1 00:00:04,280 --> 00:00:07,360 Speaker 1: Welcome to the Kick Your Expert led podcast, helping you 2 00:00:07,440 --> 00:00:11,840 Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming 3 00:00:11,840 --> 00:00:12,240 Speaker 1: a parent. 4 00:00:12,600 --> 00:00:16,360 Speaker 2: On the podcast and our online pregnancy program grow My Baby, 5 00:00:16,520 --> 00:00:19,520 Speaker 2: we share my experience of helping more than four thousand 6 00:00:19,560 --> 00:00:20,680 Speaker 2: babies to be born. 7 00:00:20,680 --> 00:00:23,360 Speaker 1: And our experience of running a women's health clinic and 8 00:00:23,440 --> 00:00:24,520 Speaker 1: parenting for boys. 9 00:00:24,720 --> 00:00:27,720 Speaker 2: We're here to help everyone to feel empowered in pregnancy 10 00:00:27,880 --> 00:00:30,720 Speaker 2: and birth with real life, practical information. 11 00:00:32,640 --> 00:00:34,760 Speaker 1: Welcome everyone, I'm Bridgid Maloney and. 12 00:00:34,680 --> 00:00:36,440 Speaker 2: I'm Obstrician doctor Patrick. 13 00:00:36,159 --> 00:00:38,280 Speaker 1: Maloney, and today we're going to talk about something that 14 00:00:38,520 --> 00:00:42,960 Speaker 1: everybody knows something about, and that is the drip. The 15 00:00:43,040 --> 00:00:46,600 Speaker 1: sintosin is labor yes, and why some people say no, 16 00:00:46,880 --> 00:00:50,280 Speaker 1: and what the evidence actually says. So I'm really I 17 00:00:50,320 --> 00:00:54,600 Speaker 1: want to want to do for this one is bring 18 00:00:54,600 --> 00:00:57,000 Speaker 1: to you the arguments that people might have, Okay, and 19 00:00:57,040 --> 00:00:59,280 Speaker 1: then we're going to talk about the benefits so people 20 00:00:59,320 --> 00:01:02,720 Speaker 1: can see what the objections might be towards the sintosinon 21 00:01:02,960 --> 00:01:09,200 Speaker 1: drip and then what they can then learn about to 22 00:01:09,240 --> 00:01:12,759 Speaker 1: help them make some decisions about their progress in pregnancy 23 00:01:12,840 --> 00:01:14,760 Speaker 1: and labor and birth. 24 00:01:15,000 --> 00:01:15,200 Speaker 2: Good. 25 00:01:15,800 --> 00:01:18,240 Speaker 1: But you know, now we've said sintosin and drip and 26 00:01:18,280 --> 00:01:20,160 Speaker 1: just expect everybody to know it. So let's start there. 27 00:01:21,040 --> 00:01:21,560 Speaker 1: What is it? 28 00:01:23,160 --> 00:01:27,240 Speaker 2: Well, the sintoson is a drug. It's called various things 29 00:01:27,240 --> 00:01:32,880 Speaker 2: around the world, but it's a synthetic form of the 30 00:01:33,120 --> 00:01:38,560 Speaker 2: natural laboring hormone and it helps in labor if there's 31 00:01:38,959 --> 00:01:42,280 Speaker 2: a good reason why we would want the labor to 32 00:01:42,360 --> 00:01:48,280 Speaker 2: either start up or to go faster and stronger, and 33 00:01:49,200 --> 00:01:50,960 Speaker 2: good reason is an important. 34 00:01:50,520 --> 00:01:51,560 Speaker 3: Part of that discussion. 35 00:01:51,560 --> 00:01:54,960 Speaker 2: It's a drug that has to be used for valid reasons, 36 00:01:55,760 --> 00:01:59,040 Speaker 2: and there are some risks in using it, so we 37 00:01:59,120 --> 00:02:02,520 Speaker 2: need to be careful of how we use it. 38 00:02:03,920 --> 00:02:06,040 Speaker 1: And people know the two terms, won't they They'll know 39 00:02:06,160 --> 00:02:09,440 Speaker 1: induction and maybe they'll know augmentation. 40 00:02:09,800 --> 00:02:12,120 Speaker 2: Yeah, so let's talk about those two things because they're 41 00:02:12,240 --> 00:02:15,960 Speaker 2: very often blurred in discussions about this, and it's important 42 00:02:16,000 --> 00:02:23,680 Speaker 2: that they're not so using sintosinon to induce labor. The 43 00:02:23,720 --> 00:02:26,119 Speaker 2: most common scenario that I can think of would be 44 00:02:27,560 --> 00:02:31,560 Speaker 2: that the waters have broken, so come to term, waters 45 00:02:31,560 --> 00:02:36,040 Speaker 2: have broken, but no labor comes. When this happens a bit, 46 00:02:37,280 --> 00:02:44,480 Speaker 2: and therefore there's an infection rate where bacteria from the 47 00:02:44,560 --> 00:02:47,680 Speaker 2: vagina can get up into the water around the baby, 48 00:02:48,639 --> 00:02:53,160 Speaker 2: and newborns do poorly when they're born infected. So after 49 00:02:53,320 --> 00:02:56,040 Speaker 2: a period of time, if the labor has not come, 50 00:02:56,480 --> 00:02:59,240 Speaker 2: sometimes the appropriate advice is to use some sinto to 51 00:02:59,240 --> 00:03:06,400 Speaker 2: get that labor up going. And that's using sinto to induce. 52 00:03:06,560 --> 00:03:09,680 Speaker 2: So to bring about a labor where there is not one, Okay, 53 00:03:09,800 --> 00:03:11,520 Speaker 2: because the water's breaking, that doesn't count. 54 00:03:11,680 --> 00:03:14,079 Speaker 1: Can I just talk about the water's breaking? So I mean, 55 00:03:14,280 --> 00:03:19,160 Speaker 1: if somebody's picked up this episode because they've been told 56 00:03:19,200 --> 00:03:21,519 Speaker 1: that they should think about having an induction, and they're 57 00:03:21,520 --> 00:03:24,080 Speaker 1: going to have that induction started by the drip and 58 00:03:25,360 --> 00:03:29,480 Speaker 1: they're hearing for the first time that water's breaking, don't 59 00:03:29,520 --> 00:03:32,720 Speaker 1: necessarily equate to the start of labor. That is at 60 00:03:32,720 --> 00:03:34,320 Speaker 1: odds to every single. 