Black cohosh is a very popular herbal supplement for pregnant women, most commonly used to ripen and prepare the cervix for labor. It is also frequently used by midwives and naturopathic obstetricians to induce labor that has gone past term. While black cohosh remains extremely common among advocates of natural birth, its use is controversial in the mainstream medical community because some perceive it as unsafe.
How Black Cohosh Works
Traditionally, black cohosh has been used to treat a wide spectrum of gynecological problems and other ailments. It has historically been considered to be a virtual panacea among the practitioners of Native American herbalism, and it is used for the treatment of sore throat, depression, menopause, ammenorrhea, menstrual cramps, common pregnancy complications, and infertility. It has also been used for inducing labor and lactation.
Black cohosh's effects on the female endoctrine and reproductive systems can be explained by the estrogen-like compounds contained in the root and leaves of the plant. These natural herbal compounds, called phytoestrogens, trigger the body into "believing" that it is experiencing increased levels of estrogen production, leading to noticeable effects on the uterus, ovaries, endometrium, and breasts.
Black Cohosh During Pregnancy
During the third trimester of pregnancy, black cohosh is frequently recommended by midwives as a method of ripening the cervix to prepare it for labor. Some preliminary studies have demonstrated that black cohosh supplements, especially when taken alongside other herbal remedies like red raspberry leaf, can enable childbirth to be easier, less painful, and faster. This may reduce or eliminate the need for dangerous interventions including pain medication and cesarean section.
Black cohosh is also commonly used as a uterine stimulant, to induce labor when a pregnancy has gone past term, or when a medical complication necessitates immediate delivery. As an herbal supplement, large doses of black cohosh can trigger labor, and moderate doses can augment the process of childbirth if labor has stalled or is failing to progress. Because of its ability to stimulate labor, black cohosh is never recommended except during late or post-term pregnancy.
Studies of Black Cohosh for Childbirth
Many animal and human studies have definitively concluded that black cohosh's effects are significantly greater than placebo, and that it does have an obvious estrogenic effect. Fukinolic acid, a recently discovered phytoestrogen, is believed to be the primary active compound of black cohosh, and induces contractions in the uterus--possibly by stimulating the body's own production of oxytocin, much like the pharmaceutical drug Pitocin.
Black cohosh has been extensively used by modern midwives and is recommended by renowned natural-birth practitioners like Ina May Gaskin and Ann Frye--leaders in the modern movement for low-intervention childbirth. Although they and other midwives report a total of thousands of successful, safe births achieved with black cohosh supplementation, one case report was less encouraging.
The Safety of Black Cohosh during Pregnancy
A New Zealand midwife used a combination of black cohosh and blue cohosh (an unrelated herb, despite the similar name) to induce labor in a post-term pregnancy. After the birth, which took place in the patient's home, it became clear that the baby had suffered neurological damage during labor. The combination of herbs was implicated as the cause, although similar case reports might point toward blue cohosh, not black, as the culprit.
Black cohosh is also known to be an anticoagulant, and might be associated with prolonged bleeding or postpartum hemorrhage, especially if the patient has a history of blood platelet disorders or similar problems. While there are no peer-reviewed case reports of this complication, unreported events of this nature may be common.
Practical Understanding of Black Cohosh
Despite concerns, black cohosh may still be a safer alternative to some pharmaceutical drugs. The extremely common, synthetic counterpart of black cohosh, Pitocin, acts in a similar manner and is routinely used in an overwhelming majority of births, often with severely negative results. Pitocin and similar labor-augmenting drugs have been associated with uterine rupture, violent labor, worsened pain, and other complications, and these issues may be less likely when black cohosh is used in its stead.
Mainstream obstetricians and medical practitioners tend to recommend against the use of black cohosh because it is not studied as a drug or supplement in most medical schools. While its safety and efficacy may be comparable, or even preferable, to pharmaceutical equivalents like Pitocin, it is rarely recommended except by midwives and naturopaths, because health care providers often simply lack a comprehensive understanding of the herb's uses.
Because of its potential to create problems, albeit to a lesser extent than pharmaceutical counterparts, pregnant women should avoid ingesting black cohosh except with the full knowledge and understanding of their healthcare providers. Only a qualified midwife or obstetrician can fully determine the wisdom of using black cohosh during pregnancy or labor, based on the individual situation of the patient.
Sources Used:
Gunn TR, Wright IM: The use of black and blue cohosh in labour. New Zealand Medical Journal 109: 410-411, 1996.
Kruse SO, Lohning A, Pauli GF, Winterhoff H, Nahrstedt A: Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Medica 65: 763-764, 1999.
Upton, R, ed. Black Cohosh Rhizome Actaea racemosa L. syn. Cimicifuga racemosa (L.) Nutt. Standards of analysis, quality control, and therapeutics. American Herbal Pharmacopoeia and Therapeutic Compendium. Santa Cruz, CA. American Herbal Pharmacopoeia, 2002: 1-38.
Juniper Russo - Juniper Russo is a natural health consultant and freelance writer native to the southern United States. Outside of Suite101, Russo's ...
