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Our challenge is to improve outcomes for mothers and babies by being a catalyst for change.
We are campaigning for the reintroduction of the Licensed dose and dilution of synthetic oxytocin, and the reduction of the postpartum haemorrhage rate.
Because, in 2001 the Royal College of Obstetricians and Gynaecologists 'advised' in a new policy document for induction of labour, that synthetic oxytocin should be used according to more concentrated dilutions than are licensed, and that - at the same time - the rates of infusion can be increased skipping over several possible licensed steps at once.
We believe these sharp increases may diminish the normal pattern of release of natural oxytocin, so that the optimum rate of infusion to enhance or promote as natural a labour as possible, may be missed - unnecessarily.
We (Monica Tolofari and Linn Shepherd) who have, in the past, used synthetic oxytocin according to the licensed directions, achieving an extremely low postpartum haemorrhage rate, want to flag up the aforementioned change to practice as well as that the postpartum haemorrhage rate (35% instead of 3-5%) is off any previous scale.
We used to have a 3 - 7 % postpartum haemorrhage (PPH) rate but now it fluctuates between 35 - 40 % in the UK (NHS digital 2016, 2017, 2018, 2019, 2020). In the decades when the PPH rate remained low, the licensed synthetic oxytocin dosage, dilution and increment range was given and used for Induction and augmentation of labour.
Differences between women was always acknowledged in Induction policies, when the PPH rate was low, even though it was not called individual care at the time but nevertheless was taken into consideration when administering oxytocin for Induction; for example parity, was the main differentiation (the number of babies a woman may have given birth to), and her sensitivity to synthetic oxytocin was considered. Women would be gently nudged into labour without an epidural with the aim of using synthetic oxytocin to mimic natural labour. Now that we currently have a much higher PPH rate, and a one size fits all synthetic oxytocin policy/regime for Induction of labour, this begs the question:
Why is this higher PPH rate happening now?
Is there anyone else asking the same question and seeking answers?
I love this quote
'The greatest gift is not being afraid to question" - Ruby Dee