61 00:03:34,040 --> 00:03:37,400 Speaker 2: Movie, every movie you've ever seen. That's right, that's not 62 00:03:37,440 --> 00:03:39,480 Speaker 2: how it's done. So the winter, the waters break, the 63 00:03:40,480 --> 00:03:43,160 Speaker 2: big strong contractions come. That's not how it really works. 64 00:03:44,480 --> 00:03:51,080 Speaker 2: There's often several hours, there's sometimes days, and there can 65 00:03:51,120 --> 00:03:56,720 Speaker 2: be weeks weeks. Yeah, so those events are not necessarily 66 00:03:56,760 --> 00:04:03,040 Speaker 2: one immediately following the other. Infection is in that scenario 67 00:04:03,600 --> 00:04:07,800 Speaker 2: is the potential problem. And if we look, for example, 68 00:04:08,040 --> 00:04:10,680 Speaker 2: at somebody whose waters have been broken for twenty four 69 00:04:10,680 --> 00:04:15,000 Speaker 2: hours and there's still no labor. We have to weigh 70 00:04:15,080 --> 00:04:19,400 Speaker 2: up the risks of doing nothing and letting that situation 71 00:04:19,520 --> 00:04:24,240 Speaker 2: continue versus the risks of intervening by starting up a 72 00:04:24,279 --> 00:04:28,159 Speaker 2: sintos not drip, And too often the discussion of risk 73 00:04:29,160 --> 00:04:33,640 Speaker 2: concentrates on the risk of the intervention and ignores the 74 00:04:33,760 --> 00:04:35,360 Speaker 2: risks if we don't do the. 75 00:04:37,000 --> 00:04:40,120 Speaker 1: That is so true. So we've talked about induction with 76 00:04:40,200 --> 00:04:42,600 Speaker 1: the drip, what about augmentation with the drip? 77 00:04:42,800 --> 00:04:45,200 Speaker 2: Augmentation is different. So that's when a labor is up 78 00:04:45,240 --> 00:04:49,360 Speaker 2: and going but doesn't seem to be progressing well. And 79 00:04:49,440 --> 00:04:54,440 Speaker 2: this is you know, there's all sorts of arguments about 80 00:04:54,480 --> 00:04:57,159 Speaker 2: how fast a labor should go and what's optimal and 81 00:04:57,200 --> 00:05:00,680 Speaker 2: what's best and so forth, but everybody agrees that we should. 82 00:05:00,360 --> 00:05:02,160 Speaker 3: Have some progress at some point. 83 00:05:02,560 --> 00:05:07,640 Speaker 2: So for labor has really stalled, Let's say we get 84 00:05:07,640 --> 00:05:12,080 Speaker 2: to about four centimeters, examine the woman again later on 85 00:05:12,120 --> 00:05:15,200 Speaker 2: and find that there's been no progress in the intervening time, 86 00:05:15,240 --> 00:05:17,279 Speaker 2: and in fact, when we look at the contractions that 87 00:05:17,279 --> 00:05:20,599 Speaker 2: have happened in the four hours between those examinations, there's 88 00:05:20,640 --> 00:05:23,520 Speaker 2: really been no useful progress at all. But also no 89 00:05:24,680 --> 00:05:29,800 Speaker 2: really strong contractions either. Yeah, they've petered right off. And 90 00:05:30,120 --> 00:05:38,800 Speaker 2: we knew from observations that historically that those people the 91 00:05:39,160 --> 00:05:42,320 Speaker 2: outcomes were poor for those women and those babies, and 92 00:05:42,400 --> 00:05:45,000 Speaker 2: labors that went on for a particularly long period of 93 00:05:45,040 --> 00:05:53,240 Speaker 2: time and were left to progress entirely without intervention, the 94 00:05:53,320 --> 00:05:56,840 Speaker 2: outcome for those women and those babies was poor. And 95 00:05:56,960 --> 00:06:02,520 Speaker 2: so when we look at the really disturbing data for 96 00:06:02,600 --> 00:06:08,320 Speaker 2: obstetric outcomes prior to the middle of the twentieth century, 97 00:06:07,600 --> 00:06:12,599 Speaker 2: the group that needed help and weren't getting it were 98 00:06:13,120 --> 00:06:17,120 Speaker 2: were women in particularly prolonged labors. 99 00:06:18,000 --> 00:06:19,720 Speaker 1: You say that thing about you know, you can't let 100 00:06:19,760 --> 00:06:22,120 Speaker 1: to some set or something. 101 00:06:22,400 --> 00:06:24,760 Speaker 2: Oh, yeah, it's a bit of a slip thing. Yeah, 102 00:06:24,760 --> 00:06:26,800 Speaker 2: a bit of a flippant old thing. But it's basically 103 00:06:26,839 --> 00:06:34,280 Speaker 2: that the labors there is there's compelling data that that 104 00:06:35,000 --> 00:06:39,480 Speaker 2: a progressive labor is a good one. So our augmentation 105 00:06:39,880 --> 00:06:42,240 Speaker 2: is using the sintosin on to make a slow labor 106 00:06:42,320 --> 00:06:42,720 Speaker 2: hurry up. 107 00:06:43,480 --> 00:06:45,640 Speaker 1: We got to mention at the start that some countries 108 00:06:45,680 --> 00:06:48,000 Speaker 1: call it different things, don't they there's pittocin. 109 00:06:48,520 --> 00:06:51,480 Speaker 2: It's the same thing, it's just different because. 