We were delighted to be invited to present our findings at the Midlands 2020 Maternity & Midwifery Online Festival. UK. See the Conference agenda - Click the link below https://www.maternityandmidwifery.co.uk/live-stream-midlands-maternity-midwifery-festival-2020/3583/#midlandslivestream
The use of electronic devices such as CTG, Sonicaid and Telemetry can malfunction because of interference from other sources maternal pulse, electrical/radio waves and is not 100% reliable, therefore use of a Pinard stethoscope for monitoring the fetal heart is absolutely necessary for the assessment of fetal well-being. providing the person listening has a fully functioning ear. When the Pinard is used, and documented in conjunction with electronic recorded devices, confirming the fetal heart by Pinard's is a great tool and skill for the clinical area
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... because the licensed dosage range is available to be chosen instead, both for induction of labour and to improve the rhythm and strength of contractions which have already started.
It is unacceptable obstetric and midwifery prescribing practice to offer only unlicensed high doses of synthetic oxytocin (SO) without also giving a formal explanation of the changes, and giving the patient freedom to reject them, or give her formal, valid consent to the higher risks involved, such as greater pain requiring epidural analgesia to manage it.
Epidural drugs interfere with the physiology of labour, slowing labour down, and SO cannot be used safely to speed labour up again! The epidural immobilises a woman and stops her walking around and having an active birth.
High doses of SO, can lead to tetanic contractions, fetal distress, and interventions - higher Caesarian Section rates, forceps delivery, Post Partum haemorrhage (PPH), birth trauma, neonatal admissions and more. Epidural drugs also cross the placenta.
The only benefit is the possibility of a shorter labour – although the potential length of any one labour cannot be accurately guessed beforehand, so how long is shorter?
A stronger dilution is licensed for management of PPH if it happens, after the baby is born.
Synthetic oxytocin when used as directed (as licensed) leads to obstetric outcomes with as low an incidence of complication as spontaneous obstetric labour obtains.
This information is for women being offered an intravenous oxytocin induction
If you are expecting a baby - and induction of labour has been mentioned to you - you are welcome to use the charts from the Parliamentary petition download, (saved to a mobile device, or printed out), to show and discuss with your midwife and hospital doctors at your next meetings with them.
They may not have seen the full dosage range before - with all the possible steps between 1, 2, 4, 8, 12, 16 and 20 m/U per minute - but when they read the manufacturer's advice on p 4 of the petition download, they will see that these variations should be available as standard, for you to choose. Your fully informed consent is required before the infusion begins.
An epidural may not need to be recommended if you choose 5 IU in 500 ml or 2.5 IU in 500 ml (the licensed dilutions).
You can withdraw your consent at any time.during any procedure
Please note that all Parliamentary Petitions were closed early on the 6th November 2019 by the Parliamentary Committee, due to the UK Election scheduled for the 12th December 2019 https://petition.parliament.uk/petitions/277586
Syntocinon is a synthetic hormone called oxytocin, it is powerful enough to be bring forth a baby out of its mothers womb, it is licensed for medical use in Childbirth for Augmentation, Induction of labour and management of Post Partum Haemorrhage (PPH). It is especially useful for commencing, strengthening and restarting and enhancing uterine contractions when used as directed by the manufacturers licensed instruction. It has a long history of approximately 60 years use in hospitals across the world. Epidural analgesia may be needed with current oxytocin regimes in Western countries during the use of synthetic oxytocin infusion because of the strong uterine contractions that are produced by this synthetic hormone, If the therapeutic or licensed doses are used and smaller steps are titratied during administration according to manufacturer's licensed directions, women may not need epidurals enmasse when Induced or augmented (and the consequential intervention that comes with having an epidural) for pain relief.
How is synthetic oxytocin administered?
It is similar to the natural Oxytocin hormone found in the body and is delivered directly into the Bllod stream via a vein by drip infusion mixed with sterile electrolyte fluid infusion and the dosage is controlled by syringe driver, infusion by volumetric pump or manually by counting drops for drip infusion for accurate dosage according to the uterine contractions that have been Induced by synthetic oxytocin (drip infusion is used where access to volumetric pumps or syringe drivers are not available).
