Methods of Induction of Labour

A Systematic Review

Ellen L Mozurkewich; Julie L Chilimigras; Deborah R Berman; Uma C Perni; Vivian C Romero; Valerie J King; Kristie L Keeton


BMC Pregnancy Childbirth. 2011;11(84) 

In This Article

Complementary and Alternative Medicine Methods

Castor Oil

Our search identified one systematic review of the efficacy of castor oil for induction of labour.[40] The authors of this Cochrane review identified only one study with 100 subjects comparing castor oil with no treatment. The trial was judged to be of poor methodologic quality due to methods of allocation. There were no observed differences in rates of caesarean delivery, meconium stained fluid, or Apgar less than 7 at five minutes. More women receiving castor oil reported experiencing nausea (52/52 versus 0/48; RR 97.08, 95% CI 6.16 to 150.34; NNH = 1).[40]

Unfavorable Cervix Subgroup In one trial with 100 women, there was no difference in caesarean deliveries between women who received castor oil or no treatment.[40]

Summary: Compared with no treatment, castor oil is associated with increased maternal side effects.


Our search identified a Cochrane systematic review that included 3 trials with 212 women that focused on acupuncture for induction of labour.[41] Compared with standard care (oxytocin, prostaglandins, or "routine care"), more women undergoing acupuncture did not require the use of other induction methods (2 trials, 147 women, 49/73 versus 34/74; RR 1.45, 95% CI 1.08 to1.95; NNT = 5). No differences were found in time to delivery, rates of caesarean delivery, instrumental vaginal delivery, or epidural anesthesia. Fetal or neonatal outcomes were not estimable.[41]

Unfavorable Cervix Subgroup There was no data in the included trials concerning the effect of acupuncture for labor induction in women with unfavorable cervices.[41]

Randomised Controlled Trials Published After the Search Date of Systematic Reviews We identified three further trials with 684 participants, three published after the search date of the systematic review[42–44] and one that was not identified by the Cochrane search.[45] These studies did not reveal any differences between acupuncture and placebo or no treatment in any outcome of interest.

Summary: The use of acupuncture for induction of labour is investigational; no advantages for this method have been demonstrated.

Breast Stimulation

Our search identified one systematic review that combined six studies with 719 subjects that evaluated breast stimulation for labour induction.[46] There were no differences in cesarean deliveries, meconium staining, or uterine hyperstimulation when comparing breast stimulation with no treatment. Breast stimulation decreased the number of women who were not in labour within 72 hours (4 studies, 437 women, 136/217 versus 206/220; RR 0.67, 95% CI 0.60 to 0.74; NNT = 4). Breast stimulation was associated with less postpartum hemorrhage (2 studies, 300 women, 1/150 versus 9/150; RR 0.16, 95% CI 0.03 to 0.87; NNT = 20). There were more perinatal deaths among pregnancies assigned to breast stimulation than to no treatment, although this difference was not statistically significant (3 studies, 337 participants, 3/167 versus 0/170; RR 8.17, 95% CI 0.45 to 147.8). This result should be interpreted with caution, as all of the deaths occurred in a single trial conducted among high risk women in a developing country.[46]

Two studies with a total of 99 subjects compared breast stimulation with oxytocin. There were no differences in caesarean deliveries. In one trial with 37 women, more women assigned to breast stimulation were not in labour within 72 hours compared with those who were allocated to the oxytocin group, although this difference was of borderline statistical significance (10/17 versus 5/20; RR 2.35, 95% CI 1.00 to 5.54). There were no differences in uterine hyperstimulation or meconium staining. There were three perinatal deaths in the breast stimulation group versus one in the oxytocin group, a non-significant difference. All deaths were from the same trial conducted among high risk women in a developing-world setting.[46]

Unfavorable Cervix Subgroup There was no information on cesarean deliveries in the one included trial that included women with unfavorable cervices.[46]

Summary: Breast stimulation may reduce the number of women not in labour within 72 hours compared to no treatment but is less effective than oxytocin for this outcome. More research is needed to evaluate the safety of breast stimulation.


The Cochrane review of intercourse for induction of labour included one study with 28 subjects.[47] Participants were assigned to have intercourse nightly for three nights versus no intercourse. There were no differences in delivery within three days or five minute Apgar less than seven.[47]

Unfavorable Cervix Subgroup There was no information on cervical status or cesarean deliveries in the one included study.[47]

Summary: There is not enough evidence to evaluate the efficacy and safety of intercourse for induction of labour.

Homeopathic Methods

Our search identified one systematic review of two studies with 133 participants that compared homeopathic herbs for labour induction with placebo.[48] Only one of the studies included in the Cochrane review reported on the pre-specified clinical outcomes of interest. That study included 40 subjects and reported no difference in rates of vaginal delivery not achieved with 24 hours, caesarean deliveries, operative vaginal delivery, need for oxytocin augmentation of labour, or length of labour.[48]

Unfavorable Cervix Subgroup There was no information in the included study on cervical status.[48]

Summary: There is not enough evidence to evaluate the risks and benefits of homeopathy for induction of labour.

Hypnotic Relaxation

We identified one quasi-randomised study of hypnotic relaxation for induction of labour in post-term pregnancies.[49] Forty women were assigned to hypnotic relaxation and an equal number to no intervention based on alternate days of the week. Controls were also chosen based on the baseline characteristics of parity, gestational age, and cervical status. There were no differences in delivery within 24 hours or time to delivery. The authors did not report any other outcomes.[49]

Unfavorable Cervix Subgroup There was no information on the effect of hypnotic relaxation among women with unfavorable cervices.[49]

Summary: Compared to no intervention, hypnotic relaxation did not affect likelihood of delivery within 24 hours. Data were insufficient to evaluate any other outcome.


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