Oxytocic drugs can be used in various ways and for different reasons in the 3rd and 4th stages of labour by your caregiver.
These can be used:
Only when bleeding heavily
In cases of delayed placental separation
Oxytocic injections are routinely given into the woman's thigh during the birth of the baby's shoulders and body as a precautionary measure ('prophylactically' or just in case) to actively manage the 3rd stage in all delivery suites and if requested in birth centres or homebirth. Their use is aimed at reducing the time it takes for the placenta to be born (and thus the blood loss) and control the bleeding from the uterus soon after the birth in the hope of preventing possible problems such as excessive bleeding, known as postpartum haemorrhage or PPH.
The drugs used in this case are usually 10 Units of Syntocinon or less commonly one dose of pre-mixed Syntometrine. Even if the woman has been having a drip with Syntocinon to induce or augment her labour, she will still require an injection of Syntocinon as the baby is being born.
In birth centres or homebirth, oxytocic drugs are usually only used whenever a problem presents itself. This may be to manage excessive bleeding or to help deliver a retained placenta if all other natural interventions fail to work. Some birth centres recommend the use of oxytocic drugs if the labour has been long (more than 24 hours) or the 2nd stage or pushing phase has been long (more than 2 hours) as these factors can increase the woman's chances of bleeding.
If the woman has had a previous birth in which she encountered problems with excessive blood loss, it is likely that an oxytocic drug will be used routinely in these birthplaces for the second or subsequent birth, in a similar way to the delivery suite. This is just in case the woman bleeds again.
Only when bleeding heavily
If the woman has already had an injection of Syntocinon routinely with the birth of her baby, but starts to bleed heavily after the birth, her caregiver will need to give her a further injection of an oxytocic medication. Depending on how heavy the blood loss is, it will either be given into her thigh or into the vein (the injection into the vein will either be directly into the vein as an injection, like taking blood, or via a drip if she has one in place).
Another dose of Syntocinon may be considered as each dose only lasts for up to 5 to 10 minutes, but it is more likely that she will need to be given Syntometrine, or more commonly just plain Ergometrine to help control the bleeding. Another dose of Syntocinon may not be considered adequate and it may be more desirable to use the Ergometrine, which will last for a longer period.
If the 3rd stage is being managed naturally and the woman starts to bleed a little more than would be expected, Syntocinon would be administered as an injection into the thigh or the vein. If the placenta has already been delivered, Syntometrine may be used or possibly just Ergometrine. If an initial dose of Syntocinon were not effective then Ergometrine would most likely be administered as a stronger means of stimulating the uterus. In most birth centres about 20 to 30 % of women will end up receiving an oxytocic drug after planning to have a natural 3rd stage.
In case of delayed placental separation
If Syntocinon has already been routinely given and the placenta does not detach after a period of time, then the placenta will need to be manually removed in the operating theatre. The time allowed will vary from caregiver to caregiver, with some waiting for a couple of hours or more and others waiting 20 minutes or less. If the woman is not bleeding heavily, then time is not so much of an issue, with 45 to 90 minutes considered reasonable.
Giving Syntometrine or Ergometrine at this point will only make the uterus clamp down harder and shut the cervix tight, making the delivery of the placenta or manually removing the placenta more difficult.
If the 3rd stage is being managed naturally, your caregiver will probably firstly try some natural forms of stimulation mentioned earlier such as hydrating the mother, emptying the bladder, placing the baby at the breast or changing positions. If these strategies do not stimulate the uterus to contract, then your caregiver will administer an intramuscular injection of Syntocinon to help bring on uterine contractions and hopefully separate the placenta.
Last revised: Saturday, 1 December 2012
This article contains general information only and is not intended to replace advice from a qualified health professional.