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Smith CA
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2010, Issue 3
http://www.thecochranelibrary.com
Caroline A Smith1
1 Centre for Complementary Medicine Research, The University of Western Sydney, Penrith South DC, Australia
Contact address: Caroline A Smith, Centre for Complementary Medicine Research, The University of Western Sydney, Locked Bag
1797, Penrith South DC, New South Wales, 1797, Australia. caroline.smith@uws.edu.au.
Citation: Smith CA. Homoeopathy for induction of labour. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003399.
DOI: 10.1002/14651858.CD003399.
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
Background
This is one of series of reviews of cervical ripening and labour induction using standardised methodology. Homoeopathy involves
the use, in dilution, of substances which cause symptoms in their undiluted form. A type of herb, ’caulophyllum’ is one type of
homoeopathic therapy that has been used to induce labour.
Objectives
To determine the effects of homoeopathy for third trimester cervical ripening or induction of labour.
Search methods
The Cochrane Pregnancy and Childbirth Group’s Trials Register (1 December 2009), and bibliographies of relevant papers.
Selection criteria
Randomised controlled trials comparing homeopathy 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 generic 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. The initial data extraction was done centrally.
Main results
Two trials, involving 133 women, were included in the review. The trials were placebo controlled and double blind, but the quality was
not high. Insufficient information was available on the method of randomisation and the study lacked clinically meaningful outcomes.
This trials demonstrated no differences in any primary or secondary outcome between the treatment and control group.
Authors’ conclusions
There is insufficient evidence to recommend the use of homoeopathy as a method of induction. It is likely that the demand for comple-
mentary medicine will continue and women will continue to consult a homoeopath during their pregnancy. Although caulophyllum
is a commonly used homoeopathic therapy to induce labour, the treatment strategy used in the one trial in which it was evaluated may
not reflect routine homoeopathy practice. Rigorous evaluations of individualised homeopathic therapies for induction of labour are
needed.
Homoeopathy for induction of labour (Review) 1
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
PLAIN LANGUAGE SUMMARY
There is not enough evidence to show the effect of homoeopathy for inducing labour. Sometimes it is necessary to induce labour
(getting labour started artificially) when a pregnant woman or her unborn child are at risk. Homoeopathy involves the use of diluted
substances which in their undiluted form, cause certain symptoms. The principle is that a homoeopathic substance will stimulate the
body and healing functions so that a state of balance is gained and symptoms are relieved. The review of two trials, involving 133
women, found there was not enough evidence to show the effect of a homoeopathy as a method of induction. More research is needed.
REFERENCES
Beer 1999
Methods Double-blind placebo controlled trial. The method of allocation concealment was unclear
Participants 40 women 38-42 weeks’ gestation with PROM. The study was undertaken in Germany
Interventions Caulophyllum D4 or a placebo tablet. Doses were repeated hourly for 7 hours or until labour started
Outcomes Time to the onset of regular uterine contractions, labour and delivery outcomes. Maternal and neonatal
infection
Risk of bias
Dorfman 1987
Methods Double-blind placebo controlled trial. The method of concealment was not described
Participants 93 women were recruited to the study at 36 weeks’ gestation. The study was undertaken in France.
Women were excluded from the study if they had a history of a poor obstetric history, a current history
of hypertension, diabetes, previous caesarean section or cephalo-pelvic disproportion
Interventions The treatment group received 5 homoeopathic therapies: caulophyllum, arnica, actea racemosa, pulsatilla
and gerenium, with three granules administered morning and evening from 36 weeks’ gestation. When
labour commenced, the same dosage was given every 15 minutes and stopped after 2 hours or sooner if
the woman was comfortable. Not details were provided on the placebo or the precise dosage
Risk of bias
Arnal-Laserre 1986 We have been unable to contact the authors, and do not have enough information to make a decision
whether the trial meets the inclusion criteria
Coudert-Deguillaume 1981 We have been unable to contact the authors, and do not have enough information to make a decision
whether the trial meets the inclusion criteria
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
3 Caesarean section 1 40 Risk Ratio (M-H, Fixed, 95% CI) 5.0 [0.26, 98.00]
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Vaginal delivery not achieved 1 40 Risk Ratio (M-H, Fixed, 95% CI) 0.33 [0.01, 7.72]
within 24 hours
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Augmentation with oxytocin 1 40 Risk Ratio (M-H, Fixed, 95% CI) 1.0 [0.50, 1.98]
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Instrumental delivery 1 40 Risk Ratio (M-H, Fixed, 95% CI) 1.0 [0.54, 1.86]
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
2 Length of labour 1 40 Mean Difference (IV, Fixed, 95% CI) -0.40 [-7.21, 6.41]
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Difficult labour 1 93 Risk Ratio (M-H, Fixed, 95% CI) 0.28 [0.12, 0.66]
Analysis 3.1. Comparison 3 Homoeopathy versus placebo, Outcome 1 Augmentation with oxytocin.
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Fixed,95% CI IV,Fixed,95% CI
-10 -5 0 5 10
Favours control Favours treatment
APPENDICES
Generation of random sequence Computer-generated sequence, random num- Case number, date of birth, date of admission,
ber tables, lot drawing, coin tossing, shuffling alternation.
cards, throwing dice
Concealment of allocation Central randomisation, coded drug boxes, se- Open allocation sequence, any procedure based
quentially sealed opaque envelopes on inadequate generation
12 January 2010 New search has been performed Search updated. No new trials identified. Two trials, previously identified, have
been translated and are now excluded
HISTORY
Protocol first published: Issue 2, 2000
Review first published: Issue 4, 2001
29 July 2003 New citation required and conclusions have changed Substantive amendment.
13 May 2003 New search has been performed This update includes one new trial. Two further trials
have been identified and will be included in a future up-
date when they have been translated. The Implications
for research section has also been updated.
CONTRIBUTIONS OF AUTHORS
The review author prepared the review, selected studies for inclusion, extracted the data and prepared the text of the review.
DECLARATIONS OF INTEREST
None known.
SOURCES OF SUPPORT
External sources
• No sources of support supplied
INDEX TERMS