My first Cochrane review
Oxytocin to speed up labour
Together with my colleagues George Bugg and Farah Sidiqui, my first Cochrane review was published in July. Access it here. I’ve just done a podcast to go with it. Here’s what I said.
“Oxytocin strengthens uterine contractions and is widely used to speed up slow labour. Many experts believe that it also reduces the need for Caesarean section, but this claim is controversial. Proponents of “natural childbirth” claim that it does more harm than good and may be dangerous for the baby. In much of the obstetric and midwifery world, opinions are polarised. Until recently there was not much evidence to back either view, but in 2008 two large trials, one from the UK and one from Denmark were published. These have now been combined with six other smaller and older studies in our Cochrane review.
It turns out the early use of oxytocin seems to have no effect on Caesarean section, instrumental delivery or any other important maternal outcome. However it does shorten labour by an average of about two hours. There were few bad outcomes for the baby in any of the trials, but as far as we could tell there appeared to be no substantial dangers to the baby.
The implications for parents are that if offered oxytocin to speed up labour they should not worry too much. Enthusiasts for natural childbirth can safely decline it in the knowledge that they are not missing out on a treatment which might reduce the need for a Caesarean section. People who want to get labour over with quickly, should go for it, in the knowledge that it “does what it says on the tin”, namely shortens labour, and as far as we can tell is safe for the baby.
In a scientifically ideal world, someone might wish to perform a really huge trial to measure baby safety more precisely, but we doubt if many parents would wish to participate in such an enterprise. However, the trials thus far have bundled together all types of slow labour progress, including early delay, late delay, delay where the contractions appear weak and delay where they appear strong. Future small trials might wish to evaluate the use of oxytocin for each of these subtypes of slow labour separately.”