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. 2005 Jul 20;2005(3):CD003392.
doi: 10.1002/14651858.CD003392.pub2.

Breast stimulation for cervical ripening and induction of labour

J Kavanagh  1 , A J Kelly, J Thomas
Affiliations

Breast stimulation for cervical ripening and induction of labour

J Kavanagh et al. Cochrane Database Syst Rev. .

Abstract

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.

Objectives: 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.

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

Selection criteria: Clinical trials of breast stimulation for third trimester cervical ripening or labour induction.

Data collection and analysis: 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.

Main 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).

Authors' 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.

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Conflict of interest statement

None known.

Figures

1.2
1.2. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
1.3
1.3. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 3 Caesarean section.
1.4
1.4. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 4 Serious neonatal morbidity/perinatal death.
1.6
1.6. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
1.8
1.8. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 8 Uterine hyperstimulation without fetal heart rate changes.
1.12
1.12. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 12 Meconium stained liquor.
1.13
1.13. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 13 Apgar score < 7 at 5 minutes.
1.16
1.16. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 16 Perinatal death.
1.23
1.23. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 23 Postpartum haemorrhage.
1.28
1.28. Analysis
Comparison 1 Breast stimulation versus no intervention (all women), Outcome 28 Not in labour at 72 hours.
2.2
2.2. Analysis
Comparison 2 Breast stimulation versus no intervention (all women, favourable cervix), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
2.4
2.4. Analysis
Comparison 2 Breast stimulation versus no intervention (all women, favourable cervix), Outcome 4 Serious neonatal morbidity/perinatal death.
2.8
2.8. Analysis
Comparison 2 Breast stimulation versus no intervention (all women, favourable cervix), Outcome 8 Uterine hyperstimulation without fetal heart rate changes.
2.16
2.16. Analysis
Comparison 2 Breast stimulation versus no intervention (all women, favourable cervix), Outcome 16 Perinatal death.
2.28
2.28. Analysis
Comparison 2 Breast stimulation versus no intervention (all women, favourable cervix), Outcome 28 Not in labour at 72 hours.
3.4
3.4. Analysis
Comparison 3 Breast stimulation versus no intervention (all women, unfavourable cervix), Outcome 4 Serious neonatal morbidity/perinatal death.
3.6
3.6. Analysis
Comparison 3 Breast stimulation versus no intervention (all women, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
3.12
3.12. Analysis
Comparison 3 Breast stimulation versus no intervention (all women, unfavourable cervix), Outcome 12 Meconium stained liquor.
3.16
3.16. Analysis
Comparison 3 Breast stimulation versus no intervention (all women, unfavourable cervix), Outcome 16 Perinatal death.
3.28
3.28. Analysis
Comparison 3 Breast stimulation versus no intervention (all women, unfavourable cervix), Outcome 28 Not in labour at 72 hours.
4.2
4.2. Analysis
Comparison 4 Breast stimulation versus no intervention (all primiparae), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
4.4
4.4. Analysis
Comparison 4 Breast stimulation versus no intervention (all primiparae), Outcome 4 Serious neonatal morbidity/perinatal death.
4.6
4.6. Analysis
Comparison 4 Breast stimulation versus no intervention (all primiparae), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
4.8
4.8. Analysis
Comparison 4 Breast stimulation versus no intervention (all primiparae), Outcome 8 Uterine hyperstimulation without fetal heart rate changes.
4.12
4.12. Analysis
Comparison 4 Breast stimulation versus no intervention (all primiparae), Outcome 12 Meconium stained liquor.
4.16
4.16. Analysis
Comparison 4 Breast stimulation versus no intervention (all primiparae), Outcome 16 Perinatal death.
4.23
4.23. Analysis
Comparison 4 Breast stimulation versus no intervention (all primiparae), Outcome 23 Postpartum haemorrhage.
4.28
4.28. Analysis
Comparison 4 Breast stimulation versus no intervention (all primiparae), Outcome 28 Not in labour at 72 hours.
5.2
5.2. Analysis
Comparison 5 Breast stimulation versus no intervention (all primiparae, favourable cervix), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
5.4
5.4. Analysis
Comparison 5 Breast stimulation versus no intervention (all primiparae, favourable cervix), Outcome 4 Serious neonatal morbidity/perinatal death.
5.8
5.8. Analysis
Comparison 5 Breast stimulation versus no intervention (all primiparae, favourable cervix), Outcome 8 Uterine hyperstimulation without fetal heart rate changes.
5.16
5.16. Analysis
Comparison 5 Breast stimulation versus no intervention (all primiparae, favourable cervix), Outcome 16 Perinatal death.
5.28
5.28. Analysis
Comparison 5 Breast stimulation versus no intervention (all primiparae, favourable cervix), Outcome 28 Not in labour at 72 hours.
6.4
6.4. Analysis
Comparison 6 Breast stimulation versus no intervention (all primiparae, unfavourable cervix), Outcome 4 Serious neonatal morbidity/perinatal death.
6.6
6.6. Analysis
Comparison 6 Breast stimulation versus no intervention (all primiparae, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
6.12
6.12. Analysis
Comparison 6 Breast stimulation versus no intervention (all primiparae, unfavourable cervix), Outcome 12 Meconium stained liquor.
6.28
6.28. Analysis
Comparison 6 Breast stimulation versus no intervention (all primiparae, unfavourable cervix), Outcome 28 Not in labour at 72 hours.
7.23
7.23. Analysis
Comparison 7 Breast stimulation versus no intervention (all multiparae), Outcome 23 Postpartum haemorrhage.
7.28
7.28. Analysis
Comparison 7 Breast stimulation versus no intervention (all multiparae), Outcome 28 Not in labour at 72 hours.
8.2
8.2. Analysis
Comparison 8 Breast stimulation versus oxytocin (all women), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
8.3
8.3. Analysis
Comparison 8 Breast stimulation versus oxytocin (all women), Outcome 3 Caesarean section.
8.4
8.4. Analysis
Comparison 8 Breast stimulation versus oxytocin (all women), Outcome 4 Serious neonatal morbidity/perinatal death.
8.6
8.6. Analysis
Comparison 8 Breast stimulation versus oxytocin (all women), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
8.8
8.8. Analysis
Comparison 8 Breast stimulation versus oxytocin (all women), Outcome 8 Uterine hyperstimulation without fetal heart rate changes.
8.12
8.12. Analysis
Comparison 8 Breast stimulation versus oxytocin (all women), Outcome 12 Meconium stained liquor.
8.16
8.16. Analysis
Comparison 8 Breast stimulation versus oxytocin (all women), Outcome 16 Perinatal death.
8.28
8.28. Analysis
Comparison 8 Breast stimulation versus oxytocin (all women), Outcome 28 Not in labour at 72 hours.
9.4
9.4. Analysis
Comparison 9 Breast stimulation versus oxytocin (all women, unfavourable cervix), Outcome 4 Serious neonatal morbidity/perinatal death.
9.6
9.6. Analysis
Comparison 9 Breast stimulation versus oxytocin (all women, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
9.12
9.12. Analysis
Comparison 9 Breast stimulation versus oxytocin (all women, unfavourable cervix), Outcome 12 Meconium stained liquor.
9.16
9.16. Analysis
Comparison 9 Breast stimulation versus oxytocin (all women, unfavourable cervix), Outcome 16 Perinatal death.
9.28
9.28. Analysis
Comparison 9 Breast stimulation versus oxytocin (all women, unfavourable cervix), Outcome 28 Not in labour at 72 hours.
10.4
10.4. Analysis
Comparison 10 Breast stimulation versus oxytocin (all primiparae), Outcome 4 Serious neonatal morbidity/perinatal death.
10.6
10.6. Analysis
Comparison 10 Breast stimulation versus oxytocin (all primiparae), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
10.12
10.12. Analysis
Comparison 10 Breast stimulation versus oxytocin (all primiparae), Outcome 12 Meconium stained liquor.
10.16
10.16. Analysis
Comparison 10 Breast stimulation versus oxytocin (all primiparae), Outcome 16 Perinatal death.
10.28
10.28. Analysis
Comparison 10 Breast stimulation versus oxytocin (all primiparae), Outcome 28 Not in labour at 72 hours.
11.4
11.4. Analysis
Comparison 11 Breast stimulation versus oxytocin (all primiparae, unfavourable cervix), Outcome 4 Serious neonatal morbidity/perinatal death.
11.6
11.6. Analysis
Comparison 11 Breast stimulation versus oxytocin (all primiparae, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
11.12
11.12. Analysis
Comparison 11 Breast stimulation versus oxytocin (all primiparae, unfavourable cervix), Outcome 12 Meconium stained liquor.
11.16
11.16. Analysis
Comparison 11 Breast stimulation versus oxytocin (all primiparae, unfavourable cervix), Outcome 16 Perinatal death.
11.28
11.28. Analysis
Comparison 11 Breast stimulation versus oxytocin (all primiparae, unfavourable cervix), Outcome 28 Not in labour at 72 hours.
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References

