Thursday, May 22, 2008

Nipple stimulation Vs. Oxytocin injection

Little mist of frustration lingers around when the electric tripped off while the lecturer was trying to put on the Water Birth video on the screen. Bad time I guess. Shit always happen when you’re in Indonesia (no offend). Yesterday, the Psychiatry replacement class was cancelled due to a stupid miscommunication between the class coordinator and the lecturer. The coordinator was the least to be blamed, I think it was the lecturer whose undergoing dementia process.

Obgyn (Obstetric & Gynecology) class went smoothly this morning (except for the blackout incident 10minutes before the class ended). The topic was Pimpinan Persalinan Normal. I think it is more or less the same as last week’s topic. Since I’ve finished covering last week’s notes, so it was easier for me to understand today’s lecture and get embraced into it.

One of my most confusing question about normal labour had been answered today. As told by Kak Nuzul, in Indonesia, particularly in RSSA, the RPS (Rangsangan Puting Susu) method is being used to stimulate the oxytocin secretion during the 1st stage of labour, while in Malaysia, no RPS is being performed as they straight away injected (intramuscularly) exogenous oxytocin into mothers. So the question is, what is the difference between RPS and injection of exogenous oxytocin on 1st stage of In-Partu (labour) mothers?
(My hypothesis : exogeneous oxytocin is rather costly compared to RPS which doesn’t cost anything as it is a natural way of secreting hormone – considering the economical status of patients in Indonesia which is lower than those in Malaysia. So, lets check out if my hypothesis is correct…)

Then later today further during the lecture, I found out that in Indonesia, there is actually an injected exogenous oxytocin to mothers, but it only happen during 3rd stage of labour which is AFTER the baby is born. (After all, it can’t be about the economical factor isn’t it?)

So, why is the introduction (intramuscular injection) of oxytocin (which is to induce contraction of the uterus muscle) only happening during the active management during the 3rd stage (which is to eliminate the placenta) and not during the 1st or 2nd stage during which the process of giving birth to the baby? My idea of oxytocin as to induce contraction of uterus muscle is more helpful and beneficial if it can help the mother in delivering the baby rather than expedient in eliminating the placenta after birth.

The doctor/lecturer then calmly answered to my question. As what I understand from his explanation, during the 1st and 2nd stage of labour, the uterus need a gradual contraction with a rhythmic and more stable frequency in order to 1. make a proper dilation and effacement of the cervix and 2. deliver the baby safely. If oxytocin is injected during these stages, the contraction of uterus is vigorous and more rapidly without a resting pace in between each contractions. These prompt contraction will not construct to cervix dilation and effacement, and likewise will put a high pressure on the baby. Thus, the idea of injecting exogenous oxytocin during these stages is rather harmful than helpful. Meanwhile, the exogenous oxytocin is however very supportive during the 3rd stage of labour (which is the elimination of placenta), because it helps the uterus to make one powerful contraction without or with less effort from the exhausted mother to push it out.

So, the final question is, how true is that in Malaysia, exogenous oxytocin is injected into In-Partu mothers during the 1st and 2nd stage? If RPS is not being performed, how do they help the mothers in stimulating the secretion of oxytocin? If it is true that exogenous oxytocin is being used, how is the dosage?

Something I found on the internet today :

Love-making Sexual intercourse is thought to work in two ways. It may trigger the release of a hormone called oxytocin - the 'contraction' hormone - and this may increase the frequency of Braxton-Hicks, or practice, contractions. Semen also contains substances called prostaglandins. These can help to ripen, or soften, the neck of the womb (cervix) ready for it to dilate whenlabour contractions start.

If you think your waters may have broken, don't make love as this may increase the risk of infection, but do seek advice from your midwife or your local maternity unit.

Nipple stimulation This will release the hormone oxytocin and may help start labour. It's only likely to be successful if your cervix is 'ripe' and ready to dilate, otherwise it seems to help with the ripening process. There is no agreement on how much nipple stimulation you need, or how often, to stimulate contractions.

Walking This is also a common suggestion. The explanation appears to be that the pressure of your baby's head pressing down on the cervix from the inside stimulates the release ofoxytocin, hopefully bringing on labour. If your baby has not 'dropped' or is still high in the pelvis, walking will also encourage your baby into a better position so that labour is more likely to start on its own. (Click here for more)

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