Updated: Mar 25, 2019
I am regularly contacted by individuals and practitioners enquiring about the routine prophylactic administration of 10iu of intramuscular (IM) Syntocinon (synthetic oxytocin) following the birth of baby.
Recommended to reduce maternal blood loss and facilitate the delivery of the placenta, there are questions regarding the timing of administration of Syntocinon and whether this interacts with placental transfusion through delayed or optimal cord clamping.
This blog is not intended to advocate against human physiology which is, within our medicalised model of care compromised through many complex factors such as: hospital setting, birth spaces, multiple caregivers, induction of labour, augmentation, epidural, medication and much more. Women should be supported in their choice for physiological placental birth if they wish, this means the options for third stage of labour should be discussed properly so women can make an informed decision based on their individual circumstances and risk factors. And most importantly, the midwife should advocate to optimise physiological hormonal processes.
NICE guidelines (2014) recommend all woman to have active management of the third stage, because it is associated with a lower risk of a postpartum haemorrhage and/or blood transfusion. For active management NICE suggest 10 IU of Syntocinon by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby.
Despite the rigorous research undertaken by NICE prior to producing the recommendations, practitioners continue to query whether oxytocin immediately after birth is the ideal time to administer the injection. Some practitioners have concerns about whether this impacts of the amount of blood the baby receives through DCC.
A recent randomised control trial (RCT) by Satragno et al., (2018) provides answers to this question. Their primary outcome to measure weight gain (by blood transfer) using two groups: