A Cochrane review included 6 studies with a total of 719 women; 5 studies compared breast stimulation with no intervention and 2 studies with oxytocin alone. Breast stimulation compared with no intervention resulted in a significant reduction in the number of women not in labour at 72 hours (62.7% vs 93.6%, RR 0.67, 95% CI 0.60–0.74). This result was not significant in women with an unfavourable cervix. A major reduction in the rate of postpartum haemorrhage was reported (0.7% vs 6%, RR 0.16, 95% CI 0.03–0.87). No significant difference was detected in the caesarean section rate (9% versus 10%, RR 0.90, 95% CI 0.38–2.12) 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 0.45–147.77). When comparing breast stimulation with oxytocin alone the analysis found no difference in caesarean section rates (28% vs 47%, RR 0.60, 95% CI 0.31–1.18). No difference was detected in the number of women not in labour after 72 hours (58.8% vs 25%, RR 2.35, 95% CI 1.00–5.54) or rates of meconium staining. There were four perinatal deaths (17.6% vs 5%, RR 3.53, 95% CI 0.40 to 30.88).
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).