Beyond the Myths: Real Science in Women’s Health - Does Medicine to Stop Labor Really Work?
Tocolysis, giving medicine to stop labor, doesn't really work. But many doctors still beliebe in it.
When I was a resident, the arrival of a woman in preterm labor often set the room buzzing. The plan was clear: start intravenous fluids, put her in bed, and begin tocolysis—medications designed to stop contractions. In fact, in the early 1980s we actually gave the woman intravenous alcohol and told her to also drink it to stop labor. We had drunk pregnant patients on labor & delivery. The hope was to turn off labor like flipping a switch. Families clung to the idea that these drugs could hold off birth for weeks, even months, buying precious time for the baby to grow.
It was a reassuring story. Unfortunately, it was more myth than medicine.
What Is Tocolysis?
Tocolysis refers to the medical intervention used to inhibit or suppress uterine contractions, primarily employed to delay preterm labor and allow for fetal maturation or maternal stabilization.
The term derives from the Greek "toco-" (childbirth) and "-lysis" (loosening/dissolution). Tocolytic agents work through various mechanisms - beta-agonists like terbutaline relax uterine smooth muscle, calcium channel blockers such as nifedipine reduce calcium availability for muscle contraction, and NSAIDs like indomethacin inhibit prostaglandin synthesis.
Over the years, many drugs have been tried, alcohol IV or drinking it, beta-agonists like terbutaline, magnesium sulfate, calcium channel blockers such as nifedipine, and indomethacin, an anti-inflammatory.
The goal is noble: prevent preterm birth, which remains one of the leading causes of newborn illness and death worldwide. But the question is whether these medicines actually succeed.
The Hard Evidence
Research has shown that tocolytics do not prevent preterm birth in the long run. They cannot reverse the complex biological cascade once labor has truly begun. At best, they can buy 24 to 48 hours—a short window that matters only because it gives time to administer steroids for fetal lung maturity and, if needed, transfer the mother to a hospital with a neonatal intensive care unit.
What they cannot do is hold off labor for weeks. The dream of “stopping” preterm birth with a pill or IV remains out of reach.
The Risks
Like many myths in obstetrics, the belief in tocolysis persisted partly because it felt right. Contractions are the problem; relax the uterus and you solve it. But these drugs are not harmless:
Beta-agonists can cause rapid heart rate, palpitations, and dangerous shifts in electrolytes.
Magnesium sulfate, though sometimes used for neuroprotection, can lead to toxicity, breathing difficulties, and heart rhythm problems when given in high doses for tocolysis.
Indomethacin may affect the fetal heart and kidneys if used too long.
For mothers and babies, the risks often outweighed the limited benefits.
Why the Myth Lingered
Stopping labor is an attractive promise. For parents facing the frightening prospect of preterm birth, tocolysis seemed like an active, hopeful intervention. For doctors, it offered something concrete to do in a situation that otherwise felt powerless. Doing “something” was easier than admitting we couldn’t halt the process.
Where We Are Now
Today, most professional guidelines are clear: tocolysis may be used briefly—not to prevent preterm birth, but to allow time for steroids and safe transfer. Beyond that, prolonged use does not change outcomes.
The real progress has come from other strategies:
Antenatal corticosteroids to mature fetal lungs.
Magnesium sulfate to protect the baby’s brain before very preterm birth.
Progesterone and cervical cerclage in selected high-risk women to reduce recurrence of preterm birth.
These are evidence-based steps that improve survival and long-term health—whereas prolonged tocolysis does not.
Reflection
The story of tocolysis is a sobering reminder: not every treatment that looks logical delivers results. Sometimes, the bravest course is to accept the limits of what medicine can do and focus instead on what truly works.
For patients, the question is: would you want a treatment that feels reassuring in the moment but doesn’t change the outcome—or would you rather put your trust in measures proven to help your baby long after birth?
Age-old myths that premature labor, and hence miscarriage and preterm birth cannot be prevented. The myth is perpetuated because it is profitable to do so. Here is the thing, women used to have many births, by necessity, and lately not as many, one, two, three, and rarely many more. But she is capable of getting pregnant from menarche until menopause, for decades, even a few times a year. Miscarriage may generate as much in expence as a normal birth. I have helped a woman to have her own baby when she sought my help after prior 24 miscarriages. A premature baby may generate as much as a million or more, only to go home if fortunate to survive, and many do, than God for the Neonatal expertise. Prematurity generates in US, $65 Billion annually. All concerned are drooling at the prospect of getting a chunk. Why would anyone that likes money be interested in stopping a lucrative enterprise. I may be the only one who does because my practice in one year alone saved $25 Million by preventing premature births. You see, I believe that life is a miracle and a baby is a gift from God, the most precious treasure one can have. I also believe that the best Return on Investment is the prevention of a premature birth, and the best way of ensuring a brighter future for the next generation is to have our babies be born well at term, not too soon, not too small. Prevention is the way to go. Yes, we can stop premature labor and prevent premature birth and miscarriage, because as the saying goes, "If there is a will, there is a way". Fortunately, now, we have much knowledge and ability at our disposal, ranging from the simple ways, such as demonstrated by Papiernik, J. J. way, resource mothers, Peterson, to a most complex way by Dr. Sem's way. Hydration may help some, but if excessive may kill. Alcohol must not be excluded, progesterone, Mg, betamimetics, oxytocin antagonist, PG antagonists, Ca channell blockers, and GTN by NO donor. I know because I have done it. Everyone can at least give a good honest college try. The question is the priority, money or life, and the quality of life.