110 00:06:51,240 --> 00:06:54,880 Speaker 1: It is one of the most widely obstetric drugs used 111 00:06:55,240 --> 00:06:56,120 Speaker 1: in the world, isn't it. 112 00:06:56,440 --> 00:07:01,359 Speaker 2: Yeah, And the careful and sensible and safe use of 113 00:07:01,400 --> 00:07:05,280 Speaker 2: that drug is one of the many reasons why the 114 00:07:05,400 --> 00:07:12,440 Speaker 2: data for pregnant women improved so dramatically in around about 115 00:07:12,440 --> 00:07:16,160 Speaker 2: the middle of last century, and why and why it's 116 00:07:16,200 --> 00:07:18,640 Speaker 2: never been safer to have a baby. 117 00:07:19,360 --> 00:07:22,400 Speaker 1: All Right, So I've looked at the arguments. I've done 118 00:07:22,440 --> 00:07:28,240 Speaker 1: my research akaa, Google research good and I got these 119 00:07:28,240 --> 00:07:30,440 Speaker 1: from Reddit okay. 120 00:07:30,320 --> 00:07:33,200 Speaker 2: So Journal, the International Journal of Excellence. 121 00:07:33,280 --> 00:07:36,600 Speaker 1: YEA number one argument that I found was that the 122 00:07:36,880 --> 00:07:39,600 Speaker 1: contractions are more painful and in intense. So people say 123 00:07:39,640 --> 00:07:43,680 Speaker 1: things like they got really intense really quickly, I didn't 124 00:07:43,720 --> 00:07:48,440 Speaker 1: get a break between contractions, and people who had it, 125 00:07:48,560 --> 00:07:52,000 Speaker 1: you know, had it and also had a birth without it, 126 00:07:52,040 --> 00:07:55,240 Speaker 1: said that the contractions were a lot worse than natural contractions. 127 00:07:55,680 --> 00:08:01,160 Speaker 2: Yes, So let's let's divide those up into a few 128 00:08:01,160 --> 00:08:07,360 Speaker 2: different things to examine. Firstly, the contractions that we're talking 129 00:08:07,400 --> 00:08:11,720 Speaker 2: about that help us in our first labor to get 130 00:08:12,680 --> 00:08:16,200 Speaker 2: from zero to ten and let the baby out. 131 00:08:17,280 --> 00:08:20,160 Speaker 3: They hurt and useful. 132 00:08:20,240 --> 00:08:28,680 Speaker 2: Contractions are painful, very painful, and so to say, if 133 00:08:28,720 --> 00:08:32,679 Speaker 2: we're talking about sintosinon made my contractions more painful. 134 00:08:32,360 --> 00:08:36,360 Speaker 3: Cause it did. That is what it's supposed to do. 135 00:08:37,760 --> 00:08:43,240 Speaker 2: And mostly when we're when someone says I had one 136 00:08:43,320 --> 00:08:46,360 Speaker 2: labor with it and one label without it, she's comparing 137 00:08:46,400 --> 00:08:49,439 Speaker 2: her first labor with her second, which we've discussed elsewhere 138 00:08:49,480 --> 00:08:52,760 Speaker 2: on the podcast. Is not comparing apples with apples. So 139 00:08:52,880 --> 00:08:57,960 Speaker 2: the first labor is long and difficult, and second and 140 00:08:58,000 --> 00:09:05,040 Speaker 2: subsequent labors on average a better. So it's particularly particularly 141 00:09:05,120 --> 00:09:10,480 Speaker 2: fraught to compare one with the other. So if we 142 00:09:10,760 --> 00:09:14,040 Speaker 2: make a better and safer comparison, which is between, say, 143 00:09:14,080 --> 00:09:16,680 Speaker 2: for in terms of the quality of our data, between 144 00:09:16,679 --> 00:09:18,480 Speaker 2: a big group of women who have sintoson in a 145 00:09:18,480 --> 00:09:21,199 Speaker 2: certain clinical scenario and a big group of women who 146 00:09:21,200 --> 00:09:26,200 Speaker 2: have sintosinon who don't have sintoson in the same scenario, 147 00:09:26,559 --> 00:09:30,760 Speaker 2: say stalled labor at four centimeters, then we know the 148 00:09:30,760 --> 00:09:34,400 Speaker 2: sinti group is to better outcomes what we don't want 149 00:09:34,400 --> 00:09:37,640 Speaker 2: to do. But they will also have more painful contractions, 150 00:09:37,679 --> 00:09:43,080 Speaker 2: of course they will. We're restoring painful contraction, which of 151 00:09:43,120 --> 00:09:45,920 Speaker 2: course is going to lead to pain. What we want 152 00:09:45,920 --> 00:09:49,080 Speaker 2: it to lead to is contractions that are effective and 153 00:09:49,160 --> 00:09:55,800 Speaker 2: put that labor back on track. The comment that somebody 154 00:09:55,840 --> 00:09:57,559 Speaker 2: made there about I didn't get enough of a rest 155 00:09:57,600 --> 00:10:02,200 Speaker 2: between my contractions, that is a POTENTI chull red flag 156 00:10:02,240 --> 00:10:07,080 Speaker 2: that the sinto may have been used incorrectly. So when 157 00:10:07,160 --> 00:10:11,199 Speaker 2: we are in labor, good strong labor, the baby's getting 158 00:10:11,200 --> 00:10:15,600 Speaker 2: oxygen when we're not contracting and not when we are. 159 00:10:16,240 --> 00:10:20,920 Speaker 2: So there needs to be a long contract a long 160 00:10:22,600 --> 00:10:28,160 Speaker 2: gap between contractions to refill the store of oxygen that's 161 00:10:28,160 --> 00:10:32,000 Speaker 2: sitting in that no man's land between the placenta and 162 00:10:32,000 --> 00:10:34,920 Speaker 2: the baby, so that the baby there's. 163 00:10:34,760 --> 00:10:38,640 Speaker 3: Some for the for the baby to use right throughout 164 00:10:38,679 --> 00:10:39,319 Speaker 3: the cycle. 165 00:10:39,720 --> 00:10:42,480 Speaker 1: And what would happen if somebody said that, you know, 166 00:10:43,160 --> 00:10:45,319 Speaker 1: in between contractions, they put their hand up and they 167 00:10:46,040 --> 00:10:48,920 Speaker 1: you know, I'm not getting a break here. Well, firstly 168 00:10:48,920 --> 00:10:51,280 Speaker 1: you would hope that somebody would realize that the contractions 169 00:10:51,280 --> 00:10:56,000 Speaker 1: are coming to hard and fast. But secondly, can they say, 170 00:10:56,200 --> 00:10:58,040 Speaker 1: you know, can I turn the drip down or can 171 00:10:58,080 --> 00:10:59,120 Speaker 1: the drip be turned down? 172 00:10:59,280 --> 00:11:02,640 Speaker 2: Yeah, so this is not something that we need to 173 00:11:02,640 --> 00:11:08,160 Speaker 2: rely on on a guesswork here. When a sintoson infusion 174 00:11:08,240 --> 00:11:10,600 Speaker 2: is running in Australia, there's two things that should be happening. 