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Oxytocin injection for placental delivery

(97 Posts)
CoteDAzur Tue 10-Mar-09 21:14:23

I found out today that our hospital is undergoing a six month trial where every woman is given an oxytocin injection before delivery of placenta.

I kind of remember that routine injection of oxytocin without even waiting to see if placenta will be delivered on its own is A Bad Thing, but can't remember why.

Can anyone help? I have a meeting with doctor tomorrow and would appreciate some pointers as to how I should argue my case - a scientific way of saying "I'm not your guinea pig and you are not pumping me with hormones for no good reason".

me23 Fri 13-Mar-09 19:46:02

it is shocking! In lectures today we were told of some research a midwife did where she had scenarios concerning what active 3rd stage is and what physiological 3rd stage is and only 25% of the midwives in the unit got it right shock she said us first years are already a lot more clued up about 3rd stage then quite a few midiwves out there.

3rd stage is the most risky time of labour for the woman so it does need to be done with skilled people in attendence. For people considering physiological 3rd stage (which is the way nature intended and allows the baby to receive all the blood it is meant to) should ask their hospital what is the percentage of these.

SnowlightMcKenzie Fri 13-Mar-09 17:06:29

Marmaduke My midwife only unit birth had the mw swinging from the cord during a natural 3rd stage. I also wasn't allowed to be upright until I agreed to the injection (due to risk of pph hmm).

It's quite shock tbh.

BoffinMum Fri 13-Mar-09 07:56:29

Perhaps it has something to do with a redefinition of what 'normal' birth is?

Many people would not see breech as 'normal', for example.

BoffinMum Fri 13-Mar-09 07:56:27

Perhaps it has something to do with a redefinition of what 'normal' birth is?

Many people would not see breech as 'normal', for example.

MarmadukeScarlet Fri 13-Mar-09 01:29:12

Boffinmum, but these weren't 'hospital' midwives it was a midwife only unit with no Obs consutlant or other medical staff - so surely should be skilled at 'normal' birth?

Biccy Thu 12-Mar-09 21:06:12

I apologise as I have only read the start of this thread, but I would find out what will happen if you don't have the injection - as in how long they will give you to deliver the placenta and what will happen if you don't do it within that time. I didn't have the injection, naively believing that if it didn't work naturally I would then get the injection - but no, fortunately I did deliver it after 55 minutes (and the help of a marvellous midwife), but had I reached 60 minutes I was told it would have been an epidural and straight to theatre with me... which would have been very annoying having done the whole birth with not so much as gas and air. If I'd known that was the sequence on refusing the injection, I don't think I'd have rised it, and think I will probably opt for it next time (assuming there is a next time).

But, surely they can't force you?

BoffinMum Thu 12-Mar-09 20:55:42

I would have thought the whole point of being a mw would be to be a kind of consultant for normal birth, including VB of twins, breech deliveries, that kind of thing. However they appear in some cases to have been turned into obstetric handmaidens. sad

susie100 Thu 12-Mar-09 16:19:41

Boffinmum - I agree entirely. It is very sad that hospital midwives are becoming deskilled in many traditional techniques like a natural third stage, breach birth (ironically now is incredibly dangerous in hospital cos no one knows how to deal with in and starts fiddling rather keeping the hands off the breach!)

it then becomes a viscious cycle where the concept of risk in childbirth gets totally skewed. Sigh.

BoffinMum Thu 12-Mar-09 13:43:40

I looked it up last night before conking out, could backtrack to the reference if you like, but I think it was based on something like WHO data or mainstream gold standard stuff like that. However NCT teachers also talk sense so she may have been referring to the local area or something like that.

Of course stats are meaningless without context, so things like environment, maternal age, nutrition, labour management and probably even something daft like the cycle of the moon all play a part in these things.

Sheeta Thu 12-Mar-09 13:40:37

BoffinMum thanks for that - our NCT teacher told me the wrong info then.

1 in 1000 eh? Now that makes me feel really special.

BoffinMum Thu 12-Mar-09 13:40:22

shock MarmadukeScarlet!!!

I may be wrong, but I thought they should be able to feel with their hands after the birth that the uterus had not contracted. They also should have examined the placenta to make sure it was intact, which it clearly can't have been.

It sounds like if you think you have a hospital mw, then an injection is the way to go, as they may be so deskilled at managing natural third stage that they could do real harm (like the swinging on the cord thing someone described earlier).

