Chapter 20 The reproductive tract
Phytomedicines in childbirth
Taking (any) medicine during pregnancy is generally not advisable as safety of the mother and fetus cannot be guaranteed. Raspberry leaf is included here simply because according to folklore it has a widespread use in facilitating childbirth, and it is often recommended that it be taken during pregnancy for this purpose, but the use cannot be recommended as there is little clinical evidence available to demonstrate either safety or efficacy.
Ergometrine 
Ergometrine (Fig. 20.1) is an alkaloid extracted from ergot (Claviceps purpurea Tul.), a parasitic fungus growing on cereals, usually rye. It is used to manage the third stage of labour (in conjunction with oxytocin), and to control postpartum haemorrhage if the placenta has not been completely expelled. It must be used only under the care of a midwife or obstetrician.
Raspberry leaf, Rubus idaeus L. (Rubi idaei folium)
Raspberry leaf (Rubus idaeus, Rosaceae) ‘tea’ has been used for centuries to facilitate childbirth, and it is usually recommended that it be drunk freely before and during confinement for maximum benefit. The raspberry shrub is well known and will not be described. It is cultivated in many temperate countries for the fruit.
Constituents
The leaves have not been well investigated, but contain uncharacterized polypeptides and flavonoids, mainly glycosides of kaempferol and quercetin, including rutin.
Therapeutic uses and available evidence
A retrospective observational study on 108 mothers in Australia indicated that a shortening of labour and reduction in medical intervention occurred, with no untoward effects apart from a single case of diarrhoea and anecdotal reports of strong Braxton Hicks contractions. However, a larger, randomized placebo-controlled trial of 192 women by the same authors did not confirm such benefits, although no adverse effects for either mother or baby were noted (Simpson et al 2001). Uterine relaxant effects have been demonstrated in animals (Rojas-Vera et al 2002), and raspberry leaf appears to affect only the pregnant uterus of both rats and humans, with no activity on the non-pregnant uterus. However, no further identification of the active principle(s) has been made and a recent review concludes that in the absence of good clinical data, raspberry leaf cannot be recommended in pregnancy (Holst et al 2009).
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