Labour Augmentation by Means of Oxytocin - Obstetric Outcome and Women's Experiences

In contemporary handling of labouring women in the western world, it has become extremely common to intervene through "active" or disciplined" management (Enkin et al., Widela et al., Gerdhardstein et al., Frigoletto et al). It is a widespread routine - and potential side effects will therefore have a great impact. The use of the hormone oxytocin to enhance and speed up labour is the most common method, but the sparse scientific data regarding its effect are inconsistent and mostly demonstrate uncertain and sometime side effects (Thornton & Lilford, Frazer 1994, 1998, Cammu & Van Eeckhout).

The effects, when evaluated, are short-term effects of maternal (obstetric) and fetal outcomes. The studies performed have mostly aimed to investigate whether the active management can reduce the rate of caesarean sections. However, in a meta-analysis of four randomised studies of the effects of oxytocin as intervention in spontaneous labour (Frazer), no significant reduction in the incidence of caesarean section, instrumental deliveries, and use of analgetics or hyper stimulation of labour was found. The only statically significant differences were in side effects: an increased incidence of discomfort and of pain in the group given oxytocin. In this meta-analysis, no significant differences in fetal conditions between the groups were found.

Only one of the studies found sought the women's view on the augmentation procedures (Enkin). Over half of the women who were interviewed, said that the oxytocin treatment was unpleasant and indicate that they would like to try without the drug when giving birth the next time. Over 80% felt that it had increased the amount of pain that they had experienced.

In spite of poor evidence of benefits, around half of birth giving women in Sweden receive oxytocin during labour and in some other countries, far more than that (Waldenström, O'Driscoll, Enkin). It has become the standard care of treating labours with slow progress. According to an investigation by the Swedish National Board of Health and Welfare (Socialstyrelsen 1996), the indications for oxytocin use and the amounts administered are not systematically recorded, and the assessments of its effects are even less well recorded. This makes evaluation by using existing documents very unreliable, and randomised controlled studies.

Aims of the study