Natural Oxytocin is a very powerful nonapeptide hormone, synthesised in the hypothalamus and stored in the Pituitary gland in the brain, in readiness to be released directly into the blood stream when required, it acts in a pulsatile way. Oxytocin commonly known as the 'love' hormone. It is released when the body requires it for various reproductive and non reproductive functions such as non sexual touch, sexual function, olfactory stimuli and the commencement of uterine (womb) contractions in labour, during breastfeeding and after birth often causing uterine contractions called 'after pains'. During pregnancy there is a steady increase in oxytocin levels.
Syntocinon is man-made, used to stimulate rhythmic (womb) uterine contractions during labour augmentation and Induction of labour. After birth it is used to prevent and or control postpartum haemorrhage.
Here are some of the questions that we have asked, please contact us for further detailed information or help with your regime or guideline.
1. Is the augmentation and induction service meeting the standard of the licensed dose and dilution, is your regime/policy safe, sound and empowering to women service users?
Only you can answer this.
2. What is the licensed therapeutic maximum licensed dose of Synthetic oxytocin?
•Maximum Licensed dose is 20 mU/MIN FOR LIVE Pregnancy.
3. What is the licensed dilution and dose for Intravenous Infusion?
Please check the instructions in your box of oxytocin ampoules, because that will be the licensed product. At the time of writing this, 2nd November 2017, You will find that it states that the licensed dose and dilution is - 5 iU oxytocin added to 500 ml of physiological electrolyte solution such as 0.9% Nsaline. For patients who cannot have 0.9% Nsaline, 5% Dextrose can be used as an alternative diluent.- mix the solution well by turning the bag or bottle upside down several times.
Motorised pumps deliver smaller volumes than drip infusions and differ in their specification in terms of minimum volume delivery.
For motorised pumps one needs to consider the minimum volume which the pump delivers in order to calculate the correct dose and dilution (Please see the chart provided for motorised pumps in the download section below)
The starting dose is between 1- 4 mU per minute (2-8 drops per minute for drip infusion) with not less than 20 minutes interval apart. The increments not exceeding 1 - 2 mU per minute until a pattern of uterine contraction similar to that of a normal labour is established. In a term pregnancy, labour can be achieved with less than 10 mU/min (20 drops per minute for drip infusion).
Intravenous oxytocin use for fetal intra uterine death requires higher doses - 10 IU oxytocin added to 500 ml physiological electrolyte. The reason why one needs a higher dose is that the pregnancy may be premature and the uterus is less sensitive to oxytocin when the pregnancy is not at term.
4. Does giving the licensed increments, dose and dilution improve outcomes for women and their babies?
Yes, the licensed use acknowledges that this is a pain inducing hormone, that gently nudges a woman into labour, and harnesses her own natural oxytocin, and prompts her own endorphins into action. Over-dosage with synthetic oxytocin has inherent problems such as complication of hyper-stimulation of the uterus, fetal distress and its interventions. These are avoided by using the licensed dosage range appropriately thus obtaining better outcomes. Overdosage dulls the uterine oxytocin receptors, and can cause uterine atony which predisposes to postpartum haemorrhage.
This question will be answered later.
6. What is the purpose of the bolus button on the motorised pump, during an intravenous oxytocin infusion?
Synthetic oxytocin is known to be a pain inducing hormone? Therefore the use of a bolus button on a pump is cruel and unnecessary and should immediately be disabled permanently when oxytocin is being used for infusion during augmentation and Induction
The Side effects are covered well on Net doctors click on link http://www.netdoctor.co.uk/medicines/pregnancy/a7608/syntocinon-oxytocin/
KHAJEHEL, M (2017). Labour and Beyond: The Roles of Synthetic and Endogenous Oxytocin in Transition to Motherhood British Journal of Midwifery, April 2017, pp230 - 238
Pregnant women who are informed of potential side effects, can be engaged in their care and be enabled to make informed decisions. The dose and dilution that a women and her unborn baby receives, can differ from one hospital to another. It is important for the safety and the management of labour and pain in the mother, that the current manufacturers's licensed Syntocinon dose and dilution is offered.
Contact us for further information
Anecdotally, the number of women seeking advice about pineapple consumption at the end of pregnancy, with the purpose of inducing labour, in various clinics has grown phenomenally.
The enzyme Bromelain found in unprocessed fresh, not canned pineapples, is proposed to help stimulate uterine contractions and ripen the cervix, but it is not known how many pineapples need to be consumed, to gain the right dose of Bromelain that would produce the desired effect of inducing labour. Bromelain is thought to be more concentrated in the core and stem of the pineapple, which is edible, it is also important to note that heat above 67C destroys the enzyme Bromelain in pineapples. Unfortunately, there is a current lack of robust evidence in this area. It does not however mean that it is not effective. Even in the health sector, evidence is not always available or forthcoming for every procedure or activity carried out, often it is because there has been a long standing history of tradition, which can sometimes gather some momentum, thus creating a form of credibility because it has been repeatedly done, which is neither acceptable either. Until there is further clear evidence, we can only recommend eating pineapples as one of the 5 a day, fruit and vegetable which is a nutrient dense food and healthy for pregnant mother and fetus.
In terms of how much you should eat to absorb the levels needed to stimulate labour is unknown. A Random controlled trial is therfore needed before we are able to stamp our approval and recommend eating pineapple for induction of labour.
Drinking raspberry leaf herbal tea has been a long standing tradition for many pregnant women. Historically women would start drinking 1 cup per day from 32 weeks onwards and increase to 2 or 3 cups per day after a few weeks, to increase the tone and strength of contractions leading to a shorter labour and hopefully less intervention. However, because there is not enough strong research evidence to suggest that it induces labour, is harmful, or shortens labour, we cannot recommend the tea. However, we acknowledge the longevity of its use and understand the temptation to drink it, especially if your grandmother, mother, aunt, sister, friend, cousin or great grandmother used it with positive effects. The lack of formal evidence does not neccessarily mean that it is ineffective nor effective.
Dates are an amazing dried fruit, packed packed full of nutrients for health. A prospective research by Al-Kuran et al (2008) of 114 pregnant women has shown promising research results. Women who consumed 6 date fruits per day for 4 weeks before their Expected Date of Delivery (EDD), had a 96% spontaneous labour rate, a significant difference compared to 79% of those women who did not eat dates. The date eaters had shorter labours and a statistically significant reduction in induction rate.
A randomised trial needs to be performed asap, to see whether the results can be replicated on a larger scale. This could potentially change and reduce the number of Inductions, Interventions and Caesarian section rates, thus leading to optimal outcomes for mothers and their babies globally.
Click to see the abstract https://www.ncbi.nlm.nih.gov/pubmed/21280989
Examining and reviewing Syntocinon regimes across the UK. Answering mother's questions about Induction of labour
We would like a debate about the use of Synthetic oxytocin in labour and for the management of post partum haemorrhage. A parliamentary petition was launched by us in Ocyober 2019. There has been some delay due to the 1st Petition being rejected. The second petition was accepted at the end of October, only to be closed early a few days later on the 6.11.19 due to the pending UK Election on 12.12.19.
We will keep you updated
We are waiting for your reflections on your experience of induction of labour and testimonies
Syntocinon Partograms will be available to NHS Trusts & Private Sector Trusts
Mothers can contact us for information regarding Induction of Labour
Syntocinon a synthetic hormone called oxytocin , is a relatively mature medicine, used for sixty years for Induction of Labour. Please check the Syntocinon or synthetic oxytocin above for more details
1. What are my options and route for Induction? Natural and Alternative Complimentary medicine - Dietary methods, Aromatherapy, Acupressure/acupuncture and Herbal. Traditional hospital procedures and medicine - Membrane Sweep, Prostaglandins gel or pessaries, Syntocinon Infusion, Artificial rupture of membranes. 2. Can I refuse to be Induced? Answer Yes, but every decision taken does have consequences which can be positive or negative. Decide what risk is acceptable after gaining sound information, so that an informed decision can be made. 3. What is Syntocinon? Synthetic Oxytocin, a hormone similar to the natural hormone Oxytocin found in the body. See section above on Syntocinon. What are the side effects? See section on Syntocinon side effects
We are a group of midwives available to discuss your options for medical induction of labour
Based in the UK we are also available for professionals who need or want advice on updating their local Syntocinon (synthetic oxytocin) induction & augmentation guideline or policy
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