Evening Primrose Oil and possible problems - Mothering Forums

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#1 of 26 Old 11-26-2008, 10:28 AM - Thread Starter
 
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The subject of EPO comes up here and other forums quite a bit; it seems that ingesting and/or inserting EPO is commonly recommended by moms and birth professionals as a way to hasten cervical ripeness and bring about birth 'sooner' and possibly 'easier' way. What I understand about EPO is that it contains compounds that aid a woman's body in production of prostaglandins--a type of hormone that is associated with producing changes in the cervix necessary as part of labor. EPO contains, in other words, some of the 'nutrients' needed for a woman to build the prostaglandins she needs to build for a normal labor.

Of course, various foods also contain components used in prostaglandin production, just as food contains proteins, vitamins, minerals and so forth that our bodies use to perform the all the different tasks of being alive and making babies. To put it in a simplified, general way.

While I understand the logic of using EPO, I have seen a few births in which it proved to be overkill--and have heard stories from other mws who have seen this as well. In brief, too much EPO (for the particular woman involved) seems to cause *too much* cervical ripening--ripening/softening that does not occur in balance with oxytocin and contractions that help to open the cervix.

The result is that the cervix is so soft/stretchy that the baby's presenting part is enabled to descend much farther into the vagina than is warranted by dilation....a baby who may be at an advanced station, with the cervix only slightly or partly open. In one case, baby's head was visible at entroitus--with the cervix still around his head, only 4cms or so. The problem with this is that for one, moms get an overwhelming urge to push with the baby so low--but the cervix, being dragged so low, has reached the limit of it's stretchability and is usually very rigid at this point. It can't relax and open--labor becomes nearly unbearable between the intense pain at the cervix and the tremendous urge to push.

I had one primip mom do most of her labor in knee-chest (3+hrs) to get from 1 to fully--because only in knee chest, bringing baby up a little bit out of her pelvis, eased the urge to push *just enough* for her to resist. No fun whatsoever! Above, I mentioned the one with cervix over baby's head at introitus--she was having her 10th child, which surely figured into things as well. But both of these moms had one thing in common--EPO in great quantities. The primip was taking 2,000mgs orally every night, and inserting an additonal 1,000mgs most nights during the last 5wks. The Grand Multip, wanting birth to happen NOW, used most of a bottle of EPO (not sure of mgs, not my client) inserted every couple of hours over 2days time. These are just 2 examples.

Anyway--seems to me that it is wise to be careful about disturbing the balance of things that bring about labor. Again, generally speaking--a woman needs prostaglandins working on her cervix, oxytocin for contractions, and also compelementary chemical signals from the baby showing his/her readiness to be born (and to participate otherwise in being born). It also seems to me that we don't know enough about EPO to have a good idea of how much to use, when to start it and such--but because the compounds are lipid based, I suspect that it is possible to build up EPO in the system and potentially create an 'overdose' situation over time. People are individually more or less sensitive to the effects different herbs, nutrients, medications--our chemistries differ.

I can see the place of EPO in a woman's pregnancy/labor--but the same as with other herbs, my first question is going to be "Why take it?" If there seems to be a good reason to take it--great. And while perhaps almost any woman benefit from ingesting EPO to be sure they are getting 'enough' of the 'nutrients' it contains (which may not be adequately present in her diet), we don't really seem to know what constitutes a 'nutritive amount'--a min. daily req. And as seems to be happening more and more with herbs in general, a lot of people (consumers and pros alike) seem to feel that since it's an herb, it's safe....and if some is good, more is better. (Again, speaking generally here--I know many who exercise due caution and research). I know for instance that EPO is commonly sold in 1,000 mg caps--how did that amount get arrived at?

Anyway, gotta run but there are some of my thoughts. I hope others will add their own--including any research you have. I did not take the time to find my (few) EPO links, but will do so later.
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#2 of 26 Old 11-26-2008, 02:24 PM
 
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Informative, interesting and thought provoking as usual MsBlack! I too am concerned with how popular this is becoming. One mw I know "induces" almost all her clients with EPO, membrane stripping, and often castor oil. I don't really see the need for it so often.

