De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers - A prospective intervention study
dc.contributor.author | Gaudernack, Lise Christine | |
dc.contributor.author | Frøslie, Kathrine Frey | |
dc.contributor.author | Michelsen, Trond Melbye | |
dc.contributor.author | Voldner, Nanna | |
dc.contributor.author | Lukasse, Mirjam | |
dc.date.accessioned | 2018-11-26T10:15:17Z | |
dc.date.accessioned | 2018-12-17T13:14:43Z | |
dc.date.available | 2018-11-26T10:15:17Z | |
dc.date.available | 2018-12-17T13:14:43Z | |
dc.date.issued | 2018-03-27 | |
dc.identifier.citation | Gaudernack LC, Frøslie KF, Michelsen TM, Voldner N, Lukasse M. De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers - A prospective intervention study. BMC Pregnancy and Childbirth. 2018;18(1) | en |
dc.identifier.issn | 1471-2393 | |
dc.identifier.issn | 1471-2393 | |
dc.identifier.uri | https://hdl.handle.net/10642/6438 | |
dc.description.abstract | Background: The use of synthetic oxytocin for augmentation of labor is rapidly increasing worldwide. Hyper-stimulation is the most significant side effect, which may cause fetal distress and operative delivery. We performed an intervention consisting of an educational program and modified guidelines to achieve a more appropriate use of oxytocin. Methods: This prospective intervention study included 431 first-time mothers at term with spontaneous onset of labor before (October 2012 to May 2013), and 664 after the intervention (April 2014 to April 2015). Our outcomes were prevalence and duration of oxytocin treatment, mode of delivery, indication for operative delivery, episiotomy, anal sphincter tears, bleeding, labor duration, pain relief and the effect of oxytocin on mode of delivery. Results: After the intervention, 52.9% were diagnosed with dystocia, compared with 68.9% before (p<0.001). Oxytocin was not always used in accordance with the guidelines, but a significant reduction in oxytocin rates from 63.3% to 54.1% (p<0.001) was obtained. More women without dystocia according to the existing guidelines were augmented after the intervention (18.9% vs 8.4%, p<0.001). Assessing all labors, the median duration of oxytocin treatment was reduced by 72% (from 90 to 25 min) without increasing the median duration of labor (385 min in both groups). There was a moderate reduction in operative vaginal deliveries from 26.9 to 21.5% (p=0.04), and dystocia as an indication for these deliveries increased (p=0.01). There was a moderate increase in caesarean sections from 6.7 to 10.2% (p=0.05), but no increase in dystocia as an indication for these deliveries. Women receiving oxytocin were more likely to have an operative vaginal birth, even after adjusting for birth weight, epidural analgesia and labor duration, OR: 2.1 (CI 1.1-4.0) before and OR 2.7 (CI 1.6-4.5) after the intervention. Conclusions: Our intervention led to a significant reduction in the use of oxytocin. However, more than half of the women remained diagnosed with dystocia. Operative vaginal births seem to be associated with oxytocin treatment. Therefore, augmentation with oxytocin should be used with caution and only when medically indicated. Even more modified guidelines for augmentation than the ones applied in this study might be appropriate. | en |
dc.language.iso | en | en |
dc.publisher | BMC | en |
dc.relation.ispartofseries | BMC Pregnancy and Childbirth;18:76 | |
dc.rights | © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. | en |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
dc.subject | First-time mothers | en |
dc.subject | De-medicalizations | en |
dc.subject | Oxytocin augmentations | en |
dc.subject | Operative vaginal deliveries | en |
dc.subject | Labor durations | en |
dc.title | De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers - A prospective intervention study | en |
dc.type | Journal article | en |
dc.type | Peer reviewed | en |
dc.date.updated | 2018-11-26T10:15:17Z | |
dc.description.version | publishedVersion | en |
dc.identifier.doi | http://dx.doi.org/10.1186/s12884-018-1706-4 | |
dc.identifier.cristin | 1597575 | |
dc.source.journal | BMC Pregnancy and Childbirth |
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HV - Institutt for sykepleie og helsefremmende arbeid [1410]
HV - Department of Nursing and Health Promotion
Except where otherwise noted, this item's license is described as © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.