E2 is actually the standard for cervical ripening.
Despite wide use of castor oil to initiate labor, the obstetric literature contains few references to this botanical laxative. Derived from the castor plant Ricinus communis, castor oil may possess properties that are useful in post-term pregnancies. To evaluate the relationship between the use of castor oil and the onset of labor. Prospective evaluation. A community hospital in Brooklyn, NY. A total of 103 singleton pregnancies with intact membranes at 40 to 42 weeks referred for antepartum testing. Inclusion criteria included cervical examination, Bishop score of 4 or less, and no evidence of regular uterine contractions. Patients were alternately assigned to 1 of 2 study groups: a single oral dose of castor oil (60 mL) or no treatment. Castor oil was considered successful if labor began within 24 hours after dosing. Groups were compared for onset of labor in 24 hours, method of delivery, presence of meconium-stained amniotic fluid, Apgar score, and birth weight. Fifty-two women received castor oil and 48 were assigned no treatment. Following administration of castor oil, 30 of 52 women (57.7%) began active labor compared to 2 of 48 (4.2%) receiving no treatment. When castor oil was successful, 83.3% (25/30) of the women delivered vaginally. Women who receive castor oil have an increased likelihood of initiation of labor within 24 hours compared to women who receive no treatment. Castor oil use in pregnancy is underreported worldwide. This small series represents the first attempt to evaluate the medication.