175 00:11:10,600 --> 00:11:13,360 Speaker 2: One is that that person should have a midwife with 176 00:11:13,440 --> 00:11:16,920 Speaker 2: them at all times. This is a potentially dangerous struck. 177 00:11:17,000 --> 00:11:20,559 Speaker 2: It can be overdone, overused and lead lead to very 178 00:11:20,559 --> 00:11:23,800 Speaker 2: poor outcomes. But that doesn't mean that if it's used 179 00:11:23,840 --> 00:11:28,120 Speaker 2: properly and safely, it isn't excellent. So what we we 180 00:11:28,559 --> 00:11:30,440 Speaker 2: want someone with that with that woman at all times. 181 00:11:30,600 --> 00:11:32,520 Speaker 2: And one of the things that attendant should that that 182 00:11:32,520 --> 00:11:35,480 Speaker 2: that that attendant to the birth should be looking for 183 00:11:36,800 --> 00:11:42,280 Speaker 2: is whether the whether the sintocinon is being used at 184 00:11:42,320 --> 00:11:46,400 Speaker 2: a drip rate, so the dose to bring about what 185 00:11:46,440 --> 00:11:49,200 Speaker 2: we're looking for, which is a certain number of painful 186 00:11:49,280 --> 00:11:53,480 Speaker 2: contractions every ten minutes with a nice gap in between 187 00:11:55,559 --> 00:11:57,400 Speaker 2: to restore the pool of. 188 00:11:57,480 --> 00:12:01,280 Speaker 3: Oxygen in a way that can be used by the baby. 189 00:12:03,559 --> 00:12:06,240 Speaker 1: It sort of leads to the next argument because if 190 00:12:06,240 --> 00:12:10,520 Speaker 1: they're more painful, people say, you start the drip and 191 00:12:10,600 --> 00:12:14,440 Speaker 1: you have created the cascade of interventions. And for first 192 00:12:14,440 --> 00:12:17,880 Speaker 1: time listeners, cascade of interventions people mean sort of like 193 00:12:17,880 --> 00:12:22,880 Speaker 1: the drip. More pain epidural leads to instrumental birth and 194 00:12:23,000 --> 00:12:25,960 Speaker 1: cesarean birth then, you know, so people think that you 195 00:12:26,360 --> 00:12:29,080 Speaker 1: open the floodgates for all that intervention happening. 196 00:12:29,280 --> 00:12:35,480 Speaker 2: Yeah, it's an interesting idea. There is a lot of 197 00:12:35,600 --> 00:12:39,960 Speaker 2: anecdotal evidence that the cascade of interventions exists as a phenomenon. 198 00:12:40,080 --> 00:12:43,079 Speaker 2: There's less proven evidence, but let's say, let's assume for 199 00:12:43,160 --> 00:12:45,840 Speaker 2: a moment that it does exist, and it probably exists 200 00:12:45,840 --> 00:12:49,440 Speaker 2: in some form or another. It's very difficult in an 201 00:12:49,480 --> 00:12:55,480 Speaker 2: individual case to know whether let's say, for example, we 202 00:12:55,520 --> 00:13:01,280 Speaker 2: look at sintocinon used in that first example where we 203 00:13:01,320 --> 00:13:05,400 Speaker 2: were giving the sinto because the labor had not come 204 00:13:05,440 --> 00:13:08,080 Speaker 2: after a certain amount of time, and the big ticket 205 00:13:08,200 --> 00:13:11,000 Speaker 2: intervention that the big ticket problem that we were trying 206 00:13:11,040 --> 00:13:15,000 Speaker 2: to avoid was the labor taking so many hours or 207 00:13:15,120 --> 00:13:19,160 Speaker 2: days longer. Sorry, the period of time that the waters 208 00:13:19,160 --> 00:13:21,400 Speaker 2: were broken was going to take so many hours longer 209 00:13:21,920 --> 00:13:26,440 Speaker 2: and unless unless we got on with it. So it's 210 00:13:26,559 --> 00:13:31,080 Speaker 2: very very difficult to know whether the sintosinon induced labor 211 00:13:32,000 --> 00:13:35,760 Speaker 2: caused more pain than that woman was going to have 212 00:13:36,000 --> 00:13:39,640 Speaker 2: had she just labored spontaneous, because that is also painful. 213 00:13:40,720 --> 00:13:44,760 Speaker 1: But there is an increases of women needing an epidural 214 00:13:44,840 --> 00:13:46,400 Speaker 1: if they do have the sin. 215 00:13:48,840 --> 00:13:54,560 Speaker 2: That is probably true, and there's certainly some studies that 216 00:13:54,600 --> 00:13:57,840 Speaker 2: have found that and one of the problems might be 217 00:13:58,400 --> 00:14:02,120 Speaker 2: that it comes on pretty hard fast, yeah, rather than 218 00:14:02,160 --> 00:14:06,560 Speaker 2: the natural one that would creep potentially creep up on us. 219 00:14:06,920 --> 00:14:12,120 Speaker 2: And if they're very severe, quite quickly, then there might 220 00:14:12,240 --> 00:14:14,360 Speaker 2: be in the mind of the laboring woman more of 221 00:14:14,360 --> 00:14:18,000 Speaker 2: a stuff. This is really bad and I was comfortable 222 00:14:18,040 --> 00:14:21,320 Speaker 2: half an hour ago, so now I want an EPPI. 223 00:14:21,880 --> 00:14:24,120 Speaker 2: Whereas the woman with the natural labor that creeps up 224 00:14:24,120 --> 00:14:28,880 Speaker 2: in intensity might be more able to be used to 225 00:14:28,920 --> 00:14:29,800 Speaker 2: that or withstand that. 226 00:14:30,880 --> 00:14:33,680 Speaker 1: So someone that gets the drip might end up with 227 00:14:33,720 --> 00:14:37,160 Speaker 1: an epidural higher chance of getting epidural, But it doesn't. 228 00:14:37,200 --> 00:14:39,960 Speaker 1: An epidural doesn't lead to a higher chance of cesarean. 