Quote of the month (October 2015): a marginal benefit

upside down tree“The implausibility of the hypothesis that more than half of all first labours were intrinsically abnormal did not stop widespread adoption from the 1980s onwards of high rates of oxytocin augmentation whenever labour was slower than average. Unfortunately, this has been combined with the inability of some birth attendants to recognise abnormal cardiotocogram patterns (1) to produce a medico-legal crisis. Jonsson et al. have reported that in 60 cases of intrapartum-related care resulting in disciplinary action, there was ‘injudicious use of oxytocin’ in more than two-thirds, and it was the primary reason for disciplinary action in a third (2). Berglund et al. reported in 2008 that of 177 cases of birth asphyxia due to malpractice in labour, 71% involved incautious use of oxytocin (3). In the UK, the NHS Litigation Authority report that in 2012–2013, approximately £1.4 million per day was being paid out in maternity malpractice settlements (almost 20% of the maternity budget). The Cochrane review published in August 2013 (4) reported that including both prevention and therapy trials (with 8033 subjects), the risk ratio of caesarean section was 0.89, with confidence intervals from 0.79 to 1.01 (consistent with a reduction in caesarean section rate from 12.3 to 9.7%, or no effect at all) and on average labour was shorter by 1.3 hours. A marginal benefit that we can no longer afford.”

1. BJOG 2000;107:1138–1144. 2. Acta Obstet Gynecol Scand 2007;86:315–319. 3. BJOG 115:316–323. 4.DOI: 10.1002/14651858.CD006794.pub4

– Philip J Steer

P.S. For those who haven’t yet seen it, another recent study’s authors have found that “intrapartum exposure to the drugs fentanyl and synthetic oxytocin significantly decreased the likelihood of the baby suckling while skin-to-skin with its mother during the first hour after birth”.  (Brimdyr et al 2015)

Brimdyr K, Cadwell K, Widström A-M et al (2015). The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth. Birth,DOI: 10.1111/birt.12186
Steer, PJ (2015). Oxytocin should not be used to augment labour: FOR: There is too much risk for too little benefit. British Journal of Obstetrics and Gynecology. Online ahead of print. DOI: 10.1111/1471-0528.13571
Photo credit: Yu-chuan Hsu via Unsplash

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