Kacip Fatimah in Pregnancy and Postpartum: the Uterotonic Safety Question

Kacip fatimah's oldest and most specific traditional use is also its most dangerous one to get wrong: a decoction drunk in the final weeks of pregnancy to ease labour, and continued after birth to help the uterus contract back down. This page asks what actually happens when that claim is tested — and the honest answer turns out to involve a real rat pharmacology study that found exactly the uterotonic effect the tradition describes, a 2024 case report of a catastrophic uterine rupture in a woman who drank a "Fatimah" herbal water in labour, and zero controlled human evidence either way. None of that adds up to reassurance.

Table of Contents

  1. The Traditional Claim, and What "Selusoh" Means
  2. Two Plants, One Confusing Name
  3. What Human Evidence Exists: None
  4. The Rat Pharmacology That Does Exist
  5. A Real Case Report, and an Honest Complication
  6. Why This Use Is Different From Every Other Claim on This Site
  7. Drug and Physiology Interactions That Compound the Risk
  8. What This Page Is Not Saying
  9. Key Research Papers
  10. Connections
  11. Featured Videos

The Traditional Claim, and What "Selusoh" Means

The Malay name selusoh fatimah comes from a root meaning to loosen or ease, and it is used as a direct reference to easing childbirth. That is worth sitting with before looking at any evidence, because a name that states the intended outcome is not neutral. This site's own page on motherwort makes the same point about a different plant: "mother" historically meant the uterus, "throw-wort" the throes of labour, and the name means "acts on the uterus" — which is exactly why the plant is contraindicated in pregnancy, not exempt from caution. Kacip fatimah's naming does the identical thing. A herb whose own name promises to loosen the womb for delivery is, definitionally, a herb being taken for a pharmacological effect on uterine muscle. That is not a reason to dismiss the tradition. It is a reason to ask, carefully, whether the effect is real and what it does at the doses people actually drink.

The traditional pattern itself is consistent across ethnobotanical sources: a decoction taken in the final weeks of pregnancy, traditionally beginning around the seventh or eighth month, to make labour shorter and easier, and then continued through the forty-day Malay confinement period after birth to help the uterus contract back to size, reduce bleeding, and restore strength. It is one of the most specific and best-attested traditional uses on this entire site — which is precisely why it deserves the most scrutiny rather than the least.

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Two Plants, One Confusing Name

Before going further, a naming problem has to be cleared up, because it matters for everything that follows on this page. A completely different plant, Anastatica hierochuntica — the resurrection plant or rose of Jericho, a desert mustard native to the Middle East and North Africa — is known across the Malay world as rumput fatimah or sanggul fatimah, and in Arabic as kaff Maryam. It is used specifically to help labour along, for the same obstetric purpose as kacip fatimah, and it is regularly confused with Labisia pumila because of the overlapping name and the overlapping use. Anastatica hierochuntica has its own documented concern in the obstetric literature over excessive uterine stimulation when taken in labour. That concern belongs to that plant. It does not, on its own, tell you anything about Labisia pumila.

The reason this matters here rather than as a footnote is that the case report described below uses the name "rumput Fatimah" for the material the patient drank, while the paper's title and indexing call it Labisia pumila. Botanical naming in informal, home-prepared herbal medicine is not always precise, and "rumput" simply means grass or herb in Malay and Indonesian — it is not a reliable species marker on its own. Hold that ambiguity in mind for the case report section below; it is addressed directly there rather than smoothed over.

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What Human Evidence Exists: None

There is no randomised trial of kacip fatimah in pregnancy or labour. There is no controlled study of postpartum uterine involution in women given the herb, and no controlled study of postpartum blood loss. This is not a case of thin or old evidence — it is a complete absence, and it should be named as a finding rather than skipped past.

A 2025 comprehensive review of Labisia pumila's traditional uses, phytochemistry and pharmacology — which searched Elsevier, PubMed, Google Scholar, Baidu Scholar, CNKI, ScienceDirect and Web of Science specifically under the terms "Labisia pumila," "Kacip Fatimah" and "Marantodes pumilum" — concluded plainly that current research has focused almost entirely on estrogen-deficiency-related conditions and bone disease, and that "there is no scientific evidence for other traditional uses" — a category that explicitly includes the childbirth-facilitation use the review itself lists as the plant's primary ethnopharmacological relevance. That is about as direct a confirmation of the evidence gap as a review gets.

One qualification is worth making transparently: that same review's search scope should have included the rat pharmacology study described in the next section, which was published in an Elsevier journal within its stated search window. Whether it was found and judged not to count as "scientific evidence for" the traditional use, or simply missed, is not stated. Both primary sources are cited on this page so you are not depending on either one alone.

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The Rat Pharmacology That Does Exist

Absence of human evidence is not the same as absence of any evidence, and this is the one place on this page where the traditional claim has actually been tested in an animal model — with a result that supports it mechanistically.

