Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries

by | Jun 25, 2009 | 5 comments

This article published June 19, 2009 demonstrates one hospital’s experience when they changed their oxytocin (Pitocin) protocol.

I’ve included the entire article below and have emphasized what I consider to be the most interesting parts.

Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries
By Betsy Bates
Elsevier Global Medical News
Conferences in Depth

CHICAGO (EGMN) – The modification of the oxytocin infusion protocol at a large university-affiliated community hospital nearly halved the number of emergency cesarean deliveries over a 3-year period, reported Dr. Gary Ventolini.

As oxytocin utilization declined from 93.3% to 78.9%, emergency cesarean deliveries decreased from 10.9% to 5.7%, Dr. Ventolini said at the annual meeting of the American College of Obstetricians and Gynecologists.

Other birth outcomes improved as well at an 848-bed community hospital that serves as the primary teaching hospital of the Boonshoft School of Medicine at Wright State University in Dayton, Ohio.

These included significant declines in emergency vacuum and forceps deliveries and a sharp reduction in neonatal ICU team mobilization for signs of fetal distress (P = .0001 in year 3 compared with year 1).

“More and more data are showing us that we are using too much oxytocin too often,” Dr. Ventolini, professor and chair of obstetrics and gynecology at the university, said in an interview.

“Our pivotal change was to modify the oxytocin infusion from 2 by 2 units every 20 minutes to 1 by 1 unit every 30 minutes. And we see the results,” he said.

Outcomes of 14,184 births from 2005, 2006, and 2007 were retrospectively analyzed to determine any impact of the change in an oxytocin protocol implemented in 2005. Patient characteristics were similar in all three calendar years.

The most profound changes were in emergency deliveries, including caesarean deliveries, vacuum deliveries (which dropped from 9.1% to 8.5%), and forceps deliveries (which fell from 4% to 2.3%).

The overall cesarean section rate remained unchanged, as did the rates of cord prolapse, preeclampsia, and abruption.

Dr. Ventolini cited a recent article in the American Journal of Obstetrics and Gynecology that suggests guidelines for oxytocin use, including avoidance of dose increases at intervals shorter than 30 minutes in most situations (Am. J. Obstet. Gynecol. 2009;200:35.e1-.e6).

Dr. Ventolini and his associates reported no financial conflicts of interest relevant to the study.

What do you think?
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5 Comments

  1. would love to see folks at ACOG do a trend on the 5pm BD ( before dinner )C section rate..anyone??

    Reply
  2. I am not surprised that the overall c/s rate has remained nearly the same. The hospital had to continue the income stream somehow, in order to keep the shareholders (did you know hospitals were a business?) happy. More money, more dividends. I am glad someone is finally seeing the connection between pit and the c/s rate…duh. Better late than never I suppose…Now, if we could get them to quit scheduling repeats until after 42 weeks, then I think we might have it made…:)and our infant morbidity/mortality rate would probably go down, as well…

    Reply
  3. What’s sad is how surprised Doctor Ventolini sounds! What, slowing things down, and giving labour a chance to work without stressing the baby can reduce the number of emergency deliveries? Amazing, who would have thought.
    I really need to look into the stats for use of pitocin in my area. My brain is still stuck back in the mid 70’s to early 80’s, when I had four unmedicated hospital births, without even IVs. My DD had both her boys at home with certified midwives. The overmedicalization of birth has cheated so many women.

    Reply
  4. “The overall cesarean section rate remained unchanged”

    That’s what’s really sick. Emergency cesareans dropped but prophylactic ones rose enough to make up for the drop, apparently.

    Repulsive.

    Reply
  5. I’m still banging my head on my desk over here.

    NINETY THREE PERCENT??!?!?!

    Reply

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Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

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