Oxytocin injection for placental delivery

[CoteDAzur]

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".

Oxytocin is given to encourage the uterus to contract down and release the placenta. Syntocinon (which is combined oxytocin with "something else" - sorry) has the added effect of causing the cervix to close. Syntocinon has been implicated in cases of retained placenta - once you've given the drug you're on a stopwatch to get the placenta out, and that is often considered to be a Bad Thing. My understanding is that oxytocin in isolation has much less potential for bad side effects - its a synthetic version of the hormones your body releases when you and your baby initiate breast feeding, just a higher quicker dose.

Re. how to argue your case, the bottom line is that if they give you an intervention without your consent you can classify it as assault and sue! They cannot forcibly inject their patients against their will without facing some serious legal consequences. I'd ask them why they think its a good thing to give to all women, what the side effects are likely to be and whether there are any other risks. I'd then politely decline a managed 3rd stage (unless their arguments were extremely convincing) unless there were problems that necessitated a change in plan - you don't need to give a reason.

Good luck tomorrow

I thought it was done every where as routine any way. (It certainly seems to be in my local hostpital)

You really don't need any reason for refusing oxytocin, and you certainly shouldn't have to argue your case.

State that if they inject you against your wishes you will sue them. Can you sue them in France?

Not so sure what the deal is in France but I'd have thought it must still be a human rights issue (and its after the birth, so they can't argue that you may not like it but its in the best interests of the baby). Is there any kind of advice you could contact before your appointment? I'm wary of suggesting a way forward without knowing more about the legal situation.

Fingers crossed you can find a solution.

You also bleed longer overall if you accept the injection. That may be a minor factor, however.

Re: litigation. Where this is difficult there is always the media ....

Infant mortality in Monaco 5 per 000
Infant mortality in France 3.33 per 000

Tell them, if they stick a needle in you, you'll stick one in them!

I would say threatening to sue is a bit of a last resort, as its unlikely to go down well! However, you can make it very clear in advance that you, as a patient, do not accept this treatment, that if they give it to you anyway you'll consider it abuse, and that you are aware of your legal right to refuse treatment (assuming it exists - and its a very dangerous precedent for it not to. But I guess ultimately that's the question that needs to be answered).

If its a clinical trial, surely there has to be informed consent?

Points to consider:

1. your aim is not to get into a situation where you have to sue, just to make them realise that you won't take the injection voluntarily - leading to there being major repercussions afterwards, either legal or bad publicity or both.

2. the case would be appealed to the European Courts if you did not agree with the decision locally. As a European citizen you have a right of appeal.

What a horrible thing to be faced with. I don't know how you feel about Michel Odent but he wrote about the third stage here and there's a good discussion here. Both good for background info. which may help you to argue your case.

syntocinion isn't combined with anything it is synethtic oxytocin the same drug that is used to augment labour. It is normally used inthe 3rd stage if the woman is hypertensive.

syntometrine is combined syntocinon and ergometrine, which causes the cervix to clamp down and is useful in controlling bleeding, ergometrine can be given on its on but this will be if the woman is having a pph and bleeding needs to be managed.

Have you had other children if so did you have a natural 3rd stage with them.
nobodt should do anyting against your will. In the hopstials I know active management of the 3rd stage is very common.

Does anyone know whether routine oxytocin injection in anticipation of placental deliver is a bad thing for sure?

This paper compares syntometrine with just oxytocin on its own.

Cochrane review suggests active management of third stage and hospitals go hand in hand.

Cochrane review

My midwife tried to make me have a 'natural' third stage

It SUCKED, she was making me stand up and crouch and I kept saying "PLEASE GIVE ME THE INJECTION I JUST WANT TO SIT DOWN WITH MY BABY" and she kept saying "Please give it five more minutes!"

I know some people are anti management of third stage but there is no way I would want it done 'naturally' - I've done enough work by then, I just want to look at my baby thanks while someone else deals with that end...

Cote AFAIK the third stage is managed to prevent excessive blood loss and haemorrhage which used to be common before the injections became routine

Natural third stage is actually quite boring, I agree!! But avoids the risk of retention of the placenta and subsequent surgery. Plus postnatally the bleeding is over and done with more quickly.

is that true of a managed third stage with just oxytocin?

I need references

Cote, bearing in mind how medicalised your hospital is supposed to be, I might be tempted to go along with the injection, tbh. Do you really want another battle at the moment??? It is not the worst thing they can do to you IMO (on the other hand automatic stirrups is).

Never thought I'd say that!!

I would have it like a shot

If I had a hippy midwife again I would stick the needle in my arse myself

Cote You might want to think about accepting for this reason.....

I chose a 'natural' 3rd stage with a mw who wasn't very experienced at it. The consequence was, being made to lie on my back whilst she tugged and tugged for 20mins causing me to bleed heavily.

She then told me that it was taking far to long and that I was bleeding too heavily for her to allow it to contine so she got me to agree to the injection. Only then did she allow me off of the bed and onto the birthing stool where the placenta fell out instantly before she could tug, and the splash covered her in blood. (he he)

And this was in a MLU birthing unit.

I suppose what I am trying to say is, that if you don't do what they consider the norm, then it may get handled wrongly or badly.

The result for me was a pph. The MW would say it was BECAUSE I went for a natural 3rd stage. I would say it's because she tugged on the cord when she shouldn't have done in a natural 3rd stage.

Something to think about anyway!

MP from my brief incursion into the Cochrane literature and so on I got the impression that syntometrine and oxytocin are comparable for outcomes with a slight leaning towards syntometrine but also increased side effects. Check out the Cochrane database for more info.

I've never seen a coherent argument about this

I don't understand the enthusiasm for an unmanaged third stage

I want persuading