Breast Stimulation for Cervical Ripening and Induction of Labour

A Cochrane review [Abstract] 1 included 6 studies with a total of 719 women; 5 studies compared breast stimulation with no intervention and 2 studies with oxytocin alone. Breast stimulation compared with no intervention resulted in a significant reduction in the number of women not in labour at 72 hours (62.7% vs 93.6%, RR 0.67, 95% CI 0.60-0.74). This result was not significant in women with an unfavourable cervix. A major reduction in the rate of postpartum haemorrhage was reported (0.7% vs 6%, RR 0.16, 95% CI 0.03-0.87). No significant difference was detected in the caesarean section rate (9% versus 10%, RR 0.90, 95% CI 0.38-2.12) or rates of meconium staining. There were no instances of uterine hyperstimulation. Three perinatal deaths were reported (1.8% versus 0%, RR 8.17, 95% CI 0.45-147.77). When comparing breast stimulation with oxytocin alone the analysis found no difference in caesarean section rates (28% vs 47%, RR 0.60, 95% CI 0.31-1.18). No difference was detected in the number of women not in labour after 72 hours (58.8% vs 25%, RR 2.35, 95% CI 1.00-5.54) or rates of meconium staining. There were four perinatal deaths (17.6% vs 5%, RR 3.53, 95% CI 0.40 to 30.88).

In a randomized controlled experiment 2 390 ninety pregnant women who were giving birth via vaginal delivery were randomly assigned to 3 groups (nipple stimulation, uterine stimulation, control). After the birth, the groups were assessed in terms of the birth duration and synthetic induction with oxytocin. The phases of birth were shorter for the nipple stimulation group (first phase: 3.8 hours, second phase: 16 minutes, third phase: 5 minutes) and the uterine stimulation group (first phase: 4.0 hours, second phase: 21 minutes, third phase: 6 minutes) when compared to the control group (first phase: 6.8 hours, second phase: 27 minutes, third phase: 6 minutes). In the control group, 89.2% of the pregnant women were subject to labor induction and 8.5% to cesarean section. No women in the nipple stimulation group or uterine stimulation group had a cesarean section.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).

References

• Kavanagh J, Kelly AJ, Thomas J. Breast stimulation for cervical ripening and induction of labour. Cochrane Database Syst Rev 2005 Jul 20;(3):CD003392 [Review content assessed as up-to-date: 14 September 2009]. [PubMed]
• Demirel G, Guler H. The Effect of Uterine and Nipple Stimulation on Induction With Oxytocin and the Labor Process. Worldviews Evid Based Nurs 2015;12(5):273-80. [PubMed]