Evening Primrose Oil - Is It Safe for Labor Induction?

The number of natural induction methods and options have grown exponentially over the last several decades. In my practice, as a Functional Medicine Acupuncturist and Doula, I’ve seen a huge influx in women seeking Acupuncture and alternative medicine to speed up the labor process in the avoidance of a medically induced childbirth. While most of the natural induction methods are harmless and offer some benefit in triggering the natural hormonal reactions of labor, there are some that would be better left on the shelf.

First off, we should address the WHY behind the number of women seeking natural options to encourage the onset of childbirth. 

The current medical model of birth is intimidating for the modern mother. The US birthing statistics are dismal. Currently the US is ranked 47th in maternal care in the world, just under Iran (Go USA). A 2016 report by the Center for Disease Control stated that 23.3% of births are medically induced. A survey done by Childbirth Connection found that 41% of women who delivered in US hospitals in 2011-2012 had their primary care provider attempt induction. Of those three out of four did have their labors induced.

Why are we concerned about medical induction? The standard care protocols for medical induction have changed over the years, with more focus being put on the ripening of the cervix and less on the initiation of contractions. But, with the decrease in Pitocin use comes the increase in synthetic prostaglandins. Prostaglandin therapy produces more vaginal births within 24hrs with fewer side effects compared to Pitocin inductions, but that doesn't mean zero side effects. 

SYNTHETIC PROSTAGLANDIN
​SIDE EFFECTS AND ASSOCIATED COMPLICATIONS

CITOTEC (Misoprostol) Is FDA approved as a Gastric Ulcer Medication, but effective for labor induction.

CERVIDIL (Dinoprostone) Is FDA approved for the induction and augmentation of labor. 

MATERNAL COMPLICATIONS

• Uterine Rupture* (Higher with Cytotec)
• Nausea & Vomiting*
• Fever*

FETAL COMPLICATIONS

• Fetal Distress* (Higher with Cytotec)

Cervical Ripening agents result in fewer cesareans than Pitocin alone.

Research into Cytotec for Labor Augmentation is low, and the medication is used off-label.
​
*Per FDA Medication Label for Cervidil

SYNTHETIC OXYTOCIN (PITOCIN)
SIDE EFFECTS AND ASSOCIATED COMPLICATIONS

MATERNAL COMPLICATIONS

• Increased Postpartum Hemorrhage*
• Cardiac Arrhythmia*
• Anaphylactic Reaction*
• Fatal Afibrinogenemia*
• Hypertensive episodes*
• Nausea & Vomiting*
• Rupture of the Uterus*
• Premature Ventricular Contractions*
• Pelvic Hematoma*
• Subarachnoid Hemorrhage*
• Lower LATCH Scores and Breastfeeding Success
• Postpartum Depression

FETAL COMPLICATIONS

• Bradycardia*
• Low Apgar scores at five minutes*
• Premature Ventricular Contractions* 
• Other Arrhythmias*
• Neonatal Jaundice*
• Permanent CNS or Brain Damage* 
• Neonatal Retinal Hemorrhage* 
• Fetal Death*
• Neonatal seizures*

*Per FDA Medication Label for Pitocin

​Although medical intervention can be lifesaving and the best option for some births, this is a frighteningly high number of inductions and complications, and would cause the most medically trusting woman to consider home options for labor induction.

What is Evening Primrose?

​Evening Primrose, Oenothera biennis, is a plant native to North America, Europe, and Asia. It produces beautiful yellow flowers that bloom in the evening, hence the name Evening Primrose.  It has a long and rich history of use among Native Americans as a topical anti-inflammatory for conditions such as minor wound healing and eczema, and as an internal cure for sore throat and gastrointestinal conditions. Ayur-Veda prescribes the herb for the treatment of women’s conditions. Pliny the Elder, the ancient Greek philosopher, spoke highly of the herb and its use in the treatment of several ailments. In modern herbology it has found a popularity in the treatment of women’s health disorders such as PMS, breast lumps and tenderness, menopausal conditions, and among some midwives and lay women as an aid to induce childbirth labor. ​

So, How Does Evening Primrose Oil Work?

The active ingredients of Evening Primrose oil are Gamma Linolenic Acid (GLA), Linoleic Acid (LA), Oleic Acid, Palmitic Acid, and Stearic Acid, with the two most prominent compounds being GLA and LA. Both GLA and LA are polyunsaturated Omega 6 fatty acids. Linoleic Acid is considered an essential fatty acid, as it cannot be made in the body and must be consumed in the diet. Gamma Linolenic Acid is naturally produced in the body by the conversion of the LA found in the diet. Both Omega 6 fatty acids serve a purpose in the body, and both are part of the production of prostaglandins. As the cascade of LA conversion unfolds, LA is converted to GLA which is converted to Dihomo-Gamma Linolenic Acid (DGLA) and lastly converted into Arachidonic Acid (AA)...AA is then converted into a variety of prostaglandins and blood coagulators.