229 00:14:40,360 --> 00:14:46,760 Speaker 2: No, that is a commonly believed thing that there is 230 00:14:47,000 --> 00:14:49,600 Speaker 2: very little evidence to support that, and in fact, there 231 00:14:49,600 --> 00:14:52,960 Speaker 2: are studies that don't show that at all. You've got 232 00:14:53,000 --> 00:14:58,880 Speaker 2: to remember that the use of sinto in the stalled 233 00:14:58,960 --> 00:15:03,200 Speaker 2: labor might be the only thing that gets you to 234 00:15:04,120 --> 00:15:06,920 Speaker 2: the starting line of a vaginal birth, which is being 235 00:15:06,960 --> 00:15:11,200 Speaker 2: fully dilated. Does that make sense? So I think that 236 00:15:11,200 --> 00:15:15,280 Speaker 2: that if you if you are an installed labor at 237 00:15:15,280 --> 00:15:18,120 Speaker 2: four centimeters and you don't and you don't, what have 238 00:15:18,160 --> 00:15:21,240 Speaker 2: you got on your sinto that that's going to have 239 00:15:21,280 --> 00:15:25,320 Speaker 2: a section rate if we do nothing, that approach one 240 00:15:25,360 --> 00:15:28,800 Speaker 2: hundred percent because the baby can't come out through a 241 00:15:28,800 --> 00:15:32,040 Speaker 2: four centimes cervix. If you have the scent, what's and 242 00:15:32,120 --> 00:15:35,240 Speaker 2: all and get to fully you are at least at 243 00:15:35,240 --> 00:15:37,200 Speaker 2: the starting line of a vaginal birth. 244 00:15:37,360 --> 00:15:39,360 Speaker 1: And you know there's no judgment in there. You might 245 00:15:39,400 --> 00:15:41,880 Speaker 1: get to four centimeters after I don't know, an eight 246 00:15:41,880 --> 00:15:45,560 Speaker 1: hour labor and think, oh, well, four centimeters. They've suggested 247 00:15:45,600 --> 00:15:49,440 Speaker 1: that I have sintocinin or caesarean. Yep, And you might go, 248 00:15:49,640 --> 00:15:52,320 Speaker 1: I've done it already, labor, I'm going to go for 249 00:15:52,320 --> 00:15:52,800 Speaker 1: a cesarean. 250 00:15:52,800 --> 00:15:52,960 Speaker 3: Oh. 251 00:15:53,000 --> 00:15:53,920 Speaker 2: Sometimes people do that. 252 00:15:53,920 --> 00:15:54,360 Speaker 1: That's fine. 253 00:15:54,440 --> 00:15:56,800 Speaker 2: Yeah, that's also fine. But let's say the goal is 254 00:15:56,880 --> 00:16:00,640 Speaker 2: vaginal birth. Let's for the sake of this discussion. Then 255 00:16:00,680 --> 00:16:03,040 Speaker 2: sometimes I'll say to people, you've been laboring all night 256 00:16:03,360 --> 00:16:09,840 Speaker 2: and we're still only here. I'm now proposing that to 257 00:16:09,880 --> 00:16:11,960 Speaker 2: get this labor back on track and give us it 258 00:16:12,000 --> 00:16:15,080 Speaker 2: and give us a tilt at getting to fully and 259 00:16:15,400 --> 00:16:18,080 Speaker 2: a vaginal birth, the best course of action here is 260 00:16:18,080 --> 00:16:21,479 Speaker 2: to use some sintai and try and restore adequate progress. 261 00:16:23,000 --> 00:16:25,200 Speaker 2: You're already exhausted you sure you don't want an ep 262 00:16:25,200 --> 00:16:28,560 Speaker 2: be upfront, Yeah, and we'll often do that. Yeah, So 263 00:16:28,640 --> 00:16:31,400 Speaker 2: put in the eppy first and then ramp the scent 264 00:16:31,480 --> 00:16:32,280 Speaker 2: up and see how it goes. 265 00:16:32,360 --> 00:16:34,560 Speaker 1: Yeah, yeah, and then that can all sort of wear 266 00:16:34,680 --> 00:16:38,200 Speaker 1: off towards the end anyway, And if your goal is 267 00:16:38,240 --> 00:16:41,640 Speaker 1: to have a vaginal birth where you, you know, feel 268 00:16:41,680 --> 00:16:43,280 Speaker 1: like you're not medicated, then. 269 00:16:43,400 --> 00:16:45,680 Speaker 2: An unassisted vaginal birth. Yeah, that's right, then you can 270 00:16:45,840 --> 00:16:49,000 Speaker 2: you can certainly do that, all right. 271 00:16:49,040 --> 00:16:51,480 Speaker 1: I want to move to argument three, which is that 272 00:16:51,560 --> 00:16:54,000 Speaker 1: it increases risk. And now you've touched on that. So 273 00:16:54,080 --> 00:16:57,640 Speaker 1: what sort of risk is the main problem with sintasin 274 00:16:57,640 --> 00:16:58,080 Speaker 1: on drips. 275 00:16:58,520 --> 00:16:59,960 Speaker 2: Well, we need to look at the risks of you 276 00:17:00,040 --> 00:17:01,960 Speaker 2: using it and the risks of not using it. But 277 00:17:02,040 --> 00:17:03,840 Speaker 2: let's say we start with the risks of using it. 278 00:17:04,440 --> 00:17:09,160 Speaker 2: Those are allergic reaction and things like that are extremely uncommon. 279 00:17:10,200 --> 00:17:13,080 Speaker 2: We're talking about using it to using it in a 280 00:17:13,119 --> 00:17:16,720 Speaker 2: way that over stimulates the uterus and can lead to 281 00:17:16,920 --> 00:17:19,400 Speaker 2: very big contractions coming on one on top of the other. 