I had to blink a few times when I read that the hospital's rate of Pitocin usage began at 93.3% and declined to only 78.9%. Seriously? Less than 7% of all laboring women did NOT have Pitocin? I cannot imagine any reasonable justification for Pitting 78% of all laboring women, let alone 93%. At times I wonder if I am mistaken in my belief that our birth culture is overly medicalized and, basically, really screwed up. But when I hear that a hospital administered IV Pitocin to more than 93% of its laboring patients, I don't think that I am overreacting at all.
Anyway, ranting aside, here is the report:
Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries
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.