A 2019 study from the University of Malaya gave day-1 postpartum female rats an aqueous extract of Marantodes pumilum leaves (100, 250 and 500 mg/kg/day, orally, for seven consecutive days), then harvested the uteri for an ex-vivo organ-bath contraction study alongside protein-expression analysis. The findings were unambiguous within the model: the force of uterine contraction increased with increasing doses of the extract, and the expression of an entire uterotonic signalling cascade rose alongside it — calmodulin (CaM), myosin light chain kinase (MLCK), the sarcoplasmic reticulum calcium pump SERCA, G-protein alpha and beta subunits, inositol-triphosphate 3-kinase, the oxytocin receptor, the prostaglandin F2α receptor, the muscarinic receptor, and both oestrogen receptor subtypes. Serum estradiol fell at the higher doses while progesterone stayed low. The authors' own conclusion states that the findings "support the claims that MPE help to firm the uterus and pave the way for its use as a uterotonic agent after delivery."

Read that conclusion precisely, because what it supports is narrower than the full traditional claim. This is a postpartum, day-1-onward model — it tests the "firms the uterus and reduces bleeding after birth" half of the tradition. It says nothing about the separate "eases and shortens labour when taken before delivery" half, because no pregnant, pre-labour animal was tested here. Borrowing a postpartum-uterus result to reassure about, or to justify, antepartum use in a woman who has not yet delivered is the same kind of substitution error this site's evidence doctrine flags elsewhere when a study of one preparation, tissue or timepoint gets applied to a different one. The two traditional uses are pharmacologically distinct questions, and only one of them has even preliminary animal data.

What this study establishes, stated as plainly as the data allow: a real, dose-dependent, mechanistically detailed uterotonic effect exists in at least one rat model, driven by exactly the receptor and calcium-signalling machinery you would expect a uterotonic agent to engage. That is a stronger basis for taking the safety question seriously than "traditional use" alone would be — and it cuts against reassurance, not toward it.

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A Real Case Report, and an Honest Complication

In January 2024, obstetricians at Hasan Sadikin General Hospital in Bandung, Indonesia, published a case report titled "Labisia pumila as a Culprit of Primary Uterine Rupture Alongside Abruptio Placentae." A 35-year-old woman in her second pregnancy, with no prior uterine surgery and no other risk factor for rupture, presented with acute abdominal pain after continuously drinking a boiled herbal water to help bring on labour. At exploratory laparotomy the uterus was found ruptured over approximately 15–18 centimetres, the placenta had separated and was found outside the uterine cavity, and the baby had died in utero. A subtotal hysterectomy was performed. The authors' stated conclusion is that rational use of herbal medicine needs to be practised to avoid this kind of complication.

This is a genuinely serious, peer-reviewed, indexed report of a near-worst-case obstetric catastrophe following use of a plant identified as Labisia pumila. It deserves to be taken exactly that seriously. It also deserves one honest complication, flagged rather than hidden: within the case narrative itself, the patient describes the material as "rumput Fatimah," obtained informally from a neighbour — and, as explained above, "rumput fatimah" is the name more commonly attached in Malay ethnobotany to a different plant entirely, Anastatica hierochuntica. The plant material in this case was never botanically or chemically verified; it was a home preparation from an unverified source, described secondhand by the patient. There is no way, from the published report alone, to be certain which plant she actually drank.

What this does not mean is that the case report can be waved away. Two things are true regardless of which plant was in the pot. First, this is real, published, peer-reviewed evidence that an oxytocic herbal preparation taken deliberately during labour to hasten delivery is mechanistically capable of causing catastrophic uterine injury — the exact danger class that a genuinely uterotonic plant creates. Second, and specifically for Labisia pumila: the rat pharmacology above is not a hypothetical. It is a real, dose-dependent, receptor-level uterotonic effect published independently of this case, in a different country, by a different research group, five years earlier. A case report with an uncertain species identification, read alongside a mechanistic study with a certain one, is more concerning together than either is alone — not less.

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Why This Use Is Different From Every Other Claim on This Site

Every other benefit claim examined on this site's Kacip Fatimah pages can be tried by an adult who understands the uncertainty and accepts the risk personally — a disappointing menopause trial, an unclear cosmetic effect, wasted money. This one cannot be contained that way. A pregnant woman taking a plant specifically because it is supposed to act on her uterus is, by definition, attempting to influence uterine activity in a system where too much contraction reduces placental blood flow and can harm a fetus that has no say in the decision and no way to signal distress until damage is already occurring. There is no controlled human study of what kacip fatimah does to uterine activity, fetal heart rate, or blood loss at any dose, in any trimester. The rat data above shows the mechanism is plausible and dose-responsive. The case report shows what a related plant class can do at the extreme end. Neither an animal study nor a single case report is proof of causation in humans — but the asymmetry of the stakes means the bar for "not enough evidence to worry" is much higher here than it is for a herb whose worst-case outcome is an ineffective supplement.

