Syntocinon trial - wwyd?

[Moulesfrites]

I am 38 weeks today and had a letter from the hospital this morning making me aware of a clinical trial that is going on in the mat ward. Apparently if your first stage of labour is delayed (goes on for more than 8 hrs) they would normally give you syntocinon, which makes the contractions more efficient (and more painful). The trial they are doing involves giving some women a higher dose to see if this makes a difference. It is double blind so neither you or the dr know whether you have been given the higher or lower dose, but the doctor can find out if they need to.

My gut reaction is to recoil from this. I don 't want to stand in the way of medical progress but I don't like the idea of being unaware of what strength I have been given. You will only be asked to take part if your first stage goes on for 8 hours so I am worried that if that applies to me I will be so out of it that I might just agree to anything! Do any mnetters have any advice?

I would never want that evil drip again!! But that is just my very personal opinion, some people will have it and be holding their baby not long after, I had it to actually start my labour so it is a bit different, I think that with a first baby 8 hours isn't a really long time? Sorry I can't give you much advice, it is a very personal thing, but like I said I would decline

Personally I wouldn't. I was accelerated with synto and at only 2/3 of the dose they wanted me at, it was too much, I was contracting 6 times every 10 minutes and the baby's heart rate wasn't having time to recover (I had already had an epidural by then or they would have been peeling me off the ceiling). In the end they couldn't raise the dose to wehat I needed without distressing the baby and I went to emcs (turned out to be a good thing as he was face down and stuck).

I was told the dose was increased gradually to make sure the mother's body could handle it, so this seems a bit dodgy to me, I could have dealt with the early bit a little faster, but not much.

Of course not everyone responds like I did (I think I was more "in labour" than they thought as I wasn't dilating due to the head position, so my natural contractions were stronger than my dilation suggested) and they wouldn't do it if it was expected to be unsafe.

Incidentally, I was contracting regularly (5-15 mins apart) for 48 hours (and irregularly for 24 before that) before I had synto. I would still have refused it if I hadn't had meconium in my waters or was dilating at all (I stopped at 2cm). I agree with sunnydays that 8 hours is awfully early to bring in synto and its notorious "cascade of intervention" for a first baby if mum and baby are otherwise ok.

There is no reason to believe that they will not bring the dose up gradually - it may just be that the upper limit is increased in that arm of the trial compared to the other.

Moulesfrites, you don't sound like you have enough information to make the decision - did the letter not give you a contact name/address to ask for more details? I would suggest contacting them to ask, if you are uncertain.

PM me if you would like to discuss things further.

Thanks, - by cascade of intervention do you mean that other things become more likely if you have the synto? Eg forceps etc?

Ah thanks Poledra, I misread that. All the same, like I said, I only got up to 8ml/h when they wanted me to have 12, a higher upper limit would have made no odds, but I was a funny case, they thought my baby was in a good position (we even had a scan that morning) he wasn't, he was so stuck that even when he turned back to back with the synto contractions, he still didn't engage.

That's it Moules, being on a drip means being on a monitor, which impair your ability to be active (in theory you can still move a bit, or stay upright, but I found that the contacts on the monitors wouldn't work unless I stayed still, and I had to move from sitting up to reclining on the bed to keep them on), the stronger contractions means most end up with an epidural, which again means lying down, and this slows down labour and means you are more likely to need an instrumental delivery or section. If you need the intervention, then you don't have much choice, but if there is any doubt (as in, your progress is slower than the doctors want, but not unhealthy, or you are overdue past the hospital's policy, but baby is still happy in there) there is an argument for holding off.

Thanks for the advice - I do want to try and stay as active as poss porcelain.

Polders there are contact details on the info I have been given. I am going to have another read of it and discuss with dh and midwife, but I am still instinctively wary of it...

I'd be terribly wary from what you've said. I had it but only after 4 1/2 days of regular (5min or less) contractions and then only because it seemed that DD wasn't going to take another 4 days. It makes labour extremely painful (requiring an epidural or similar which means you can usually no longer move) and often distresses the baby.

I certainly wouldn't accept it after 8 hours and I wouldn't do a trial.

Even going by medicalised interventionist viewpoint an 8 hour first stage is not delayed if we consider a active first stage to be judged by the cervix being dilated to 4cms and regular contractions it is generally accepted that 'good' progress is half a cm an hour which equates to 12 hours.

I would not personally accept augmentation be it syntocinon (whatever the dose) or ARM after only 8 hours in the 1st stage of labour.
your hospital sounds very out of date with the current research tbh.

That is why I found it odd me23, but it a national trial involving Newcastle, Liverpool and Birmingham nhs and led by Birmingham, Warwick and Leicester unis. The info says that 80% of first stage first labours last 8 hrs on average and for the other 20 labour is considered to be delayed - I am dubious about this!

I think that syntocinon affects different women in different ways. I was induced with the drip (definitely not recommended by me) and they couldn't increase the dosage as fast as they normally would as I "didn't tolerate it very well" - I have no idea what this means, but clearly is different to the average. I had a 4 hour first stage with this notionally slower rate of syntocinon, so if they used an even higher dose I have no idea what would have happened (maybe caused distress in my baby and resulted in emcs, or perhaps I would just have burst).

I agree with the others here - I wouldn't agree to it at 8 hours and I wouldn't join the trial.

The average labour for a primip is 18 hours, thats normal. Why on earth would they want to give syntocinon after 8 hours?

I can understand syntocinon been given if;

your contractions have petered out for some reason or if you're contracting but not making good progress dilation wise (ie the contractions need a bit more ooomph). Normal progress is 0.5cm dilation an hour from 4cm to 10cm.

8 hours is no time at all. I was induced & it was fine but personally I'd tell them to feck off with their trial. You are under no obligation to do this whatsoever; you have every right to feel fully informed (i.e. know the dosage); & if you don't want to do it, tel them clearly now, get it in your notes & don't let them bully you into it while in labour. We aren't bloody guinea pigs!!

No way is eight hours anywhere near long enough for a first labour. I did another 11 hours on top of that... mind DS did have to come out of the sunroof but no amount of syntocinon would have helped him get unstuck sideways in fact it would have just distressed him. I also read a compelling theory linking that drug to autism so it would be another reason I would avoid.

Follow your intincts and you'll be fine. Clinical trial or not, I would tell them to keep their Syntocin the hell away from me! Like Sufi says, get it in your notes and don't let let them try and change your mind. All the best on the big day xxx

Syntocinon oops

8 hours isn't fucking delayed!

Jeeez, I'm bloody cross at that!!!!!!!

Tell them to stick it. Consider a complaint to NICE ethics committee!!!!