MarmadukeScarlet Thu 12-Mar-09 12:07:41

I haven't read the whole thread (bad form I know)

After DD was born in a midwife unit, in the water, no pin relief, I encouraged not to have it - I had no realy strong feeling either way, I had achieved my natural birth (reather than the C sect my consultant wanted due to previously broken pelvis) so I was happy not to have it.
The midwife said, "You've just opushed a 9lb baby out, you'll have no trouble."

Came out, no reall issues - or so I thought.

30 mins after DD was born I was told to go to the loo, DH looked after DD and the midwives went off to 'do their rounds'. I can remeber feeling my arms go numb and shouting to DH "I'm passing out" which I duely did. I came around some while later on the bathroom floor in a pool of blood so large I couldn't reach 'dry ground'.

My uterus had not contracted and I was suffering a severe PPH. I was given the injection 60 mins after DD was born. I took ages for the bleeding to stop. (it is besides the point that they didn't transfer me, call a Dr, suggest I have a transfusion or iron tablets) I was too weak to walk for 48 hours (from someone who has finished a horse cross country course with a broken collar bone and no front teeth).

I was so ill for 24 with a raging fever and rigors. I passed fist and bigger sized clots for days and bled heavily for several weeks.

at 11 weeks post partum I went for an op to put right unstiched nearly 3rd degree tear, I pointed out to consultant that I had a bit of a wiff from down there. under GA he checked, I had retained placenta and had contracted GBS (which caused massive problems in my 2nd preg).

I was ill for monthes and exhausted and found it hard to care for my DD.

If only I'd had the injection straight away, as I hadn't had any objection to it before the midwife intervened.

Bumperlicioso Thu 12-Mar-09 11:54:24

I had to argue my case against the oxytocin injection several times during my labour hmm. One of the midwives filled up a needle and put it on the table next to me as I was pushing DD out and said 'well we'll put it there just in case'. In the end the other midwife had to say 'she doesn't want it'. My placenta came out with the next contraction.

BoffinMum Thu 12-Mar-09 11:48:59

Sheeta, it's nearer 1 in 1000.
A tenth of the risk of having a general anaesthetic and dying.

Sheeta Thu 12-Mar-09 09:50:23

Just to add - retained placenta is still possible, even if you don't have the injection. angry

about a 1/200 chance I believe

susie100 Thu 12-Mar-09 09:45:09

Me too! I pregnant with number 2 and worried I now know TOO much grin

duchesse Thu 12-Mar-09 08:36:47

-ly good I mean

duchesse Thu 12-Mar-09 08:36:24

susie grin all this is starting me back on the dangerously obsessive birthing streak I thought I'd left behind ten years ago... Except that now I just take it for granted that I'll get a physiological 3r stage and all the other things I want. Advantage of being 40 something rather than in my twenties this time! Also my midwife is superlative.

BoffinMum Thu 12-Mar-09 08:02:15

It's not the Monaco govt sticking the needle in you, it's a bunch of doctors doing a trial.

They are subject to controls of their professional association. They can't just go giving women injections because they feel like writing a paper on it. They need to have informed consent.

susie100 Wed 11-Mar-09 23:15:57

Duchesse - I had a feeling you wld link to the Radical Midwives site - I was obsessed with that sitge in pregnancy and found it very useful for EVIDENCE BASED research.

There are lots of wonderful entries from an indie midwife called Mary Cronk who is a bit of a legend (esp when it comes to normalisation of things like breech birth)

CoteDAzur Wed 11-Mar-09 20:39:15

Yes, indeed sad

Sorry I didn't see your mail until now. I don't check that address often.

I don't think anyone has ever successfully sued the Monegasque royal family government, so don't bother looking for legal angles. Thank you for the thought, though.

AuldAlliance Wed 11-Mar-09 20:06:15

Cote, it just gets better and better doesn't it? hmm
Will ask DH if he can drum up legal info on patients' rights in Monaco, if you like, so you at least know if you can convincingly wield the suing argument or not.

Did you get the long, rambling and not-of-much-practical-use e-mail I sent you ages ago?

CoteDAzur Wed 11-Mar-09 18:21:59

Snowlight - My experience with DD was similar - lost lots of blood, very weak, couldn't care less about DD in the initial weeks.

I thought that was because I was in so much pain that nothing else mattered, but now I think it may also have been because initial bonding was hampered? (No skin-to-skin, baby whisked away to be weighed etc then handed to my mum outside the door hmm)

duchesse Wed 11-Mar-09 17:45:19

Also this one is quite interesting anecdotal study about a change in diet and massive increase in PPH among Indonesian women. Scroll down to "Hemorrhage in Asia"

duchesse Wed 11-Mar-09 17:28:46

this is quite an interesting thread on a midwives' forum.

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