282 00:17:19,920 --> 00:17:23,520 Speaker 2: And these are typically dosing errors. So we need to 283 00:17:23,520 --> 00:17:27,720 Speaker 2: be really careful. Gotta be careful on everyone you use 284 00:17:27,840 --> 00:17:32,680 Speaker 2: in on particularly people had a baby before, it doesn't 285 00:17:32,720 --> 00:17:36,679 Speaker 2: take much. So if someone's had a previous vaginal birth 286 00:17:38,359 --> 00:17:41,880 Speaker 2: ruptures their membranes at term, and then the labor doesn't come, 287 00:17:43,080 --> 00:17:44,840 Speaker 2: and that the sun comes up the next morning, we're 288 00:17:44,840 --> 00:17:46,080 Speaker 2: still not in labor. And you want to use a 289 00:17:46,080 --> 00:17:48,280 Speaker 2: bit of sin, you do not need much. So a 290 00:17:48,320 --> 00:17:53,240 Speaker 2: whiff will get that woman into labor. And it's not 291 00:17:53,760 --> 00:17:57,919 Speaker 2: like using it to in a stored labor in a 292 00:17:57,960 --> 00:18:01,520 Speaker 2: primate where where really we push people pretty hard. 293 00:18:02,119 --> 00:18:04,520 Speaker 1: But not too hard, because I've heard you say also 294 00:18:04,880 --> 00:18:07,880 Speaker 1: that you know that someone was pushed a bit hard, 295 00:18:07,960 --> 00:18:11,000 Speaker 1: or you know the senters really flogged flogged them. 296 00:18:11,240 --> 00:18:15,720 Speaker 2: Yeah, yeah, yeah, yeah, whopping people along. Whereas whereas the 297 00:18:15,880 --> 00:18:17,720 Speaker 2: one who's had a baby before, just to finish their thoughts, 298 00:18:17,720 --> 00:18:21,360 Speaker 2: she does not need much. And and a little bit 299 00:18:22,000 --> 00:18:25,480 Speaker 2: trickled in will will get her actually up and laboring 300 00:18:25,480 --> 00:18:28,399 Speaker 2: pretty much by itself. We don't often do this, but 301 00:18:28,440 --> 00:18:31,600 Speaker 2: she could almost turn it off again. Yeah and and 302 00:18:31,640 --> 00:18:34,359 Speaker 2: some and some of those women would be up and away. 303 00:18:35,960 --> 00:18:37,480 Speaker 2: The woman having a first baby is not like that. 304 00:18:38,359 --> 00:18:41,520 Speaker 2: If there's a if the labor's progressing slowly, we often 305 00:18:41,560 --> 00:18:43,440 Speaker 2: need to start the center and we start a really 306 00:18:43,440 --> 00:18:45,760 Speaker 2: low dose because we don't know how much we're going 307 00:18:45,840 --> 00:18:48,359 Speaker 2: to need to get to get the result we're looking for. 308 00:18:49,600 --> 00:18:51,240 Speaker 2: So we started off at a really low dose and 309 00:18:51,240 --> 00:18:54,639 Speaker 2: then very carefully watching the watching how the woman and 310 00:18:54,640 --> 00:18:58,080 Speaker 2: the baby responding to it, increase it until we get 311 00:18:58,280 --> 00:19:02,879 Speaker 2: to a frequency and duration of contractions that works to 312 00:19:03,000 --> 00:19:05,520 Speaker 2: actually put the labor. 313 00:19:05,280 --> 00:19:05,840 Speaker 3: Back on track. 314 00:19:08,160 --> 00:19:11,359 Speaker 1: All right, So is that the only risk, you know? 315 00:19:12,720 --> 00:19:15,720 Speaker 1: The hyperstimulation of the uterus. 316 00:19:15,800 --> 00:19:18,800 Speaker 2: Yeah, So hyperstimulation is where we get just a whole 317 00:19:18,840 --> 00:19:21,200 Speaker 2: lot of contractions coming one after the other, and you think, oh, well, 318 00:19:21,240 --> 00:19:23,159 Speaker 2: as long as we haven't any previous season something, the 319 00:19:23,240 --> 00:19:25,160 Speaker 2: uterus is pretty strong and made a muscle, it should 320 00:19:25,160 --> 00:19:27,440 Speaker 2: be fine. But it's not really about that. It's about 321 00:19:27,480 --> 00:19:31,679 Speaker 2: the baby getting enough oxygen and you need a gap 322 00:19:31,760 --> 00:19:34,000 Speaker 2: between contractions to ensure that that happens. 323 00:19:34,359 --> 00:19:36,720 Speaker 1: And a tired uterus. I've also heard you talk about 324 00:19:36,720 --> 00:19:38,280 Speaker 1: postpartum hemorrhage risk. 325 00:19:39,480 --> 00:19:47,320 Speaker 2: True, the tired uterus is part of using SINTO, but 326 00:19:47,359 --> 00:19:50,280 Speaker 2: it's also one of the problems with significantly prolonged labors. 327 00:19:50,920 --> 00:19:53,639 Speaker 2: So we actually we may we may actually be using 328 00:19:53,760 --> 00:19:57,240 Speaker 2: SINTO to avoid the sort of problems that happen if 329 00:19:57,280 --> 00:19:58,280 Speaker 2: you're labor for three days. 330 00:19:58,400 --> 00:20:03,199 Speaker 1: Okay, all right, I'm an argument for I heard this 331 00:20:03,280 --> 00:20:07,919 Speaker 1: a lot on Reddit, and I'm just surmising that, you know, 332 00:20:07,960 --> 00:20:10,479 Speaker 1: being attached to a drip or the continuous monitoring, all 333 00:20:10,520 --> 00:20:13,879 Speaker 1: of a sudden, their birth has gone from feeling natural 334 00:20:14,280 --> 00:20:15,560 Speaker 1: feeling medicalized. 