However, if a woman has cervical scarring I think it can be a very useful tool. Or, if a woman is "overdue" and facing a pit induction, etc.

I think it's important that women are well nourished and getting enough EFAs but it does seem overkill for most women to be inserting it vaginally routinely.
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#3 of 26 Old 11-26-2008, 09:11 PM
 
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My EPO pills come in 500 mg. It really sounds like these women were in overkill mode. Those are pretty scary stories. I really would only recommend EPO to a woman with cervical scarring (my reason for taking it) or someone one is approaching due date with absolutely no cervical change.

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#4 of 26 Old 11-26-2008, 09:19 PM
 
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I have myself recommended it for women who have no exposure to semen in order to provider a little boost towards labor that they would otherwise get.
I also think it's advisable when there are beginning to be signs that baby needs to come out - usually blood pressure related.

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#5 of 26 Old 11-27-2008, 09:48 AM - Thread Starter
 
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It's true that my 2 examples were fairly 'extreme'--most especially the Multip with her use of dosing every couple of hours. The primip's dose was not nearly like that--still probably more than some women take, tho. One real problem in both cases is that neither mw knew of the EPO until after the fact. The mw for the multip found out soon after the birth. I did not discover my client's use of the EPO until her 2nd pregnancy....it was just after talking with the other mw (of the multip mentioned), a friend of mine, that it occurred to me that EPO might have been involved in my primip's birth more than a year earlier. Since she was pregnant again by that time, I asked her about it at our next prenatal--and sure enough!

I also agree that there are some definite indicators for EPO use--scarring is a good one for sure. And I never considered the 'lack of semen' idea before, good point! Deposit of semen is certainly a naturally-occurring and more or less 'dose controlled' way for a woman to receive prostaglandin nutrients. And sex is something to ask about during the final weeks. Some religions prohibit sex during late pregnancy, some couples just aren't DTD at that time for other reasons, some women are alone....

Among those families I've worked with, I've learned to be more (and more....) pro-active and pointed about asking about supplements/herbs they are using. There seem to be more and more who will use something because either a friend/relative told them about it, or they stumbled across it somewhere online (whether a place like MDC or an herb/supp. website, etc). They don't always feel they should ask me about things first, if they believe that they have good reason to trust their source, and/or believe it is 'harmless' even if it may do no good.

Of course, it is not EPO use that has reasoned application which bothers me. Routine use of any herbs or techniques (membrane stripping, eg) to promote labor's occurrence goes against my grain, tho. And with EPO my concern is also about dose amount. Anyone have sources on this at all? Or even just gut feelings-- or anecdotal evidence about what might constitute an appropriate dosage (mgs plus frequency; oral and/or vag insert)?
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#6 of 26 Old 11-28-2008, 10:23 AM - Thread Starter
 
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Ok--can't find my original links for EPO, have just been doing a search for info on EPO and cervical ripening. What appears agreed-upon (among sites where chemical makeup of epo is even mentioned at all) is that EPO contains both a couple of essential fatty acids needed for the production of prostoglandins, and also contains isoflavones--phyto estrogen--that may also play some part in helping various female reproductive health matters (not just cervix). Since I didn't find any source (yet) that seemed solidly evidence based, I'm not going to post any links--I googled "evening primrose oil in pregnancy" and also "epo for labor".

By the way, a few also mentioned that cervical ripening can be an 'aid to baby's engagement in pelvis'--helping w/both positioning and pre labor head moulding that can ease/hasten birth. I have no idea if this claim has been or can be substantiated--only that it makes some sense to me in theory. And among the handful of women who've had the problems I noted with excess and premature cervical ripening, their babies were certainly very low with well moulded heads.

