Discontinuation of intravenous oxytocin in the active phase of induced labour

Boie, Sidsel; Glavind, Julie; Velu, Adeline V; Mol, Ben Willem J.; Uldbjerg, Niels; Graaf, Irene de; Thornton, Jim; Bor, Pınar

doi:10.1002/14651858.cd012274.pub2

Cited by 29 publications

(46 citation statements)

References 34 publications

(7 reference statements)

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“…With few exceptions, the oxytocin infusion was continued in all the observed labours, despite the national guidelines, [35] and information in Summary of Product Characteristics for Oxytocin, [14] stating that the infusion may be discontinued when labour becomes established, i.e., when cervical dilatation reaches 5 cm. In the light of the latest reports that show the bene t of discontinuing the infusion once established labour is achieved [48,49], observed practices require further analysis.…”

Section: Discussionmentioning

confidence: 99%

Oxytocin administration for induction and augmentation of labour in Polish maternity units– an observational study

Baranowska

Kajdy²,

Kiersnowska

et al. 2020

Preprint

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BackgroundThere is not enough data regarding practices and protocols that healthcare personnel follow and the amount of oxytocin that women receive during labour. Empirical evidence indicates that compliance with the guidelines improves the quality of healthcare and reduces adverse effects. The aim of the study was to evaluate oxytocin supply practices of oxytocin for labour induction and augmentation in Polish maternity units.MethodsThe article presents a prospective observational study. Data collection took place in two selected maternity units between January 15 and July 31, 2019 (n=545). Inclusion criteria were women in term pregnancies, undergoing oxytocin induction or augmentation of labour. Exclusion criteria were women who were in preterm labour, aged less than 18 years, and women whose baby was known to have a malformation. ResultsThe average total amount of oxytocin administrated to women before birth was 7,329µg following labour induction and 3.952µg following labour augmentation. The actual administration of oxytocin deviated both from the unit and national guidelines in 93,6% of all observed labours. We found no statistically significant correlation between the amount of oxytocin administered and mode of delivery, immediate postpartum blood loss or Apgar scores. There was no observed effect of total oxytocin on short-term perinatal outcomes. Hospitals with similar protocols did not differ significantly in terms of total oxytocin amount, induction to stimulation ratio—the only observed difference was the mode of delivery. ConclusionsThere is a need for a thorough analysis to find out the reasons for the observed discrepancies between protocols and practice.

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Section: Discussionmentioning

confidence: 99%

Oxytocin administration for induction and augmentation of labour in Polish maternity units– an observational study

Baranowska

Kajdy²,

Kiersnowska

et al. 2020

Preprint

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“…During the early postpartum (lactation) period, endogenous OT levels are generally elevated due to increased cerebral OT in order to buffer stress reactivity (e.g., Bell et al 2014;Cox et al 2015;Grewen et al 2010) with reduced perception of negative environmental stimuli (Altemus et al 2001;Heinrichs et al 2001). Intravenous OT administration for augmentation of labor is a frequently performed obstetric intervention (i.e., 25%) in most Western countries (Boie et al 2018). However, it has been postulated that this might interfere with normal neurobiological adaptations around birth, thereby potentially affecting maternal and infant mental health.…”

Section: Endogenous and Exogenous Ot In The Peripartum Periodmentioning

confidence: 99%

The oxytocinergic system in PTSD following traumatic childbirth: endogenous and exogenous oxytocin in the peripartum period

Witteveen¹,

Stramrood

Henrichs³

et al. 2019

Arch Womens Ment Health

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Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peripartum neurobiological alterations in the oxytocinergic system are highly relevant for postpartum maternal behavioral and affective adaptions like bonding and lactation but are also implicated in the response to traumatic events. Animal models demonstrated that peripartum stress impairs beneficial maternal postpartum behavior. Early postpartum activation of the oxytocinergic system may, however, reverse these effects and thereby prevent adverse long-term consequences for both mother and infant. In this narrative review, we discuss the impact of trauma and PTSD-FC on normal endogenous oxytocinergic system fluctuations in the peripartum period. We also specifically focus on the potential of exogenous oxytocin (OT) to prevent and treat PTSD-FC. No trials of exogenous OT after traumatic childbirth and PTSD-FC were available. Evidence from non-obstetric PTSD samples and from postpartum healthy or depressed samples implies restorative functional neuroanatomic and psychological effects of exogenous OT such as improved PTSD symptoms and better mother-to-infant bonding, decreased limbic activation, and restored responsiveness in dopaminergic reward regions. Adverse effects of intranasal OT on mood and the increased fear processing and reduced top-down control over amygdala activation in women with acute trauma exposure or postpartum depression, however, warrant cautionary use of intranasal OT. Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in PTSD-FC are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.