335 00:20:15,840 --> 00:20:20,600 Speaker 2: Yes, and needless to say, that's true. It is definitely true. 336 00:20:21,600 --> 00:20:26,320 Speaker 2: We're having a baby in the hospital. The hospital. If 337 00:20:26,359 --> 00:20:33,000 Speaker 2: things are going significantly away from a speed an efficiency 338 00:20:33,000 --> 00:20:35,640 Speaker 2: that we know is associated with good outcomes, you're likely 339 00:20:35,680 --> 00:20:40,119 Speaker 2: to be You're likely to be recommended intervention. Now, those 340 00:20:40,680 --> 00:20:46,680 Speaker 2: interventions are not bad ideas just because they're interventions. It 341 00:20:46,800 --> 00:20:55,000 Speaker 2: was interventions that that fixed the data that nature's data 342 00:20:55,640 --> 00:20:59,320 Speaker 2: which was unacceptable to the people of one hundred years ago. 343 00:21:01,359 --> 00:21:03,680 Speaker 2: For one percent of women who got pregnant to die 344 00:21:03,720 --> 00:21:09,439 Speaker 2: from that pregnancy was unacceptable to those people. Think of 345 00:21:09,560 --> 00:21:15,040 Speaker 2: the cumulity of misery. And it was interventions that fixed that. 346 00:21:16,800 --> 00:21:19,200 Speaker 1: So people talk about less mobile, but you can still 347 00:21:19,240 --> 00:21:20,440 Speaker 1: move around with the drip. 348 00:21:20,600 --> 00:21:23,920 Speaker 3: Yep, So you can. 349 00:21:24,760 --> 00:21:29,880 Speaker 2: Then we don't tend to have people walking the corridors 350 00:21:30,320 --> 00:21:33,240 Speaker 2: with a drip. Because of the need for electronic fetal monitoring. 351 00:21:33,240 --> 00:21:34,960 Speaker 2: We want to make sure that we're not overstressing the 352 00:21:35,000 --> 00:21:38,200 Speaker 2: baby with the sinto, but certainly around the room that's fine. 353 00:21:38,600 --> 00:21:40,919 Speaker 1: And is it always continuous monitoring that you need if 354 00:21:40,920 --> 00:21:42,639 Speaker 1: you're on a drip or can they put it on 355 00:21:42,680 --> 00:21:43,399 Speaker 1: and off a little bit? 356 00:21:44,440 --> 00:21:48,600 Speaker 2: We have continuous monitoring for people on sinto, because often 357 00:21:48,760 --> 00:21:53,920 Speaker 2: the first sign that that too much is being given 358 00:21:54,960 --> 00:21:57,520 Speaker 2: is a change in the fetal heart rate, which is 359 00:21:57,560 --> 00:21:59,680 Speaker 2: the baby saying, you know, I'm not getting enough oxygen 360 00:22:00,440 --> 00:22:03,080 Speaker 2: here because you haven't given me enough of a rest 361 00:22:03,119 --> 00:22:08,359 Speaker 2: between contractions fair enough. So the woman won't necessarily notice that, 362 00:22:08,440 --> 00:22:11,040 Speaker 2: but baby will one might. I think you this stuff's 363 00:22:11,040 --> 00:22:13,840 Speaker 2: working on cracking along here, but that's not what the 364 00:22:13,880 --> 00:22:19,879 Speaker 2: baby needs. Whereas in the hyperstimulation that occurring naturally is 365 00:22:20,200 --> 00:22:25,000 Speaker 2: quite uncommon for a natural labor, So that you so 366 00:22:25,600 --> 00:22:28,119 Speaker 2: listen after each contraction is fine. 367 00:22:28,640 --> 00:22:30,440 Speaker 1: So what about they can't go into a bath or 368 00:22:30,440 --> 00:22:32,359 Speaker 1: anything like that if they're on a drip. 369 00:22:34,040 --> 00:22:39,760 Speaker 2: No, but that not in our setup. But I think 370 00:22:39,800 --> 00:22:44,760 Speaker 2: that that we're often using this in a scenario where 371 00:22:44,960 --> 00:22:49,160 Speaker 2: things have not gone according to an entirely natural and 372 00:22:49,720 --> 00:23:01,879 Speaker 2: entirely non interventional model. And you know, what, have you 373 00:23:01,960 --> 00:23:05,720 Speaker 2: believed that these are interventions that are somehow forced on people. 374 00:23:06,560 --> 00:23:11,919 Speaker 2: I don't believe that's commonly true. I think that the 375 00:23:12,080 --> 00:23:16,520 Speaker 2: standard these days, certainly in Australia, would be to go 376 00:23:16,560 --> 00:23:19,760 Speaker 2: in and sit down with that woman and her support 377 00:23:19,800 --> 00:23:25,560 Speaker 2: people and say, here's where we are, here's our progress 378 00:23:25,640 --> 00:23:29,960 Speaker 2: so far, and here are my concerns. And then, like 379 00:23:30,119 --> 00:23:34,280 Speaker 2: any medical intervention for any reason, whether you've got a 380 00:23:34,520 --> 00:23:36,840 Speaker 2: whether you've got a pimple on your nose, or or 381 00:23:36,960 --> 00:23:40,879 Speaker 2: having a baby, what are the risks and benefits of 382 00:23:40,880 --> 00:23:43,919 Speaker 2: the intervention you're talking about? What are the risks and 383 00:23:43,960 --> 00:23:45,959 Speaker 2: benefits of doing nothing? 384 00:23:46,760 --> 00:23:49,879 Speaker 3: What else have you got? And can I have some 385 00:23:49,960 --> 00:23:50,760 Speaker 3: time to think about it? 386 00:23:50,920 --> 00:23:54,680 Speaker 1: Yeah? I did, forget to ask if you've had the 387 00:23:54,760 --> 00:23:57,640 Speaker 1: drip to start so in an induction and you get 388 00:23:57,640 --> 00:24:00,040 Speaker 1: into good labor, can all of that be switched off. 389 00:24:01,600 --> 00:24:05,639 Speaker 2: When you're having your first baby? It really needs to 390 00:24:05,840 --> 00:24:08,840 Speaker 2: keep running and in fact the dosoten. 391 00:24:08,359 --> 00:24:09,639 Speaker 3: Needs to be increased. 