Too good for women, really. Let’s manufacture it. There you have it, boys: Syntocinon. Our very own made-up woman’s love drug.
Now we have the drug instead of her, we can control birth. We can make her give birth when and where we like. We can make her do it to a time-table.
This is the approach to birth known as “active management” and it was made in Ireland, in Dublin’s National Maternity Hospital, in the 1960s and exported worldwide. Facing rocketing birth rates, Master Kieran O’Driscoll developed a factory system which allowed labour to last 36 hours from 1963. This was shortened to 24 hours from 1968 and 12 hours from 1972.
The woman labours according to a pre-printed sheet which does not allow for a longer labour. You just can’t have one.
And the instrument which made all this possible was the woman’s love hormone, oxytocin, produced synthetically and usually introduced into her system on a drip. All of the Irish maternity hospitals practice some level of “active management” meaning we have average induction levels of 31% while the World Health Organisation says they should be below 10 per cent.
But now we know that the misuse of artificial oxytocin can kill babies. Dr Tony Holohan’s report into four baby deaths in the Midlands Regional Hospitals found that in the cases of baby Mark Molloy and baby Joshua Keyes-Cornally, Syntocinon continued to be pumped into their mothers’ blood streams even when the babies were showing signs of foetal distress. The drug made the contractions more frequent and stronger, putting too much strain on the little hearts of babies struggling to make the big leap to earth.
Who can forget the picture of baby Joshua posted on the Internet? Mam Shauna Keyes closed her eyes to make it look like she and Joshua were sleeping. His little face is perfect as a rose bud. But he is dead.
He had no congenital abnormalities. Nor did Katelyn Keenan, Mark Molloy or Nathan Molyneaux. They all died because their births were mishandled and that is the main issue we must face, though much of the media has been led to focus on the absence of communication.
Mark Molloy and Joshua Keyes-Cornally’s cases were alike, and yet no lessons were learned. But that is the least of our willful blindness. Death or disability linked to the over-use of Syntocinon is a recurring theme here and abroad.
In 2008, young Paul Fitzpatrick was awarded over €4 m in a case against the National Maternity Hospital, who did not admit negligence. He was left severely disabled mentally and physically following his birth in 2001 when hospital staff failed to stop the flow of oxytocin following a foetal trace which showed distress. They then failed to carry out a second foetal blood sample. And they failed to perform a Caesarian section.
Concern is growing internationally that the implications of the over-use of artificial oxytocin are grave. In the UK Jack Clayton was left seriously disabled at his birth in 2005 after the flow of oxytocin to his mother was doubled while he was showing signs of distress.
The solicitor handling his case realised that her firm had seven malpractice cases in hand which were linked to the use of oxytocin. She looked into her history books and found a similar case way back in 1974.
Several UK consultants have spoken out against the over-use of the drug. Patrick O’Brien of the Royal College of Obstetricians and Gynaecologists points out that a woman’s contractions should not exceed four every 10 minutes.
The danger of allowing contractions to come too fast is that the baby doesn’t recover between them and is starved of oxygen. Jack Clayton’s mother had six contractions every 10 minutes.
Philip Steer, a consultant at London’s Chelsea and Westminster hospital, believes the use of artificial oxytocin should be banned except in rare cases when a woman is overdue or has pre-eclampsia. He says the misuse of the drug is “like somebody saying the screw is stuck, let’s hit it with a hammer.”
The Presbyterian Weill Cornell Hospital in New York has, apparently, banned the use of artificial oxytocin except in strictly limited circumstances, and the number of medical negligence cases against them has plummeted.
Steer calculates that 70 per cent of obstetric malpractice cases are linked to the use of oxytocin, but says doctors and midwives like using it because “it feels as though they are making a difference.” And that is key. Oxytocin is important in our obstetric practice because it takes the power of birth away from women and gives it to hospitals.
This is important for hospital organisation and staffing but I believe it is also founded in a cultural desire to control women. The 1993 edition of the NMH manual Active Management of Labour admits that: “Control of duration of labour is almost as important for staff as it is for mothers and babies”.
The advantages of this approach from the hospital’s point of view are obvious, but for half a century we have been told that its advantage to women is that it lowers the rate of Caesarian Section. The NMH’s C-Section rates are indeed low by Irish standards.
But the latest Cochrane review of international research finds no evidence that the use of artificial oxytocin lowers C-Section rates. It suggests “rest, food intake and adequate hydration” to progress labour.
NOVEL ideas, which ring a bell in my head which sounds suspiciously like an alarm bell. I remember begging for rest when under the care of the NMH with my fourth child and being told that I had started labour and I had to go on.
Though I had powerful natural labours with three children, I was told I needed an oxytocin drip and when I asked, “Why?” it was clear that no-one knew why. Then one woman medic piped up, “In the past, women had endless labours.” My natural labour kicked in before the drug and the two together caused the baby to rip out of me like a bomb.
Dr Tony Holohan is looking for standardised protocols on the use of artificial oxytocin which should be part of a global review of maternity services due later in the year. I believe the misuse of artificial oxytocin is the symphysiotomy scandal of the future.
This is our chance to be brave enough to admit that the use of a drug which has been the foundation stone of our maternity services for half a century degrades women and threatens babies’ lives.