Prostaglandins in Labor

There are multiple forms of prostaglandins in the body, each with its own unique functions. When we are talking about the activation of the labor processes, we are talking about the 2 series prostaglandins, or PGE2/PGF2. PGE2 prostaglandins are triggered by the naturally occurring increase in estrogens at the end of the maternal gestation period. As estrogens increase, so does the production of PGE2 and PGF2-alpha, as well as PG receptors on the cervix. PGE2 has been shown to stimulate interleukin-8, an inflammatory cytokine that promotes the influx of neutrophils and induces remodeling of the cervical extracellular matrix, and to induce functional progesterone withdrawal. PGF2-alpha has been shown to increase the levels of oxytocin in the uterus, decrease progesterone levels and increase the production of Hyaluronic Acid in the cervix in conjunction with interleukin-8 produced by PGE2. These are all wonderful things for the natural labor process. The importance of the cervical softening aspect of labor is, arguably, the most important part of natural labor. If the cervix is not soft, it cannot dilate.  All of this cannot happen without adequate AA.

Not All Prostaglandins help with labor

​DGLA can take another prostaglandin pathway to form the 1 series prostaglandin. While PGE2 is an inflammatory prostaglandin, PGE1 is an anti-inflammatory prostaglandin. PGE1 is widely used for its ability to dilate blood vessels and increase blood flow, reduce platelet aggregation, and lower blood pressure. In the normal consumption of Linoleic Acid, the body naturally converts the Omega 6 oil into the necessary prostaglandin forms, either 2 series for increasing inflammatory responses, or 1 series for increased vasodilation and anti-inflammatory responses. ​

Evening Primrose Oil Theory Vs. Reality

When you read this, it is hard to see the faults. In theory Evening Primrose oil would seem a miracle for the induction of labor. It contains LA which comes down the cascade to produce both PGE1 and PGE2/PGF2 prostaglandins and is a balance of anti-inflammatory and inflammatory responses. And, also GLA which in theory would also induce the same response, increasing the prostaglandins as needed for either inflammatory or anti-inflammatory responses. Theories are always well placed, and in theory, if evening primrose is beneficial for other women’s health conditions, such as menopause and PMS, would it not also be beneficial for the pregnant mother. Although Evening Primrose Oil contains both dietary Linoleic Acid and Gamma Linolenic Acid, and the body can convert both into the correct inflammatory prostaglandins, there is concern over the wide use of Evening Primrose for the induction of labor, because dietary GLA works differently than converted GLA. 

One of Evening Primrose Oil’s claims to fame is its ability to raise PGE1 levels  
WITHOUT raising PEG2 levels. (And there is the snap) Several research studies have given this claim backing. Dietary GLA seems to skip the AA conversion steps, not sure why or how. When GLA is consumed orally, it is converted to DGLA while the AA levels remain the same, thus increasing the production of PGE1. While this is great for those with cardiovascular disease or PMS, this can be dangerous for those at the end of pregnancy.     ​

Could Evening Primrose Increase the Risk of Postpartum Hemorrhaging? 

Increased levels of PGE1 are associated with vasodilation and anticoagulation. The rate of postpartum hemorrhaging has risen exponentially since 1993. So much so that the standard care policy with hospital birth is to administer Pitocin postpartum for prevention for all women birthing in US hospitals. Evening Primrose Oil usage can increase this risk, especially when used in conjunction with high dose fish oils. The combination could lead to blood that is unable to clot properly.

Is It Worth the Risk?

As much as we love our anti-inflammatories, and we should, labor and birth are an inflammatory process. Each of the hormonal cascades necessary to induce labor require inflammatory reactions to work properly. If we are decreasing inflammation by increasing the consumption of supplemental anti-inflammatories, this could lead to a delay in the initiation and onset of active labor, leading to an increased need for gestational inductions, or birth complications. Which are what women seeking these alternative methods are trying to avoid.

There isn’t much scientific evidence for the safe use of Evening Primrose oil orally, with more research linking its usage to an increase in birthing complications. 

One study found:

Evening Primrose Oil starting at the 37th week of gestation did not shorten gestation or overall length of labor and was associated with an increased incidence of prolonged rupture of membranes, increased need for medication oxytocin use, and an increase in the need for vacuum extraction.  

​Although the use of Evening Primrose Oil for the initiation of natural labor is often recommended as an herbal remedy to women looking to avoid the medical interventions that are ever growing in the United States, it may offer more risk than benefit.

Safe options are available, such as Acupuncture, Chiropractic, and the overall benefits of proper nutrition prior to delivery. If you want to decrease your overall risk for medical induction and complications, understanding how nutrition affects your natural labor and delivery processes is essential and should be part of modern maternity nutritional care.

Want to learn more about nutrition for childbirth success? Read my eBook, "A Patient's Guide to Childbirth Nutrition" or take my Practitioner's Course, "Advanced Nutrition in the Formation and Function of Childbirth Hormones."

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About Sarah

Sarah is the author of Functional Maternity, the first and only book to highlight the role functional medicine and nutrition play in maternal health, pregnancy, and childbirth outcomes. 

Sarah is the leading expert in the field of functional medicine in maternity and pregnancy care.

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Copyright © 2020 Functional Maternity, All rights reserved.
The content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. 

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