Something I did notice about all the sites I visited is that all recommend starting EPO at either 36 or 37 wks gestation. Some mention taking x-number of caps daily, but don't mention mgs at all. Most others recommend at least 1,000 mgs a day orally, some rec 1,500 mgs, some 2,000mgs. Some recommend 1,000 mgs orally starting at 36wks, going to 2,000mgs at 38wks PLUS 500mgs vaginally. One mentioned taking 3,000mgs a day (3g).

Anyway, I hope others will post their own opinions, experiences and any good links re EPO. I still wonder where dosage amount ideas came from? But it seems that my client who took 2,000 to 3,000mgs a day was not entirely out of range of *some recs, even though it was clearly too much for her.
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#7 of 26 Old 11-28-2008, 11:19 AM
 
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What I was taught was to start with one capsule a day at 36 weeks. Each week add another capsule until you get up to 6. Then to do two vaginally. So I guess it depends on the dosage of the capsule how much you are getting. By the time you got up to 6, it would be between 3000-6000mg. I don't know that we have ever had anyone get up to 6 pills though.

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#8 of 26 Old 11-28-2008, 12:16 PM - Thread Starter
 
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rockport--

you earlier mentioned the use of EPO for moms with cervical scarring and "approaching due date with absolutely no cervical change". So, in your note above, I take it that you are referring to use by moms in these categories?

I'm also curious about 'no cervical change'--does this mean that there is routine VE during final weeks of pregnancy? This is not part of my own practice, though pn VE does occur sometimes by maternal request. And of course, I might make the request myself if a mom had prior surgery/scarring--not sure. That would be a category of moms I'd probably suggest to take EPO anyway.

thanks for any clarification
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#9 of 26 Old 11-28-2008, 02:24 PM
 
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Interesting!

I've never recommended EPO prenatally, and used it only when breaking up cervical scar tissue in early labour, so my experience with it is limited.
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#10 of 26 Old 11-28-2008, 04:28 PM
 
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thank you ms black for writing this out! i have used EPO starting at 36 weeks (500-1000mg vag per night) for my last 3 pregnancies. (didn't know about it with my first child)...with my last pregnancy (4th baby, who is now 10 days old my bodies chemistry was very very different than the others and even the low dose i mentioned above effected me far differently than my other pregnancies had...so when i had read in a previous post of yours about some negative effects of epo in an "overdose" sort of way, it really peeked my interest. even though i was using what would be a normal dose for my other pregnancies, it affected me much stronger this time and really alarmed me. i googled quite a bit trying to find what you may have been referring to, but couldn't find anything as there are no documented studies on it really. so, THANK YOU for writing this. It all makes perfect sense.

(oh, and fwiw, i have always been very upfront with my care providers about what herbs i was planning on using, when, and how much. i usually ask first before starting anything at all.)
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#11 of 26 Old 11-29-2008, 01:00 AM
 
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I'm gonna sub to this to lurk and come back and read everything when I have more time. Does anyone know any studies about EPO use? I might look through some of the yahoo groups and see what I can find.

Very interesting discussion though, if there's no studies, it would be a great topic for one.
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#12 of 26 Old 11-29-2008, 01:53 AM
 
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pretty facinating stuff Ms.

Carrie, The Birthteacher CCE and Doula, real mom to five; and womb-mom to G. born at 23w by emergency C. 12/09
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#13 of 26 Old 11-29-2008, 01:03 PM
 
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rockport--

you earlier mentioned the use of EPO for moms with cervical scarring and "approaching due date with absolutely no cervical change". So, in your note above, I take it that you are referring to use by moms in these categories?