References to studies included in this review

Adewole 1993a {published data only}
    1. Adewole IF, Franklin O, Matiluko AA. Cervical ripening and induction of labour by breast stimulation. African Journal of Medicine and Medical Science 1993;22:81‐6. - PubMed
Adewole 1993b {published data only}
    1. Adewole IF, Franklin O, Matiluko AA. Cervical ripening and induction of labour by breast stimulation. African Journal of Medicine and Medical Science 1993;22:81‐6. - PubMed
Chayen 1986 {published data only}
    1. Chayen B, Tejani N, Verma U. Induction of labor with an electric breast pump. Journal of Reproductive Medicine 1986;34(2):116‐8. - PubMed
Damania 1992 {published data only}
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Elliott 1984a {published data only}
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Salmon 1986a {published data only}
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References to studies excluded from this review

Adewole 1993c {published data only}
    1. Adewole IF, Franklin O, Matiluko AA. Cervical ripening and induction of labour by breast stimulation. African Journal of Medicine and Medical Science 1993;22:81‐6. - PubMed
Damania 1988 {published data only}
    1. Damania KR, Nanavati MS, Dastur NA, Daftary SH. Breast stimulation for cervical ripening. Journal of Obstetrics and Gynaecology India 1988;38:663‐5.
Di Lieto 1989 {published data only}
    1. Lieto A, Miranda L, Ardito P, Albanc G. Changes in the Bishop Score induced by nipple stimulation. A cross‐over randomized study. Clinical and Experimental Obstetrics and Gynecology 1989;1:26‐9. - PubMed
Elliott 1983 {published data only}
    1. Elliott JP, Flaherty JF. The use of breast stimulation to ripen the cervix in term pregnancies. American Journal of Obstetrics and Gynecology 1986;145:553‐6. - PubMed
Elliott 1984b {published data only}
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Kadar 1990 {published data only}
    1. Kadar N, Tapp A, Wong A. The influence of nipple stimulation at term on the duration of pregnancy. Journal of Perinatology 1990;10(2):164‐6. - PubMed
Salmon 1986b {published data only}
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