Oxytocin
Source
The hormone oxytocin promotes active contraction of the uterus during childbirth and milk production. Artificially synthesized oxytocin, administered intravenously or intramuscularly, is used to provoke and stimulate labor, intensify contractions - it plays an important role in maintaining their rhythm and automaticity. The need to use the drug and its dose are determined by the doctor leading the birth. Proponents of natural childbirth oppose the use of this drug unless absolutely necessary.
In what cases is oxytocin used?
Oxytocin is used to induce or stimulate labor if the doctor has assessed it as non-productive. If the waters have already broken and there are no contractions, oxytocin is prescribed on average 4 hours after they break. Oxytocin is also prescribed to enhance labor if labor has been going on for several hours and the cervix does not dilate or dilates too slowly (less than 1–1.2 cm per hour), or if contractions weaken or stop. In addition, the drug is used for the prevention and treatment of uterine bleeding and to stimulate lactation.
In what cases is oxytocin contraindicated?
The use of this hormone is contraindicated in all cases in which delivery through the birth canal is impossible and which are an indication for cesarean section. Oxytocin should not be used in cases of progressive gestosis or severe Rh conflict between mother and fetus; if a woman is allergic to synthetic oxytocin (which is rare), with partial placenta previa and premature birth, with a discrepancy between the size of the fetal head and the woman's pelvis, with a predisposition of the uterus to rupture (traumatic birth, scar after cesarean section. Chronic hypoxia, intrauterine retention fetal development, FPI (fetoplacental insufficiency), uterine sepsis, cervical cancer, high blood pressure or renal failure are also contraindications.
Contraindications to the use of a Foley catheter
In some cases, the use of a two-way catheter can complicate the course of labor or even cause intrauterine infection of the fetus, and therefore Foley is not used in the following situations:
- the presence of an infection in the vagina that causes inflammatory processes - cervitis (in the cervix), vaginitis (in the vaginal mucosa, etc.),
- low placenta previa,
- internal bleeding,
- rupture of the amniotic sac.
If you have been prescribed induction of labor with a Foley catheter, then you can purchase them in the online store Sterilno.com. Our advantage is direct cooperation with all manufacturers presented in the catalog. And also leave feedback about your experience using this method of inducing labor. Your feedback will be important and useful for expectant mothers!
How does this drug affect the child?
The use of oxytocin may impair oxygen supply to the fetus. During the natural course of labor, blood vessels manage to deliver oxygen-enriched blood to the placenta, and more frequent and stronger stimulated contractions lead to a deterioration in the blood supply to the uterus and placenta. In addition, speeding up the delivery process increases the risk of birth injuries. Modern research proves that oxytocin does not have an adverse effect on a healthy fetus, however, labor stimulated by oxytocin is carried out under monitoring of the condition of the fetus and the contractile activity of the uterus.
How does oxytocin “work”?
Oxytocin is a complex hormone that is produced in the brain and performs functions in the body associated with childbirth and lactation. From the brain through the bloodstream, oxytocin travels to target organs - the uterus and mammary glands, exerting its effect on them. Oxytocin has a stimulating effect on the smooth muscles of the uterus, increasing its contractile activity, and also has an effect on lactation, since, firstly, it slightly increases the secretion of prolactin, the hormone responsible for milk production, and secondly, it promotes the contraction of myoepithelial cells (cells surrounding the alveoli of the mammary gland, where milk is produced). This causes milk to be “pushed” from the glands into the ducts. Research in recent years has shown that oxytocin also has an effect on the psycho-emotional sphere of men and women, causing a more favorable disposition towards other people and increasing trust in strangers, and most importantly, oxytocin is involved in the formation of mother-child attachment immediately after childbirth.
The concentration of oxytocin in the blood does not change during different phases of the menstrual cycle and changes little during pregnancy, remaining at a low level. Towards the end of pregnancy, the amount of oxytocin increases and becomes maximum at night, and decreases during the day, which is why labor most often begins at night. During childbirth, the concentration of oxytocin increases even more and reaches a maximum at the end of the second and third stages of labor.
Are there other ways to stimulate labor?
Labor can be stimulated in various ways. To “start” the birth process, physical activity (walking, swimming, gymnastics) is often enough. One of the natural stimulants of the onset of labor is sexual intercourse. You can achieve more active labor with the help of homeopathic remedies, aromatherapy, herbal remedies - for example, raspberry leaf tea, as well as medications based on prostaglandins. Puncture of the amniotic sac (amniotomy) is also an effective way to induce labor.
What complications can oxytocin cause?
As the strength and duration of contractions increase, the pain intensifies. If the dosage of oxytocin is incorrectly selected, there is a danger of hyperstimulation of contractions: they become too frequent and prolonged (more than two minutes). Other complications are also noted: deterioration of the fetus' condition and increased risk of birth trauma, premature placental abruption, uterine atony and postpartum hemorrhage, threat of uterine rupture. Proponents of natural childbirth believe that oxytocin is overused in maternity hospitals, and that without it, childbirth, although it will take longer, is more likely to be easier for the baby and less painful and traumatic for the mother.
