Oxytocin is usually released by the pituitary gland in the brain towards the end of pregnancy to stimulate the smooth muscle of the womb. It is a hormone that causes the muscle of the womb to contract during labour so that the baby can be pushed out.
Synthetic oxytocin, known as syntocinon, is used to induce labour for medical reasons, or if labour has not started naturally. The dose of the medicine is adjusted until the contractions produced follow a similar pattern to that of natural labour. Syntocinon is used routinely to kick-start or speed up labour, when the contractions are too weak to be effective. In the latter scenario, syntocinon strengthens the contractions of the womb.
In the right hands, syntocinon can be a valuable tool in assisting delivery and may prevent women from otherwise requiring a caesarean section (although this school of thought is not universal). By slowly increasing the amount of syntocinon given, ie turning up the drip, the frequency of contractions can be accelerated. If labour is slow and not progressing and the woman is exhausted, this may be an opportunity to initiate strong, regular and efficient contractions.
However, a woman’s contractions should not exceed three to four every ten minutes. This is crucial because during each contraction, the blood supply carrying the baby’s vital oxygen is cut off so the danger in allowing them to come too rapidly is that there is not enough time for the unborn baby to recover in between, depriving it of oxygen. In some cases syntocinon can hyperstimulate the womb, which means the contractions come so close together that the baby is starved of oxygen which can result in brain damage or death to the unborn baby.
Parents of a young boy born with brain damage have successfully brought a clinical negligence claim against the John Radcliffe Hospital in Oxford because of the substandard management of labour and specifically the mismanagement of syntocinon. Their son has cerebral palsy.
During labour, the obstetric team administered syntocinon to increase the mother’s contractions, following which the fetal heart rate began to show signs of distress. It was alleged that the appropriate care in those circumstances should have been to reduce or stop the syntocinon and allow the fetal heart rate to recover. Instead, the syntocinon drip was left on and the foetus suffered distress due to a shortage of oxygen in the womb, which caused him to pass meconium (a response to fetal distress) which he then inhaled. The substance blocked his trachea and prevented him from breathing, which caused him irreversible brain damage.
The parents successfully argued that the meconium would not have been passed had the foetus not been stressed by the excessive contractions caused by the negligent and inappropriate continuation of the syntocinon. The case settled out of court for a substantial sum of damages.
Alison Johnson, an associate director in Penningtons Manches’ clinical negligence team who represents families of children injured at birth, comments: “Guidelines published by the National Institute for Health and Clinical Excellence (NICE) state that synthetic oxytocin (syntocinon) should be used only if contractions are ‘inadequate’. When it is used, in appropriate circumstances, care must be taken to monitor the contractions and the fetal heart rate in response to them. If too much syntocinon is given, abnormalities in the fetal heart rate will show up clearly and those must of course be acted upon immediately. Furthermore, pregnant women should be counselled carefully as to the benefits and risks associated with syntocinon and it may be appropriate for non-interventional steps to progress labour to be tried first, such as encouraging the mother to go for a walk, or dimming lights to encourage natural production of oxytocin.
“If you feel that your child’s delivery was not managed properly and perhaps the obstetric or midwifery team did not act appropriately when administering syntocinon, please do get in touch with us and we can advise you of your options and how we may be able to help your family.”