BetterBirth Report Addendum: Special Topics on Complication Management
Oxytocin is a well-established postpartum intervention to prevent and manage hemorrhage, a leading cause of maternal mortality.
Routine use of oxytocin before delivery is increasingly common worldwide to augment labor and has been shown to reduce the need for c-section deliveries.17,18,19 The WHO recommends that the augmentation of labor be carried out in facilities where there is capacity to manage its potential outcomes, including adverse effects and failure to achieve vaginal birth (i.e., maternal and fetal monitoring, and emergency c-section access).
Without adequate monitoring and surgical capacity, intrapartum oxytocin can cause harm, including higher levels of stillbirths, neonatal deaths, neonatal morbidity (most often related to fetal asphyxia), and maternal postpartum hemorrhage.20
During direct observation, at baseline, oxytocin use was documented during 5,484 deliveries. Oxytocin was used to augment labor in 79% of deliveries even while less than 1% of observed cases had a partograph (documenting fetal heart rate and contraction patterns).
Among cases with health outcomes (n=2,862), we found that perinatal mortality rates were higher for women given oxytocin before delivery than for those who did not receive the drug (p = 0.055). In terms of newborn outcomes, when providers administered oxytocin before delivery, bag-and-mask use for babies was 7.7%, as opposed to 2.1% among babies born without maternal oxytocin.
These findings suggest that antepartum oxytocin may have a harmful effect on newborn health in this context, very likely because of the lack of monitoring, lack of readily available c-sections, and the oxytocin administration method (i.e., single intramuscular dose rather than an intravenous “titrate to effect” dose that can be adjusted and optimized throughout a woman’s labor).
OXYTOCIN USE AT BETTERBIRTH INTERVENTION FACILITIES
At BetterBirth intervention facilities, use of oxytocin for labor augmentation was ~30% after two months of coaching, and remained lower even after the completion of the intervention.
Additionally, postpartum use of oxytocin for prevention of maternal hemorrhage was higher in intervention sites (2 months: I=80%,C=21%, p<0.0001; post-intervention: I=54%,C=15%, p=0.0001). This experience demonstrates that this clinical practice can be adapted in a relatively short period of time.
Critically, we need to curtail harmful practices like unmonitored intrapartum use of oxytocin. Given the potential benefits of oxytocin’s intrapartum use, in the medium-term, it is important to consider building monitoring capacity and increasing access to c-section deliveries at frontline facilities to facilitate the safe use of this medication. ■