Removal of the Foley catheter
The procedure for removing the catheter should be carried out only by the attending physician, in two stages:
- through the 2nd stroke of the catheter, use a syringe to remove all liquid from the balloon,
- pull the tube out with a clamp and carefully remove it from the vagina.
Almost always, a patient with a Foley catheter remains in the hospital until labor begins. Very rarely, such women in labor are allowed to go home, because if the catheter falls out, only a doctor can replace it. Any independent manipulation of the catheter is strictly prohibited!
For what purpose is oxytocin prescribed after childbirth?
If the doctor believes that the uterus is not contracting quickly enough after childbirth, oxytocin can be used to improve its contraction and prevent postpartum uterine bleeding. However, the use of synthetic oxytocin can replace the production of its own hormone in a woman’s body, which can then negatively affect lactation. Early latching and sucking stimulates the body's natural production of oxytocin and leads to faster uterine contractions.
How does the drug work?
This hormone acts directly on the uterus, increasing the strength and duration of contractions. As the cervix dilates, so does its sensitivity to oxytocin. A prerequisite for using the drug is the readiness of the cervix - it must be softened, shortened, with the canal slightly open. Oxytocin is more effective during the active phase of labor, when the cervix is dilated by 6 cm or more, and is often used when contractions weaken, occipital presentation is posterior, when the uterus needs to turn the baby - this requires strong and prolonged contractions. The second important condition is that the administration of oxytocin is possible only after opening or spontaneous rupture of the membranes. The drug is also used for secondary weakness of labor already during the period of pushing, when a woman experiences delays in the beginning of the next pushing, as well as in the afterbirth period, when stimulation of uterine contractions is necessary for the birth of the placenta.
Cochrane
What is the essence of the problem?
We decided to look at the effectiveness, risks and side effects of oxytocin injected into a muscle (intramuscularly) versus injected into a vein (intravenously) to prevent excessive blood loss in the third stage of labour. The third stage of labor is when the placenta separates from the mother's uterus and is born after the baby is born.
Previous studies have shown that oxytocin given to a woman during or immediately after birth is effective in reducing excessive bleeding after vaginal birth. There are no reliable studies to show whether the route of administration of oxytocin, into a muscle or into a vein, makes any difference to the effectiveness of oxytocin or the health of the mother and child.
Why is it important?
Blood loss during the third stage of labor depends on how quickly the placenta separates from the uterus and how well the uterus contracts (contracts) to close the blood vessels leading to the placenta.
Most maternal deaths associated with childbirth occur in the first 24 hours after birth, mainly as a result of complications of the process leading to excessive blood loss, also known as “postpartum hemorrhage.” Excessive bleeding is an important cause of maternal mortality, especially in low-income countries where pregnant women are more likely to have anemia (too few red blood cells in the blood).
Oxytocin given into a vein can sometimes cause serious side effects such as a sudden drop in blood pressure and an increase in heart rate, especially when given quickly in a small amount of solution (undiluted). The method of injecting oxytocin into a muscle requires much less time than it takes to inject it into a vein. It is also more convenient for medical personnel as it requires relatively less skill and can therefore be carried out by personnel with limited skills.
What evidence did we find?
We searched for evidence on 7 September 2021 and identified three studies (involving a total of 1,306 women) comparing intramuscular and intravenous oxytocin in women during or immediately after birth. The studies were conducted in hospitals in Turkey (two) and Thailand (one) and recruited women giving birth to their first child at term (not earlier or later). The methods the studies used to allocate women to treatment groups were not clear, and in all three included studies both women and staff would have been aware of which treatment they were receiving. This may have influenced the results and means we cannot be confident in the evidence.
The included studies did not report some important outcomes. Only one study reported severe blood loss (a liter or more) after birth and showed that there may be no difference or little difference between intramuscular and intravenous oxytocin. None of the women in one study required surgery to remove the uterus after receiving intramuscular or intravenous oxytocin. In another study, two women required blood transfusions, one after intramuscular oxytocin and one after intravenous oxytocin. The quality of the evidence was low or very low, so we had very little confidence in the results. The studies did not report other important outcomes such as maternal death, low blood pressure, maternal dissatisfaction with intramuscular or intravenous oxytocin, or the number of infants with jaundice (yellowing of the skin). We found no clear difference or minimal difference between intramuscular and intravenous oxytocin in terms of blood loss of 500 mL or more, in terms of the use of additional drugs to reduce bleeding, and in terms of whether the placenta was delivered naturally or whether it had to be removed by doctors.
What does it mean?
The results of the three included studies did not clearly show which method of administering oxytocin was better for the mother or the baby. More research is needed to answer this question.
The number of included studies was small and our important outcomes did not occur very frequently, so there was insufficient evidence to decide whether intramuscular or intravenous oxytocin is more effective and safe for women in the third stage of labour.