I'm also curious about 'no cervical change'--does this mean that there is routine VE during final weeks of pregnancy? This is not part of my own practice, though pn VE does occur sometimes by maternal request. And of course, I might make the request myself if a mom had prior surgery/scarring--not sure. That would be a category of moms I'd probably suggest to take EPO anyway.

thanks for any clarification
My own preference is to do as few VE as possible. We do get a lot of requests prenatally. Unfortunately the MW that I occasionally work under and who is delivering my baby is a little more hands on. She does a VE at 36 weeks and then does them as clients ask, if they are having a lot of activity, or if something might conflict schedule wise. If we have 2 women about to go into labor, she has to go out of town, or a holiday coming things like that.The cervical scarring comes up in the initial prenatal paperwork, so that is when I would have them start taking. I am actually just now getting my business up and running, so I will be less hands on about VE. I probably will only do them as clients request. So, if they are requesting a VE and there is no cervical change at that point I would recommend. Does that make sense to you?
My personal plan is to refuse the 36 week VE. I might let her do one for my prenatal the week of Christmas, I haven't decided yet though. Other than that I don't want any.

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#14 of 26 Old 11-29-2008, 01:11 PM
 
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I forgot to add that I have had a LEEP myself and was taking EPO for scarring. I was taking 500mg almost every day. (I admit that I would forget or was having trouble during the MS period.) I had an episode of contractions for 1 1/2 every 3-7 minutes. I was near my midwife's office, so she checked me. I wasn't dilating or effacing, but things had softened too much for only being something like 17 weeks. So she had me quit taking it and wants me to resume at 36 weeks. (Which is just a little over a week now. Yea!!) So even in cervical scarring, you can probably get too much if you are taking it the whole pregnancy.

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#15 of 26 Old 11-30-2008, 09:33 AM - Thread Starter
 
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Thanks everyone for replies.

hislittlelambs--I guess I'd be surprised if you had found anything in your search. I just don't think much real research has been done yet on EPO (nor on a lot of other herbs). We seem to be getting to the point of analyzing some herbs chemically, to have an idea of how they might work--so now we know that EPO does have the omega 6 efa's, for instance. But as for actual studies....not so much. I guess *we*....you, me, these other moms and mws here and elsewhere in the real world...are at the cutting edge!

sevenkids--so, you put EPO on a glove and massage it into cervix, or have mom insert caps, or....? I have heard of this before--but no specifics. Care to share? Also, do you see good results (as far as you can tell)?

rockportmw--thanks for all that. thing is, some women who've had LEEP have scarring and may need help in the form of EPO (for instance) to dilate properly. But don't some others have the opposite problem--incompetent cervix, the tendency toward preterm labor? I realize that 'incomp. cerv.' is about 'painless dilation' which technically makes it different than 'preterm labor' but in people's accounts (mws and moms) there seems to be a lot of crossover there, or muddling of terms and effects. Main point being that for some, dilation tends to want to occur too soon. Which makes me wonder how advisable it is to take anything that might cause cervical changes, before 36wks or so.

Also thinking here....if EPO is a source of omega 6 efa's along with phyto-estrogen, and those compounds are presumably what EPO contributes toward production of prostaglandins....doesn't it make sense to try to get a good sense of what efa's/phytoestrogens a woman may already be ingesting from her diet, before suggesting she take EPO?

Any other stories, strategies, questions on EPO are very welcome here
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#16 of 26 Old 11-30-2008, 09:34 AM
 
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I generally would only use EPO in large amounts orally, or in any amount vaginally if I were actively trying to encourage cervical ripening/ labour. Then I'd be getting a lot into the mother, say 2 capsules orally every 4 hours (and IRT EPO, 1000mg is pretty standard for a capsule, though you can get other amounts; generally assume cap=1000mg) and 6 caps vaginally 1x in the first day, and increasing to 2-3x in the next day. (again, I would only move on to such high doses if the mother was at least at term (and I count term to be 41.5 weeks) and/or with some other indication of need to aid cervical ripening, in combination with oxytocic stimulators.

The only source I can think of on top of my head would be HMvolII. Frye recommends 6-7 caps inserted in/ around the cervix to prepare for induction.

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#17 of 26 Old 11-30-2008, 11:41 AM
 
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I poke a hole into 7-8 capsules, put the oil on a glove and massage it into the scar tissue. Seems to work pretty well, a bit better than just using jelly or olive oil. I never thought about using before labour because even if mom has scar tissue, I never know how it's going to respond to labour until labour actually happens. A lot of the time, scar tissue breaks up fine, and it's not a problem until it's a problem.