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Drug and Physiology Interactions That Compound the Risk

A separate line of laboratory work adds a second, independent reason for caution that has nothing to do with the uterotonic mechanism directly. A 2016 study comparing five commonly used Southeast Asian herbs — Eurycoma longifolia, Labisia pumila, Echinacea purpurea, Andrographis paniculata and Ginkgo biloba — for their effect on human cytochrome P450 2C8, a major drug-metabolising liver enzyme, found Labisia pumila to be the most potent inhibitor of the five, with an inhibition constant twice that of quercetin (the assay's positive control) and an uncompetitive inhibition mechanism distinct from the other herbs tested. A separate 2014 screening study, testing the extract and its isolated constituents against the three major regulators of drug clearance — cytochrome P450 enzymes, P-glycoprotein, and the pregnane X receptor — found significant time-dependent inhibition of CYP3A4 plus reversible inhibition of CYP2C9 and CYP2C19.

Neither study was conducted in pregnant women, and neither tested any specific obstetric drug combination. What they establish is that kacip fatimah is not pharmacologically inert with respect to drug metabolism generally, which matters in pregnancy and the postpartum period specifically because that is exactly when a woman is most likely to be on other medication — antihypertensives for pre-eclampsia, anticoagulants, antibiotics, anaesthetic agents around delivery. "No documented interaction" for kacip fatimah in pregnancy reflects that the specific combinations have never been studied, not that the underlying enzyme systems are unaffected. The absence of a case report of a drug interaction is not the same as evidence that one could not happen.

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What This Page Is Not Saying

It is worth being precise about the limits of this caution, because overstating a hazard is its own kind of inaccuracy. This page is not asserting that kacip fatimah is a proven teratogen — there is no birth-defect signal in any study cited here, and a uterotonic effect on smooth muscle is a mechanistically distinct hazard from a developmental one; the two should not be conflated into a single vague "avoid in pregnancy for safety" without saying which safety. It is not asserting that every woman who has ever taken a confinement-period decoction of kacip fatimah postpartum has been harmed — the tradition of postpartum use specifically, after delivery rather than before it, is the one traditional use the rat pharmacology actually models, and the case report describes antepartum use in active labour, a different clinical situation. And it is not asserting that the 2024 case report proves Labisia pumila caused that rupture, for the naming reasons explained above.

What the evidence, taken together, does support is narrower and still serious enough to act on: a herb with a real, dose-dependent, receptor-level uterotonic mechanism demonstrated in a validated animal model, zero controlled human safety data at any stage of pregnancy, and a peer-reviewed report of a catastrophic uterine injury following use of a plant that may or may not have been this one. That combination is sufficient reason for any pregnant woman to discuss it with an obstetrician or midwife before use, and for most to avoid it, regardless of how long the tradition has existed. A long tradition documents that a practice is old and widespread. It was never in a position to detect a rare catastrophic outcome, because no one was counting.

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Key Research Papers

  1. Wan Omar WFN, Giribabu N, Karim K, Salleh N (2019). Marantodes pumilum (Blume) Kuntze (Kacip Fatimah) stimulates uterine contraction in rats in post-partum period. Journal of Ethnopharmacology. — PubMed
  2. Rahman L, Praharsini K, Januajie A, Anwar R (2024). Labisia pumila as a culprit of primary uterine rupture alongside abruptio placentae: a case report. International Medical Case Reports Journal. — PubMed
  3. Wang Y, Yan F, Xu DQ, et al. (2025). Traditional uses, botany, phytochemistry, pharmacology and applications of Labisia pumila: a comprehensive review. Journal of Ethnopharmacology. — PubMed
  4. Zakaria AA, Noor MHM, Ahmad H, et al. (2021). A review on therapeutic effects of Labisia pumila on female reproductive diseases. BioMed Research International. — PubMed
  5. Muthiah YD, Ong CE, Sulaiman SA, Ismail R (2016). Inhibition of human cytochrome P450 2C8-catalyzed amodiaquine N-desethylation: effect of five traditionally and commonly used herbs. Pharmacognosy Research. — PubMed
  6. Manda VK, Dale OR, Awortwe C, et al. (2014). Evaluation of drug interaction potential of Labisia pumila (Kacip Fatimah) and its constituents. Frontiers in Pharmacology. — PubMed
  7. Teh BP, Ahmad N, Ibnu Rasid EN, et al. (2021). Herbal-based formulation containing Eurycoma longifolia and Labisia pumila aqueous extracts: safe for consumption? Pharmaceuticals. — PubMed
  8. Karimi E, Jaafar HZ, Ahmad S (2011). Phytochemical analysis and antimicrobial activities of methanolic extracts of leaf, stem and root from different varieties of Labisia pumila. Molecules. — PubMed
  9. Norhayati MN, George A, Hazlina NH, et al. (2014). Efficacy and safety of Labisia pumila var alata water extract among pre- and postmenopausal women. Journal of Medicinal Food. — PubMed
  10. Ali Z, Khan IA (2011). Alkyl phenols and saponins from the roots of Labisia pumila (Kacip Fatimah). Phytochemistry. — PubMed

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