Oxytocin to augment labour during home births: an exploratory study in the urban slums of Dhaka, Bangladesh

Abstract

Objective In Bangladesh, the majority of women give birth at home. There is anecdotal evidence that unqualified allopathic practitioners (UAPs) administer oxytocin at home births to augment labour pain. The objective is to explore the use of oxytocin to augment labour pain during home births in an urban slum in Dhaka, Bangladesh.Design Cross-sectional survey.Setting KamrangirChar slum, Dhaka, Bangladesh.Population Married women with a home birth or who experienced labour at home in the 6 months prior to the survey (n = 463) were interviewed. Twenty-seven UAPs were interviewed to validate women's responses.Methods Bivariate and multivariate logistic regressions were used to identify significant predictors of oxytocin use.Main outcome measures Reported use of oxytocin to augment labour pain.Results Forty-six percent of women reported using medicine or other treatments to augment labour pain, 131 of whom reported using oxytocin (28% of total). Traditional birth attendants were the predominant decision-makers of when to use oxytocin. The medication was provided by a UAP who administered the drug via saline infusion or intramuscular injection. Higher education, lower parity, reported long labour (more than 12 hours), and knowledge of and positive attitudes towards oxytocin were significantly associated with oxytocin use after controlling for other factors. In the validation exercise, there was agreement about the use of oxytocin to augment labour in 22 of 27 cases (82%).Conclusions About one-third of women used oxytocin to augment labour pain. This practice has implications for health education as well as future research to assess the impact on adverse maternal and neonatal outcomes.Keywords Bangladesh, home delivery, oxytocin, urban slum.Please cite this paper as: Moran A, Wahed T, Afsana K. Oxytocin to augment labour during home births: an exploratory study in the urban slums of Dhaka, Bangladesh. BJOG 2010;117:1608-1615. IntroductionIn Bangladesh, maternal mortality remains a significant public health issue, with a maternal mortality ratio of 320 per 100 000 live births.1 Urbanisation is occurring at a rapid pace (7% per year), 2 and the majority of this growth is in urban slum settlements comprising poor populations. Although women in urban slums have access to skilled care, they are less likely to give birth in a facility than are women in nonslum urban areas (12.4 and 46.5%, respectively). 3The informal health sector, especially unqualified allopathic practitioners (UAPs), plays a significant role in providing health services to the poor. [4][5][6][7][8] These providers are close to the home, willing to make house calls, trusted by the community, have longer working hours and offer services at lower costs.9,10 UAPs, comprising village doctors (VDs) and unlicensed drug sellers, have limited training of a few weeks to a few months from semiformal private institutions. Training is focused on common illnesses and diseases, and rarely includes labour or delivery. These training institutions are unregulated and do n...

Knowledge, Attitudes, and Practices Related to Uterotonic Drugs during Childbirth in Karnataka, India: A Qualitative Research Study

“…Many respondents within these cadres described the need to increase pain in order to facilitate delivery, generally achieved through oxytocin injections. Several respondents described women needing caesarean sections because the “pain didn’t come.” This is similar to findings by other researchers in India and South Asia [17], [18]. Given that mothers-in-law frequently described believing that women today could not sustain or handle labor and delivery pain, it is possible that delivering women feel pressure to demonstrate “appropriate” childbirth by taking injections that increase labor pains.…”

“…Recent studies have documented inappropriate use of uterotonics in South Asia, particularly in India and Bangladesh [10], [16], [17]. Intramuscular (IM) oxytocin injection during the first and second stages of labor can be dangerous because dosing cannot be adjusted in response to the strength of uterine contractions, increasing risks of uterine rupture and harm to the fetus [13].…”

Management of uterine rupture: a case report and review of the literature

“…The study by Nguefack et al reported that 71% of cases with uterine rupture used misoprostol [9]. Studies in Bangladesh and India report the use of oxytocin by unqualified allopathic practitioners (UAP) providing health services to the poor [15]. These providers are close to homes, willing to make house calls, trusted by the community, have longer working hours and offer services at lower costs.…”

“…UAPs, comprising village doctors (VDs) and unlicensed drug sellers, have limited training of a few weeks to a few months from semiformal private institutions, focused on common illnesses and diseases, and rarely on labour or delivery. These training institutions are unregulated and do not follow a standard [15]. This type of practice should be discouraged because it is associated with obstetric and neonatal complications such as uterine rupture [15].…”

“…These training institutions are unregulated and do not follow a standard [15]. This type of practice should be discouraged because it is associated with obstetric and neonatal complications such as uterine rupture [15]. …”