Bu I'm a little leery of all this labour-prep stuff, anyway.
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#18 of 26 Old 11-30-2008, 04:50 PM - Thread Starter
 
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I poke a hole into 7-8 capsules, put the oil on a glove and massage it into the scar tissue. Seems to work pretty well, a bit better than just using jelly or olive oil. I never thought about using before labour because even if mom has scar tissue, I never know how it's going to respond to labour until labour actually happens. A lot of the time, scar tissue breaks up fine, and it's not a problem until it's a problem.

Bu I'm a little leery of all this labour-prep stuff, anyway.

thanks for this. and I agree--I am also leery of 'labor prep'.

Majikfaerie--I hear you that 1000mgs of EPO seems to have become standard dose in the caps (500 and 1000mgs are the only 2 types I've seen). I just really wonder how this was arrived at!
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#19 of 26 Old 11-30-2008, 06:35 PM
 
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Have to say, I'm finding this thread extremely fascinating. Wise Woman Herbal for the childbearing yr lists a very large range of herbs, etc and gives reasons behind their usage. Susan Weed (author) can be pretty specific about amounts. Probably would be a good person to contact for questions. From what I hear, she is pretty good at responding to correspondence and also gives lectures.
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#20 of 26 Old 11-30-2008, 06:35 PM
 
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Ok, after I slept a night I looked in a few books, and all I can find is recommendations for EPO in 1000mg doses. No indication as to why that is. I somehow recall from a jar of it that I had that the 1000mg was because it provides 100mg of GLA. I'm not sure what the recommended daily intake of GLA is, but it is connected to hormonal regulation.

ETA, I'm also leery of labour prep. IMO nature does best on it's own, but in cases of a mother with indication for induction, I use EPO as a cervical ripener. not in massive doses like mentioned in the OP, that seems excessive. herbal treatments are just like anything. too much is still too much.

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#21 of 26 Old 11-30-2008, 06:43 PM
 
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Have to say, I'm finding this thread extremely fascinating. Wise Woman Herbal for the childbearing yr lists a very large range of herbs, etc and gives reasons behind their usage. Susan Weed (author) can be pretty specific about amounts. Probably would be a good person to contact for questions. From what I hear, she is pretty good at responding to correspondence and also gives lectures.
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I just checked my WWHftCBY, and Weed also recommends EPO for cervical softening and menstrual problems. again, in oral doses of 3 caps/day and for cervical application "several capsules". hardly anything like the doses mentioned in the OP.

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#22 of 26 Old 11-30-2008, 06:53 PM
 
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I agree, she's far more conservative on her doses than what was described. It would be very interesting to talk to her and see how she came about her dosage recommendations, don't you think?
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#23 of 26 Old 11-30-2008, 07:12 PM
 
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I agree, she's far more conservative on her doses than what was described. It would be very interesting to talk to her and see how she came about her dosage recommendations, don't you think?
i agree it would be really interesting to talk to her about it, but I don't find her recommendations to be conservative. seems pretty standard to me, and Frye recommends the same. IMO, their recs are about normal, just that the doses mentioned in the OP are extreme.

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#24 of 26 Old 11-30-2008, 09:36 PM
 
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No, I just meant that her doses are more conservative than what was described. They seem to be standard.
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#25 of 26 Old 12-01-2008, 04:35 AM
 
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true, but you can take anything that is generally beneficial, and take excessive doses over extended periods and get bad results

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#26 of 26 Old 12-01-2008, 12:01 PM
 
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I agree. I think maybe we are thinking and saying the same thing, just in different ways. Susan Weed's recommended dosages are standard; I was just wondering how she came to choose those particular dosages. Did she come to them through trial and effort, were they passed down to her through tradition, etc? How does anyone choose the amounts the recommend, which is what I think one of the main original thoughts put out there for discussion.
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