OB-GYN-L Messages for August, 2005: Re: caulophyllum thalictroides tablets+ IOL

Re: caulophyllum thalictroides tablets+ IOL

From: Lorrie Stanley, CPM

lorriemidwife@sbcglobal.net

Tue Aug 16 14:11:18 2005

I am familair with herbal therapy. I have not ever used homeopathics though and that is what caulophyllum thalictroides tablets are. I have used black and blue cohosh tinctures in postdates with great success. However, i think the first mistake made by your patient was taking anything without the knowledge or consent of her healthcare provider. This is a big misconception becoming more and more popular in that since they are over-the-counter, they can self-medicate but they still have side effects and need to be monitored and taken only with the advice of someone with knowledge. blue and black cohosh can be very effective in stimulating labor, however, only with a favorable cervix or it can put the baby in distress, which is what sounds like happened in your case. her cervix was not favorable and thus caused distress in the baby and wonder why it ended in c/s. kinda of think of it this way, it is my understanding that even with pitocin induction, you have to have a favorable cervix. if not, cytotec or prostataglandins are used to rippen the cervix (correct me if i am wrong, please) before the pitocin is used. the same way works with blue and black cohosh. you rippen the cervix, then it works effectively. my dosages are usually alternating the blue and black cohosh every 30 mins but 1/2 dropperful of tincture (however pill form is even now sold at wal-mart and would take 1 tablet q.30min alternating with blue and black). after six hours of dosing, you stop taking it. it can be systemically built up in one's system and thus cause the side effects as your patient had. every instance in that i have used blue and black to stimulate labor, we have had a preciptious labor as well as the use of castor oil. i don't know anything about accupuncture but nipple stimulation would not have caused the gastroenteritis. more than likely the cohosh caused this as it sounds like she had taken too much of it. in my opinion, the meconium came from the baby being in distress, which was caused by the gastroenteritis triggered by the overdose on the cohosh.

FYI, when you have someone having a strong urge to push when not complete, have them lie on their side and it will help take the pressure off and relieve some of those pushing urges.

I also am curious, has anyone ever tried using TENS units on laboring moms for pain relief without medication? I have and my patients love it. I would love to see OBs offering this in the hospital as an option.

-- Lorrie Stanley, CPM

At Tue, 16 Aug 2005, Len2976@aol.com wrote: > >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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