After giving birth to your baby, your midwife or obstetrician may administer oxytocin as a standard procedure to reduce the initial amount of bleeding and the risk of severe postpartum bleeding. The most common drug used for this is a man-made version of oxytocin. In other words, synthetic oxytocin is a chemically engineered medicine that is supposed to mimic our own natural hormone oxytocin. Oxytocin causes the uterine muscle to contract and clamp down with pressure on the bleeding uterine vessels where the placenta was attached once.
Contractions help to shut down the uterine blood vessels that are left wide open after delivery of your baby and the placenta. This series of actions prevents you from losing an enormous amount of blood shortly after delivery and controls postpartum bleeding. Of course, as a patient you always have the right to be informed about any standard medications or procedures and to give your consent.
How do you use synthetic oxytocin?
After giving birth, synthetic oxytocin can be given as an injection, oral tables or rectal suppository. Your healthcare provider determines the best route for you to reduce your risk of postpartum bleeding.
Synthetic oxytocin can also be used to induce or augment labor by activating the uterine muscles to contract. The contractions will gradually make the cervix dilate and then push the baby through the birth canal. Synthetic oxytocin is delivered through an IV in your arm and your nurse will gradually raise the level of oxytocin you are receiving until you are having regular contractions about every 2-3 minutes.
On average, a woman will bleed around 500 ml after pregnancy, and this is entirely normal. Even bleeding up to a liter is considered normal. The body has, during the pregnancy, prepared itself to cope with this postpartum bleeding. However, there are bigger bleedings than that. Those bleedings are correlated to risks for additional complications and can be life-threatening in some cases.
If you have any risk factors
If you have any additional risk factors for suffering a postpartum hemorrhage (PPH) ,you may be receiving additional medication or procedures that can help prevent you from massive blood loss. In addition to giving you the standard injection, they may also be extra observant looking for signs of bleeding and prepare additional procedures and medications. When a PPH occurs after birth it is extra important that the staff take necessary action immediately and that you, despite the emergency, are informed about what is being done and when.
Experiencing postpartum hemorrhage can be a frightening experience. You notice that a lot of staff will come to the room to help keep you safe. You and your partner/support person should be informed who everyone is and to keep you informed. If this does happen to you, you are also able to meet with your healthcare provider once you have been stabilized to discuss what happened and why.
If you do not have any risk factors
However, if you do not have any risk factors and your pregnancy has been without complications, it may be completely fine to decline this intervention if it makes you feel better. Research has shown use of synthetic oxytocin postpartum decreases bleeding by around 125 ml (½ cup) which is considered a low amount that you will not even notice in normal circumstances.
There are also side effects and theories on negative effects which can be connected to synthetic oxytocin. It is believed to disturb our own natural oxytocin, which plays a significant role in both the mother's and the child's wellbeing after the pregnancy. These side effects can, for instance, be; stronger afterpains, increased risk for postpartum depression, delayed connection and delays in breastfeeding. Just like in many other cases, it is crucial to weigh the benefits against the risks. What is right for you?
If you do not want this intervention, it can be beneficial to write it down in your birth plan. could be formulated somewhat like this:
"I do not wish to get synthetic oxytocin as part of the standard procedure. Administer it to me only if there is a risk for severe bleeding and my consent has been requested and given beforehand."
Sources:
- Kroll-Desrosiers AR, Nephew BC, Babb JA, Guilarte-Walker Y, Moore Simas TA, Deligiannidis KM. Association of peripartum synthetic oxytocin administration and depressive and anxiety disorders within the first postpartum year. Depress Anxiety. 2017 Feb;34(2):137-146. doi: 10.1002/da.22599. PMID: 28133901; PMCID: PMC5310833.
- Hogg, B. (2009). Den okomplicerade förlossningen. I Kaplan, A., Hogg, B., Hildingsson, I., & Lundgren, I. Lärobok för barnmorskor.(3:3,s.245-302). Lund: Studentlitteratur.
- Jangsten, E., Mattsson, L. Å., Lyckestam, I., Hellström, A. L., & Berg, M. (2011).
- A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 118 (3), 362 -369. doi: 10.1111/j.1471- 0528.2010.02800