Evening Primrose Oil

[AKislandgirl]

Who's using it? When to start, dose, orally or vaginally? Give me the low down!

Thanks!

[starling&diesel]

I am, Sue.  1000 mgs orally in the morning.  Skipping the vaginal this time.

This is my midwives' recommendation:

Evening Primrose Oil (EPO)
EPO contains prostaglandin precursors – as well as essential fatty acids – which help
ripen and soften the cervix. It is also used to help prevent postpartum depression.
 Take 1000 mg orally in the morning
 Insert 1000 mg intravaginally at bedtime, as close to your cervix as you can reach
 

[nicolian]

I'm going to start using it orally (2-3 times daily) and vaginally (at night) once I hit 37 weeks, as per recommended by my midwife.

[Katico]

I am on the "no repeat induction!" train, I'll definitely be taking it, starting at 36 or 37 wks, and I think I'll do oral and vaginal dosing.

[Hannahkatiebell]

How has this helped you all before? I haven't ever heard of it...

[meggles]

My midwife recommends starting EPO around 37 weeks as well. There seems to be a lot of positive anecdotal evidence in favor of it.

I found this study, however, which recommends against taking it orally: http://www.ncbi.nlm.nih.gov/pubmed/10380450

Anyone have thoughts on that?

[nicolian]

Originally Posted by Hannahkatiebell 

How has this helped you all before? I haven't ever heard of it...

I haven't tried it before but it's supposed to soften your cervix.

[JessimaTheisen]

Semen also softens the cervix... seems cheaper and more pleasant to use for this purpose. Plus, there will not be any sex after the birth for quite a while! Might as well get it while we can.

[nicolian]

I told DH that come 37 weeks I expect his semen to be against my cervix every 8 hours.

[Katico]

Originally Posted by nicolian 

I told DH that come 37 weeks I expect his semen to be against my cervix every 8 hours.

  Poor guy, what a hardship 

I remember laying down a similar rule with DD - it quickly became "ok, let's do this, I'm exhausted"  He never seemed to lose his enthusiasm like I did, though!

[emmaegbert]

Originally Posted by Katico 

  Poor guy, what a hardship 

I remember laying down a similar rule with DD - it quickly became "ok, let's do this, I'm exhausted"  He never seemed to lose his enthusiasm like I did, though!

yeah with baby so low and huge, it starts getting uncomfortable for me, unfortunately.

[emmaegbert]

oh and I did start EPO on my EDD last time and may do the same this time too. I found it a bit messy and weird, but okay. Def wear a pantyliner or something though- greasy undies are gross IMO.

[AKislandgirl]

Thanks for the low down! I'm going to pick some up today. I think I'll start orally for now (37 weeks) and go to vaginally next week. I don't want things to get going too much until my mom is here.

[~pi]

Originally Posted by meggles 

My midwife recommends starting EPO around 37 weeks as well. There seems to be a lot of positive anecdotal evidence in favor of it.

I found this study, however, which recommends against taking it orally: http://www.ncbi.nlm.nih.gov/pubmed/10380450

Anyone have thoughts on that?

I just did a quick skim of the full paper because the abstract made me curious about how they defined quasi-experimental. (It's always a bit of a red flag in terms of generalizability.) I do not see how they got away with calling this even quasi-experimental. My only guess is that perhaps they justified it on the basis that their control group was a random sample. Their reviewers were either very generous, not very methodologically rigorous, or both. If I were reviewing this paper, I would not have been OK with that. It's clearly a retrospective cohort study. Additionally, they did not control for a number of important confounders (and they don't even have a normal Table 1 of participant characteristics), their alpha level was twice what most people use (meaning they were more likely to find differences that don't truly exist) and they provide no discussion about the potential differences in group assignment. My first thought is that women who are taking EPO might well be more motivated to want to deliver early for a variety of reasons, which does make them a different population despite the fact that all p's are classed as low-risk nullips. The authors didn't even raise that in the discussion of limitations, which is a big issue IMO. And I suspect their (very weak) findings were directly related to the upper quartile of length of labor, which was quite a bit higher in the EPO group. That could totally lead to these kinds of results with this sample size.

I don't want to sound like a total jerk here. It's interesting data, for sure, and it's great to see people tackling these questions more scientifically than usually happens with 'natural' interventions. And I am well aware that it's a lot harder than it looks to do really good science. But I wouldn't make decisions one way or the other based on a single retrospective analysis in the first place, especially not one with such weak results.

Now that I've totally trashed this paper, though, for the record, I am not taking EPO myself. The evidence of its effectiveness is just not there. Lots of people want to believe it helps, but based on what I've seen, I'd be willing to bet lots of money that a placebo-controlled EPO trial would come up with nothing. In other words, I think that the mental difference of believing you're doing something may make a tiny difference, but the chemistry? Not so much. (Semen, by the way, hasn't shown effectiveness, either. And it's been studied more rigorously, with randomization and everything! Imagine being a participant in those trials -- "Hey honey, guess what? We got randomized to the sex group!")

[meggles]

Thanks, Pi for the analysis! It really helped me to better understand the "study." :)

[Katico]

I'm glad we have a research scientist in our DDC, thank you Pi :)

[emmaegbert]

Originally Posted by Katico 

I'm glad we have a research scientist in our DDC, thank you Pi :)

truly! A HBMW and a research scientist in our DDC, makes for some excellent responses to questions :)

[~pi]

Originally Posted by meggles 

Thanks, Pi for the analysis! It really helped me to better understand the "study." :)

No problem, I was interested. I've seen this particular study mentioned before, so seeing it here for the second time was enough to prompt me to go and actually look at it this time. Also, occasionally procrastinating on the work I am doing by looking at a totally different question = fun.

And no need for quotes. It's a study! Retrospective cohort still counts.

Originally Posted by Katico 

I'm glad we have a research scientist in our DDC, thank you Pi :)

Just keep in mind I'm only one scientist, and a baby one at that. (I'm only a couple of years out of my phd.) Others could well disagree with my perspective. And while, obviously, I have enough background to feel comfortable offering my take on the methodology and findings (and I stand behind that take) also note that this isn't exactly my area of research.

[puente]

I super appreciate you reading it ~pi! 

I'm not a research scientist, but a lawyer, which always results in me thinking more information is better. It's been weighing on my mind that I SHOULD read it, and I also knew that when I got done, I'd need to ask my husband (who does science) some questions about what it meant and it just felt like a very big time-sucking task when I'd rather be polishing my floors and shopping for nursing bras.  I can totally steal your analysis and feel informed enough that it just came off my list, which is dead on awesome. 

(And as expected, the study had no effect on my plans one way or another.) 

Just really fabulous of you to knock something off my to do list.  You're like my friend who washed my kitchen windows-- totally allowing me to get to the dregs of my to do list. 

[capretta]

Originally Posted by emmaegbert 

truly! A HBMW and a research scientist in our DDC, makes for some excellent responses to questions :)

Don't forget about the EMT! And now I know we have a lawyer to take advantage of. And then there is the personal chef... What an accomplished, useful set we have!