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“…Pre-labor practices that have been associated with reduced likelihood of cesarean birth include choosing individual care providers and birth settings with lower cesarean rates, choosing types of care providers and birth settings with lower cesarean rates (e.g., midwives and birth centers), childbirth training workshops, being physically active and staying fit during pregnancy, arranging for the labor support of a doula and attempting external cephalic version with non-cephalic presentation at term [4][5][6][7][8]. After the onset of labor, factors that have been associated with reduced likelihood of cesarean birth include: delaying hospital admission until labor is well established, continuous labor support by someone in a doula role, intermittent auscultation rather than either on-admission or continuous electronic fetal monitoring, discontinuation of synthetic oxytocin for induction after onset of labor, avoiding labor epidural (associated with cesarean for non-reassuring fetal heart status), remaining upright and mobile during the first stage of labor versus lying in bed, and following guidelines related to cervical status and elapsed time for use of synthetic oxytocin and cesarean birth [7,[9][10][11][12][13][14]. Clinician interventions associated with lower likelihood of cesarean birth include clinical practice guidelines coupled with education by opinion leaders, audit and feedback, or mandatory second opinion [3,15,16].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Unplanned Primary Cesarean Birth: Secondary Analysis of the Listening to Mothers in California Survey

Sakala

Belanoff

Declercq

2020

BMC Pregnancy Childbirth

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Background: In many countries, cesarean section has become the most common major surgical procedure. Most nations have high cesarean birth rates, suggesting overuse. Due to the excess harm and expense associated with unneeded cesareans, many health systems are seeking approaches to safe reduction of cesarean rates. Surveys of childbearing women are a distinctive and underutilized source of data for examining factors that may contribute to cesarean reduction. Methods: To identify factors associated with unplanned primary cesarean birth, we carried out a secondary analysis of the Listening to Mothers in California Survey, limited to the subgroup who had not had a previous cesarean birth and did not have a planned primary cesarean (n = 1,964). Participants were identified through birth certificate sampling and contacted initially by mail and then by telephone, text message and email, as available. Sampled women could participate in English or Spanish, on any device or with a telephone interviewer. Following bivariate demographic, knowledge and attitude, and labor management analyses, we carried out multivariable analyses to adjust with covariates and identify factors associated with unplanned primary cesarean birth. Results: Whereas knowledge, attitudes, preferences and behaviors of the survey participants were not associated with having an unplanned primary cesarean birth, their experience of pressure from a health professional to have a cesarean and a series of labor management practices were strongly associated with how they gave birth. These practices included attempted induction of labor, early hospital admission, and labor augmentation. Women's reports of pressure from a health professional to have a primary cesarean were strongly related to the likelihood of cesarean birth. Conclusions: While women largely wish to avoid unneeded childbirth interventions, their knowledge, preferences and care arrangement practices did not appear to impact their likelihood of an unplanned primary cesarean birth. By contrast, a series of labor management practices and perceived health professional pressure to have a cesarean were associated with unplanned primary cesarean birth. Improving ways to engage childbearing women and implementing changes in labor management and communication practices may be needed to reduce unwarranted cesarean birth.

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Discontinuation of intravenous oxytocin in the active phase of induced labour

Cited by 29 publications

References 34 publications

Oxytocin administration for induction and augmentation of labour in Polish maternity units– an observational study

Oxytocin administration for induction and augmentation of labour in Polish maternity units– an observational study

The oxytocinergic system in PTSD following traumatic childbirth: endogenous and exogenous oxytocin in the peripartum period

Factors Associated with Unplanned Primary Cesarean Birth: Secondary Analysis of the Listening to Mothers in California Survey

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