Reconsidering the Use of Blue Cohosh in Pregnancy

I was taught in herbal medicine school that the use of blue cohosh (Caulophyllum thalictroides) as a partus preparator is a misunderstood and outdated practice that is not considered safe for the newborn. Yet, as a currently pregnant woman myself, I continue to see it suggested in classes, books, ninth-month formulas, by midwives and self-prescribed by pregnant women themselves who may have read or heard somewhere they should take it.

As responsible herbalists and birthworkers, I feel it is important that we continually update our knowledge and remain flexible to new observations and information, in order to make more educated suggestions to our clients and provide them with honest information.

Let’s take a moment to consider the reasons why women take partus preparator formulas. Often there is a thought that the woman’s own body needs help, that it is somehow insufficient to safely and easily give birth itself without intervention. Of course, the idea that an herb could make things easier sounds great, and I admit I’ve been drinking raspberry leaf tea myself with the idea of supporting a strong birth and transition. But this is something to truly think about when talking with women and suggesting things: It should be about empowering the woman, and not subtly sending a message that she needs help. Other common reasons labor-inducing herbs are taken during the last 6 weeks include the real anxiety of medical intervention should the pregnancy go beyond the mathematical amount of time deemed appropriate by the woman’s care providers. Another reason is personal comfort, and I can attest to this that being heavily pregnant is a frankly exhausting affair filled with numerous achy, painful, and uncomfortable reasons one might want to be done with it as soon as healthfully possible. Given these understandings, a “ninth month” formula may be appropriate in some situations, particularly in the case of desiring to avoid medical interventions. However, is blue cohosh appropriate to be included in that formula?

Blue cohosh is considered a low-dose botanical. It contains compounds toxic in high doses. To the mother, it may not present any symptoms of toxicity, but for the fetus, many adverse outcomes have been reported- including tachycardia, perinatal stroke, myocardial infarction, congestive heart failure, and other cardiotoxic effects; increased menconium, fetal distress, shock, increased need for neonatal resuscitation at birth, and a high-pitched neonatal cry. Severe multi-organ failure, hypoxic-ischemic injury and central nervous system damage have also been reported. Alkaloid and vasoactive constituents present in blue cohosh (i.e., methylcystine, caulosaponins, caulophyllosaponins), as well as suspected teraogenicity, mutagenicity, and oxytoxicity, may be responsible. As a mother, I say these risks are not worth it.

Often I have heard it repeated that Native American Indian women have taken blue cohosh in late pregnancy for hundreds of years to prepare the uterus for birth. Yet in searching through the ethnobotanical literature, this does not actually seem to be the case. Rather, this is a wistfully romantic vision of natives using the bounty of the earth to facilitate natural childbirth, that has been repeated through generations of European-descent herbalists. As far as what we can truthfully tell at present day, it was historically used in very difficult labors (during labor, not before) (in addition to its use as an abortifacient, emmenogogue, structural reproductive short term tonic, and so on for non-pregnant or non-desiring to be pregnant women and men). Regardless, just because something has been used in the past does not mean it was a wise usage, no matter who was doing the using! Paul Bergner, a respected herbalist, describes his efforts to track back the historical uses of blue cohosh as a partus preparator in his article, Caulophyllum: Cardiotoxic Effects of Blue Cohosh on a Fetus, published in the Medical Herbalism Journal for the Clinical Practitioner:

“The use of blue cohosh as a preparation for pregnancy appears to have entered the American medical literature in the works of medical botanist Constantine Rafinesque in 1828. He states that Native Americans employed “. . . constant use of tea 2-3 weeks prior to partruition,” attributing this information to a commercial pamphlet published in 1813 in Cincinnati by an “Indian doctor” named Peter Smith who sold the herb commercially. Note that the term Indian doctor at that time did not necessarily refer to someone of Native American ancestry, and the doctor had not necessarily studied with Native Americans. It was a description of an herbalist who used the native North American plants, plants whose uses had for the most part not entered into regular medicine. Smith’s statement cannot be accepted as a primary reference to native American use, although it was repeated in medical literature for the next hundred years on the strength of Rafinesque’s reputation. Rafinesque himself only stated that the plant deserved further study…the major source for taking it as a partus preparator is from a single reference by Peter Smith, …repeated in Rafinesque.

In conclusion, considering the adverse fetal outcomes associated with the use of this herb in the final weeks of pregnancy, I believe it is our responsibility to educate our pregnant clients about the risks, and to remove it from our formulas for use in pregnancy. Thanks for reading.


American Herbal Pharmacopoeia and Therapeutic Compendium: Blue Cohosh Root and Rhizome: Standards of Analysis, Quality Control, and Therapeutics:
The Essential Guide to Herbal Safety
Botanical Medicine for Women’s Health
Botanical Safety Handbook
Caulophyllum: Cardiotoxic Effects of Blue Cohosh on a Fetus, by Paul Bergner from the Medical Herbalism Journal for the Clinical Practitioner:
Thanks to classes, discussions, and readings from: Juliet Blankenspoor, Aviva Romm, Paul Bergner, Roy Upton, and others


3 thoughts on “Reconsidering the Use of Blue Cohosh in Pregnancy

  1. Very useful and helpful information. My approach has always been to be the least invasive, and the least additive that I can possibly be during my pregnancies, and to allow myself to trust my body and it’s inherent wisdom as far as I can take it. I will pass this information on through Twitter and repost on FB too though. It’s so important to spread the word in our communities about this kind of thing. BTW, I’m drinking raspberry tea on the daily too. I’m only 9 weeks along, and keeping my fingers crossed, but from past experience, it really does help- especially with nausea. =)

  2. Oh, and I remember being so worried when reading about thyme (which I grow and use a lot of in my cooking) and chamomile’s effects on pregnancies as well last year.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s