De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers – a prospective intervention study

Abstract

BackgroundThe use of synthetic oxytocin for augmentation of labor is rapidly increasing worldwide. Hyper-stimulation is the most significant side effect, which may cause fetal distress and operative delivery. We performed an intervention consisting of an educational program and modified guidelines to achieve a more appropriate use of oxytocin.MethodsThis prospective intervention study included 431 first-time mothers at term with spontaneous onset of labor before (October 2012 to May 2013), and 664 after the intervention (April 2014 to April 2015). Our outcomes were prevalence and duration of oxytocin treatment, mode of delivery, indication for operative delivery, episiotomy, anal sphincter tears, bleeding, labor duration, pain relief and the effect of oxytocin on mode of delivery.ResultsAfter the intervention, 52.9% were diagnosed with dystocia, compared with 68.9% before (p < 0.001). Oxytocin was not always used in accordance with the guidelines, but a significant reduction in oxytocin rates from 63.3% to 54.1% (p < 0.001) was obtained. More women without dystocia according to the existing guidelines were augmented after the intervention (18.9% vs 8.4%, p < 0.001). Assessing all labors, the median duration of oxytocin treatment was reduced by 72% (from 90 to 25 min) without increasing the median duration of labor (385 min in both groups). There was a moderate reduction in operative vaginal deliveries from 26.9 to 21.5% (p = 0.04), and dystocia as an indication for these deliveries increased (p = 0.01). There was a moderate increase in caesarean sections from 6.7 to 10.2% (p = 0.05), but no increase in dystocia as an indication for these deliveries. Women receiving oxytocin were more likely to have an operative vaginal birth, even after adjusting for birth weight, epidural analgesia and labor duration, OR: 2.1 (CI 1.1-4.0) before and OR 2.7 (CI 1.6-4.5) after the intervention.ConclusionsOur intervention led to a significant reduction in the use of oxytocin. However, more than half of the women remained diagnosed with dystocia. Operative vaginal births seem to be associated with oxytocin treatment. Therefore, augmentation with oxytocin should be used with caution and only when medically indicated. Even more modified guidelines for augmentation than the ones applied in this study might be appropriate.

Relation between Length of Exposure to Epidural Analgesia during Labour and Birth Mode

“…It has been shown than multiparous women in this study were less exposed to the risk of experiencing non-spontaneous vaginal births compared with primiparous women [30], but when multiparous women in the study were administered oxytocin, they were significantly at greater risk of suffering non-spontaneous vaginal birth. (OR 3.05; CI 95%: 1.28–7.30, p -0.01) vs (OR 1.23; CI 95%: 0.68–2.24, p -0.49).…”

“…For, intrapartum care for healthy women and babies, the NICE guidelines recommend not to routinely offer interventions (such as active management of labour, amniotomy and oxytocin) during the first stage of labour [10]. Therefore, the guidelines for labour dystocia and augmentation, based on the latest evidence should be followed, allowing labour to progress uninterrupted, and respecting its normal progress without rushing it, especially in view of Gaudernack et al’s study which shows the association between the use of oxytocin and instrumental births [30]. The NICE guidelines recommend to actively intervene in very specific cases where labour delay is confirmed (i.e., if delay in first stage of labour with ruptured membranes if cervical dilatation less than 2 cm in 4 h, NICE guidelines recommends starting oxytocin) .…”

Oxytocin and emergency caesarean section in a medium-sized hospital in Pakistan: A cross-sectional study

“…In contrast to our study, the Birthplace study had a selected population of low-risk women. Judicious use of oxytocin has been associated with a reduction in emergency CS in several studies 32 while other studies have found no increase in CS 34 . There were no cases of ruptured uterus among women receiving oxytocin, suggesting careful use of oxytocin at the study site, in particular when over half of the multiparous women had a previous CS.…”

Oxytocin bei der Geburt – wann und wie viel?

“…Aber erst die synthetische Herstellung durch Vigneaud und Kollegen in den 50er Jahren des vorherigen Jahrhunderts, führte zu seiner festen Etablierung in der Geburtshilfe [27]. Verschiedene Analysen unter Erstgebärenden in den USA ergaben, dass der Oxytocingebrauch zur Einleitung oder Wehenunterstützung zwischen 37 und 75 % lag [16]. In Deutschland lag die Rate 2014 bei 27 % aller Geburten.…”