New Training for Doctors to Reduce Postpartum Bleeding

Are you pregnant and anticipating a natural childbirth? If so, your doctor or midwife should be up-to-date with the current protocols and practices, including the postpartum use of oxytocin. Currently, an intensive educational program is now being implemented in two South American countries that stresses giving women the drug oxytocin just after a natural childbirth, as it has shown results in significantly lowering the number of cases with excessive bleeding.

Oxytocin helps the uterus contract and stop the uterine bleeding. If the uterus does not contract after the detachment of the placenta, or there are ruptures and tears in the uterus and other tissues occur during delivery, postpartum hemorrhaging can occur.

This educational program, which involved 19 hospitals in Uruguay and Argentina, also resulted in fewer episiotomies performed. While episiotomies are still practiced worldwide, studies have shown that the episiotomy-the surgical cutting of the skin between the anus and vagina-was not beneficial in preventing tearing of the vaginal tissues during delivery.

The director of the National Institutes of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development, Duane Alexander said, "It can be very difficult to change accepted medical practices. This successful intervention offers an effective model that can be translated into education programs suitable for interventions throughout the United State and Latin America."

This educational program sent up to six staff members from 10 public maternity hospitals in Uruguay and Argentina to a workshop for five days that covered developing and applying guidelines for midwives and physicians based on the best available scientific studies and evidence. Also taught during this workshop were techniques to hasten the expulsion of the placenta and bring on the uterine contractions to stop the bleeding following delivery and detachment of the placenta. The chosen were also taught how to best communicate these new guidelines and techniques to their hospitals' staff that aid in the birthing process.

At the end of the 18-month study, the researches took a look at the records of the 5,466 natural births that took place at the 10 hospitals that were using the new guidelines and also the nine hospitals where no new birthing techniques were taught. The use of oxytocin rose from 2.1 percent to 83.6 percent at the 10 hospitals that participated in the workshops. The use of the drug in the other nine hospitals that did not participate in the workshops only rose from 2.6 percent to 12.3 percent. Also, the episiotomies dropped from 41.1 percent of the deliveries to 29.9 percent at the hospitals that received the training. They rose slightly from 43.5 percent to 44.5 percent at the control hospitals.

The hospitals where the new training procedures were being used also had a 45 percent drop in postpartum hemorrhages of 500 milliliters (2 cups) or more, and a 70 percent drop of hemorrhaging with 1,000 milliliters (4 cups) or more. After one year, the use of oxytocin still remained high at 73.4 percent at the hospitals that are participating in the workshops and remain at a low 7.1 percent in the control hospitals. Also, the rate of episiotomies received during childbirth remained at a relatively stable rate at each hospital.

Given the results of this study, it is suggested that getting health care professionals to adopt the new practice of using the drug oxytocin during childbirth may be easier than getting them to eliminate the use of episiotomies all together