What is it about?

Aspiring towards 'Better Births' may provide better outcomes. The article is about how changes to the induction of labour advice in 2001 and 2008 became policy that has brought about unlicensed practice with synthetic oxytocin for induction and enhancement of labour contractions, and management of excessive bleeding after the birth. It is about how to give the licensed treatment to improve the contractions by fine tuning the intraveonous infusion rate safely, according to the contractions and relaxations of the womb, thus reducing the incidence of predictable complications! It also is about the woman's Human Right to be informed before all treatment and also her right to say yes, or no, or stop! to any procedure. This complies with the legal obligations under medical and NMC Codes of Practice. Research, for the article found no evidence that women were receiving the information that unlicensed practice was intended, nor were they being asked, formally, to consent to unlicensed practices.

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Why is it important?

It is important because there is no evidence that outcomes have improved as a result of the changes, and because the changes could have been reversed as soon as statistics showed fewer best outcomes. Women receiving this treatment are warned that they are likely to need an epidural to cope with the pain, and more babies are born by ceasarian section, and many more women experience abnormal bleeding in the first few hours after the birth. Reducing the time a woman stays in the labour room is a reasonable aspiration, but what price will she pay in complications and their resolutions, by having her labour accelerated with an unlicensed use of a drug?


Active respect for all women means that they automatically receive full information about their treatment choices so that they can consent to, or reject an unlicensed treatment, and that way be enabled to recieve their care with confidence. If doctors reserved unlicensed treatment to when it can be justified by the circumstances of an individual woman's pregnancy, patient consent could not be easily overlooked or ignored as at present. Instead, they have tried to make every woman's labour fit their idea of a convenient length regardless of complications that can be predicted and are proven by four decades of worsening results.

Mrs Monica Tolofari

Women in labour have not been assisted by the mechanisation of the labour room in hope that the midwife can divide her time between cases. Continuity of care does not have to be the same midwife; instead it means: do not leave the labourer alone. Historically, this policy was developed because it improved outcomes and saved lives. Obstetricians appear unaware that synthetic oxytocin infusion must be supervised continuously by a qualified doctor or midwife, despite that this is clearly stated in the directions for use. The key to as normal a labour as possible is HOMEOSTASIS. (Sorry for shouting.) Therefore, when synthetic oxytocin is used as a hormone and finely tuned in with the other hormones of labour to the lowest possible rate, oxytocin receptors organise organically without being desensitised. Then the infusion can be stopped prior to the birth, safely, and haemostasis should follow naturally. Fun fact: during two years of my practice, when the licensed instructions were standard procedure, the PPH rate on my radar was 5 in 5000 deliveries. Annual compensation for obstetric disasters is now over £2 billion. This money would be better spent on staffing levels, midwives' salaries, their satisfaction with work-life balance, and freedom at work to develop skills conducive to improving maternity outcomes, thereby magnifying job satisfaction, mental health and unwillingness to retire early.

Linn Shepherd

Read the Original

This page is a summary of: Postpartum haemorrhage and synthetic oxytocin dilutions in labour, British Journal of Midwifery, October 2021, Mark Allen Group,
DOI: 10.12968/bjom.2021.29.10.590.
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