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Can augmentation with oxytocin be ‘too much, too soon’?

02 December 2020
11 min read
Volume 28 · Issue 12

Abstract

The Sustainable Development Goals have specific aims to reduce maternal mortality and achieve gender equality. While a significant amount of literature focuses on lower-income countries, which have higher mortality and morbidity rates than the UK, the UK must not be complacent. Maternal mortality and morbidity can still be improved nationally by critically evaluating whether the almost ubiquitous use of interventions in obstetric units is a contributory factor. Labour augmentation with oxytocin is not without risk and this raises the question of why maternity care is not incorporated into the gender equality goals in the UK. At its most basic level, it could lead to a lack of informed consent but is influenced by the risk discourse, changing epidemiology of women and sociocultural norms.

The World Health Organization (WHO, 2019a; 2019b) reported a 38% reduction in worldwide maternal mortality rate between 2000–2017 and a 50% reduction in the neonatal mortality rate between 1990–2018. While this is an improvement, it still falls below the Millennium Development Goal (MDG) target of a 75% reduction in maternal mortality by 2015 (WHO, 2015), which has led to the revised Sustainable Development Goals (SDGs) (United Nations [UN], 2015a). The highest maternal and neonatal mortality rates continue to be in lower-income countries, in particular Sub-Saharan Africa, which accounts for 66% of maternal deaths (WHO, 2019c), whereas the maternal mortality in high-income countries is lower. In most European countries, the maternal mortality rate is under 10:100 000 (Euro-Peristat, 2018), with the UK reporting 9.2:100 000 (Knight et al, 2019). Despite the criticism that mortality worldwide cannot be adequately measured because of differing definitions and reporting methods (Bouvier-Colle et al, 2012; Euro-Peristat, 2018; WHO 2019c), the inadequacies would not preclude high-income countries having the lowest rates. While high-income countries can be praised for maternity care provision that results in low mortality rates, criticism has been made of over-medicalised practice, where non-evidence-based care causes harm and instigates disrespect and abuse (Shaw et al, 2016); this care has become known as ‘too much, too soon’ (TMTS).

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