Labor augmentation with oxytocin in low- and lower-middle-income countries: a systematic review and meta-analysis

Inconsistent definitions of labour progress and over-medicalisation cause unnecessary harm during birth

“…Concerning actual effects of augmenting labour with synthetic oxytocin, it has been shown to reduce length of labour by about two hours compared with no oxytocin or placebo in low risk women in the first stage of spontaneous labour at term 5. However, augmentation with oxytocin has not been shown to reduce caesarean sections, which was its core purpose when first introduced 56. On the contrary, two observational studies have indicated that reducing use of oxytocin may in fact reduce caesarean section rates.…”

“…They were underpowered, but found no difference in caesarean section rates among women with or without oxytocin for labour augmentation 5. No similar trials have been done since then 56. However, the Cochrane meta-analysis also included five studies among 1200 women assessing early versus delayed use of oxytocin for augmentation (differing definitions).…”

“…2 For women with weak uterine contractions, synthetic oxytocin may increase the power of contractions, but there are associated risks, including hyperstimulation, stillbirth, and neonatal complications. 45678910 Furthermore, caesarean section may still be required, and evidence that synthetic oxytocin reduces the risk of caesarean section is scarce 56. Adding to the challenge, definitions of prolonged labour are inconsistent and tend to overestimate the speed of physiological labour 11.…”

“…According to synthesis of the evidence on physiological labour progression, prolonged labour occurs in 10-15% of births 1920. Yet, cross sectional and systematic review studies indicate that 30-90% of women in hospitals worldwide receive oxytocin to accelerate contractions 61617. Also, prolonged labour remains the indication for 35%-48% of first caesarean sections, and audits suggest that many of these women in fact had uncomplicated labour progression 2122232425.…”

Modeling clinical and non-clinical determinants of intrapartum stillbirths in singletons in six public hospitals in the Greater Accra Region of Ghana: a case–control study

“…Cross-sectional studies conducted in low- and middle-income countries have identified some obstetric complications during the intrapartum period, such as preeclampsia, fetal mal-presentation, prolonged labor, preterm delivery, or cesarean section as some of the factors associated with intrapartum stillbirth 11 – 13 . Administration of two or more doses of oxytocics to augment labour before reaching the facilities can lead to intrapartum stillbirths 14 . Maternal factors that impact birth outcomes include young or advanced maternal age, use of drugs and smoking during pregnancy, untreated hypertension during pregnancy, maternal infections such as malaria, syphilis and HIV, maternal conditions especially hypertension, and diabetes, other complications during labour, traveling for more than 30 min to reach a health facility from home, health professionals taking more than 10 min to attend to the pregnant woman after reaching the facility, presence of any complication during labour and delivery, warranting treatment and poor access to caesarean section when needed contribute to intrapartum stillbirth 15 , 16 .…”