Breast stimulation for cervical ripening and induction of labour.
BACKGROUND
Breast stimulation has been suggested as a means of inducing labour. It is a non-medical intervention allowing women greater control over the induction process. This is one of a series of reviews of methods of cervical ripening and labour induction using a standardised methodology.


OBJECTIVE
To determine the effectiveness of breast stimulation for third trimester cervical ripening or induction of labour in comparison with placebo/no intervention or other methods of induction of labour.


METHODS
The Cochrane Pregnancy and Childbirth Group Trials Register (March 2004) and bibliographies of relevant papers.


METHODS
Clinical trials of breast stimulation for third trimester cervical ripening or labour induction.


METHODS
A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction.


RESULTS
Six trials (719 women) were included. Analysis of trials comparing breast stimulation with no intervention found a significant reduction in the number of women not in labour at 72 hours (62.7% versus 93.6%, relative risk (RR) 0.67, 95% confidence interval (CI) 0.60 to 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% versus 6%, RR 0.16, 95% CI 0.03 to 0.87). No significant difference was detected in the caesarean section rate (9% versus 10%, RR 0.90, 95% CI 0.38 to 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 to 147.77). When comparing breast stimulation with oxytocin alone the analysis found no difference in caesarean section rates (28% versus 47%, RR 0.60, 95% CI 0.31 to 1.18). No difference was detected in the number of women not in labour after 72 hours (58.8% versus 25%, RR 2.35, 95% CI 1.00 to 5.54) or rates of meconium staining. There were four perinatal deaths (17.6% versus 5%, RR 3.53, 95% CI 0.40 to 30.88).


CONCLUSIONS
Breast stimulation appears beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates. Until safety issues have been fully evaluated it should not be used in high-risk women. Further research is required to evaluate its safety, and should seek data on postpartum haemorrhage rates, number of women not in labour at 72 hours and maternal satisfaction.
Kavanagh
J
J
Evidence for Policy and Practice Information and Co-ordinating Centre, Social Science Research Unit, Institute of Education, University of London, 18 Woburn Square, London, UK, WC1H 0NR. j.kavanagh@ioe.ac.uk
Kelly
A J
AJ
Thomas
J
J
D001940:Breast / Q000502:physiology*; D020070:Cervical Ripening / Q000502:physiology*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D010812:Physical Stimulation / Q000009:adverse effects; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors