Is castor oil safe during pregnancy?

What does the evidence say about castor oil during pregnancy?

1. The only FDA-approved use for castor oil is as a stimulant laxative for occasional constipation, and its use as a laxative is listed as contraindicated in pregnancy because ingesting it may bring on contractions. 1
2. Castor oil can cause severe diarrhea along with cramping of both the bowel and the uterus. 2
3. The reason both effects happen together is mechanical: ricinoleic acid released from castor oil activates EP3 prostanoid receptors on smooth muscle in the intestine and in the uterus alike. 3
4. Reported adverse effects include abdominal cramping, vomiting, bloating, and dizziness, along with loss of water and electrolytes. 1
5. Where castor oil has been studied for labor induction, it was a supervised hospital protocol using a 20 mL dose from 38 weeks onward, and that cohort did not systematically record patient-reported side effects. 4

Is castor oil safe in each trimester?

• First trimester. Castor oil is not an appropriate first-trimester constipation option. Fiber, fluid, and movement come first, with bulk-forming agents as the usual next step your provider can direct.
• Second trimester. The contraindication holds through mid-pregnancy. If constipation is severe enough that you are considering something this strong, that is the moment to call your provider instead.
• Third trimester. This is when people most often hear about castor oil as a way to start labor. The studies behind that use were supervised hospital protocols at term, not something to try at home.