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Re: caulophyllum thalictroides tablets+ IOLFrom: Len2976@aol.comTue Aug 16 07:24:04 2005
I have a question for the group, particularly MWs and others who are familiar with herbal therapy, an area which I am not familiar with. Sunday afternoon I had a patient (32 y/o G1 at 38+ weeks) present to L&D with what appeared to be symptoms of aacute gastroenteritis--severe nausea, vomiting, and diarhea for about 18 hours. The woman was doubled over in pain at times screaming as though she was in transition. Her sister, who is a message therapist, had given her caulophyllum thalictroides tablets to induce labor. She had taken 2 tablets every 3 hours the evening before and yesterday morning (6 doses for a total of 12 tablets). I learned that caulophyllum thalictroides tabs are blue cohash. In addition to the blue cohash, she had also done both accupressure and nipple stimulation (for 15 minute periods per hour) to try to induce labor. She had not consulted either the MD nor any of the CNMs with our practice for advice regarding this. After assessing her and deciding she was not in active labor on admission, but was dehydrated and exhausted from the vomiting and diarhea, I admitted her, started an IV, and sedated her so she could get some rest. Her cervix was long, thick, and closed, and the FHTs were reassuring. About 4 hours later, I was called by the nurse that she was contracting regularly, her cervix was about 2-3 cms dilated, and that she wanted an epidural. When I got to L&D she had had a SROM with thick meconium stained AF. Her labor progressed steadily and I anticipated a NSVD. I usually try to encourage patients with an epidural NOT to push when the cervix is fully dilated, but to rest and wait till they either have a strong urge or the head is at a +2 station. This patient, however, had an urge to push at about 9 cms and insisted on pushing when her cervix was fully dilated and the head was at a +1 station. Unfortunately when she began pushing there were severe variable decelerations (down to 40-50's x 1 minute with slow recovery) and after a few of these I stopped her from pushing (which helped somewhat), called the obstetrician in, and she ended up a C/S. There was no nuchal cord present or other explanation for the thick mec. My questions involve the appropriate use of the blue cohash. I'm aware that some MWs use blue cohash for cervical ripening particularly with post-dates patients, but I always thought it was used in a tincture form. I could not find out anything regarding usual dosage, side effects, etc. Obviously it was as effective in inducing labor as I have sometimes seen cytotec to be--in fact it was almost a precipitous labor. Comments would be appreciated. Lenora McCall, CNM
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