392 00:24:09,800 --> 00:24:13,920 Speaker 2: Oh wow, so if you switch it off, it tends 393 00:24:13,960 --> 00:24:17,800 Speaker 2: to go back to where it was, which was installed. Yeah, 394 00:24:18,000 --> 00:24:22,040 Speaker 2: second and subsequent berths. It's not really like that. You 395 00:24:22,040 --> 00:24:23,879 Speaker 2: can use a sniff and get going and you probably 396 00:24:23,920 --> 00:24:25,120 Speaker 2: could switch those off. 397 00:24:26,920 --> 00:24:30,400 Speaker 1: Good. All right, this is my last argument. I'm sure 398 00:24:30,440 --> 00:24:34,560 Speaker 1: there's others. Email us or DMS if you think there's 399 00:24:34,560 --> 00:24:38,280 Speaker 1: another argument that you want to have discussed. And this 400 00:24:38,320 --> 00:24:42,439 Speaker 1: is harder because it's those that really don't trust that 401 00:24:42,560 --> 00:24:46,080 Speaker 1: advice that they really needed it in the first place, 402 00:24:46,240 --> 00:24:49,440 Speaker 1: you know, a questioning whether their labor was truly stalled 403 00:24:49,560 --> 00:24:52,280 Speaker 1: and whether they were given enough time to wait. 404 00:24:52,520 --> 00:24:56,280 Speaker 2: Yes, well that is a different question altogether, because that 405 00:24:56,760 --> 00:25:00,040 Speaker 2: comes down to see I've drawn this example for the 406 00:25:00,200 --> 00:25:03,320 Speaker 2: ease about discussion today about someone who's not laboring at 407 00:25:03,320 --> 00:25:06,119 Speaker 2: all and has a clear infection risk and there's a 408 00:25:06,200 --> 00:25:11,119 Speaker 2: clear problem with doing nothing. Where it gets more interesting 409 00:25:11,760 --> 00:25:16,760 Speaker 2: is the scenario in which, for example, the induction wasn't 410 00:25:16,760 --> 00:25:20,080 Speaker 2: done for a good medical reason. Yeah, so there really. 411 00:25:19,920 --> 00:25:21,000 Speaker 3: Was no problem. 412 00:25:21,440 --> 00:25:23,639 Speaker 2: Everyone just thought it would be more convenient how the 413 00:25:23,680 --> 00:25:27,680 Speaker 2: baby that day or somebody thought it was or whatever. Well, 414 00:25:27,720 --> 00:25:31,520 Speaker 2: that is different, and that, I think is where the 415 00:25:31,520 --> 00:25:35,080 Speaker 2: discussion is, where the actual discussion should be parts. 416 00:25:35,400 --> 00:25:36,960 Speaker 3: Do you need to be induced in first place? 417 00:25:39,560 --> 00:25:42,240 Speaker 2: If you really really want to avoid intervention, come into 418 00:25:42,280 --> 00:25:43,720 Speaker 2: spontaneous labor. 419 00:25:43,400 --> 00:25:46,480 Speaker 1: A term easier said than done. 420 00:25:47,600 --> 00:25:51,440 Speaker 2: But I'm just saying that that's really where the discussion 421 00:25:51,440 --> 00:25:57,360 Speaker 2: should lie. I don't think that there's any particular problem 422 00:25:57,400 --> 00:26:02,320 Speaker 2: with the careful, sensible, expert use of Sintosno, I think 423 00:26:02,320 --> 00:26:07,119 Speaker 2: there's a problem with inductions. So if we look at 424 00:26:07,200 --> 00:26:12,359 Speaker 2: that inductions, inductions for first babies that have a higher 425 00:26:12,440 --> 00:26:15,520 Speaker 2: risk of ending in ceserrean section, Yep, yeah, we've got 426 00:26:15,760 --> 00:26:19,560 Speaker 2: there's an issue there, and I think our birthing services 427 00:26:20,000 --> 00:26:23,480 Speaker 2: need to be flexible enough to allow more of those 428 00:26:23,520 --> 00:26:25,840 Speaker 2: women to cautiously wait. 429 00:26:27,160 --> 00:26:31,960 Speaker 1: It's hard, you know, because Australia is geographically kind of challenged, 430 00:26:32,680 --> 00:26:35,399 Speaker 1: and some people will have an induction because they've had 431 00:26:35,440 --> 00:26:39,280 Speaker 1: to fly in to to a regional city or a city. 432 00:26:40,280 --> 00:26:42,440 Speaker 1: Even some of our people that live three hours away 433 00:26:42,440 --> 00:26:43,120 Speaker 1: from bell are out. 434 00:26:43,160 --> 00:26:45,840 Speaker 2: You know, Well, they're the most likely of my patients 435 00:26:45,880 --> 00:26:50,120 Speaker 2: to be induced. And for those people sometimes it comes 436 00:26:50,160 --> 00:26:54,200 Speaker 2: down to the risks and benefits of induction versus the 437 00:26:54,280 --> 00:26:57,480 Speaker 2: risks and benefits of laboring spontaneously and being three hours 438 00:26:57,480 --> 00:27:02,919 Speaker 2: from their birthing hospital. So different discussion. Yeah, but if 439 00:27:02,920 --> 00:27:05,240 Speaker 2: we talk, if we want to shift the argument to 440 00:27:05,320 --> 00:27:11,280 Speaker 2: somewhere where it can actually lead to better outcomes for women, 441 00:27:11,480 --> 00:27:15,080 Speaker 2: it's probably shifting it shifting it over to can we 442 00:27:15,200 --> 00:27:19,320 Speaker 2: get this woman to a point where she can be 443 00:27:19,359 --> 00:27:26,720 Speaker 2: safely and expertly managed without inducing your labor, rather than 444 00:27:26,800 --> 00:27:28,119 Speaker 2: just saying well, the only thing we can do for 445 00:27:28,160 --> 00:27:28,520 Speaker 2: your madam. 446 00:27:28,520 --> 00:27:30,160 Speaker 3: Mister gets going, Yeah. 447 00:27:30,320 --> 00:27:33,480 Speaker 1: It's so difficult because you know you have the I've 448 00:27:33,440 --> 00:27:37,439 Speaker 1: forgotten what it's called, the massive, big one where they 449 00:27:37,480 --> 00:27:39,679 Speaker 1: got managed to convince people to have an induction at 450 00:27:39,680 --> 00:27:44,960 Speaker 1: thirty eight weeks the trial trial. I should have known, right, Yeah, 451 00:27:45,080 --> 00:27:50,280 Speaker 1: so they're saying, actually, there's less cesarean right if you 452 00:27:50,320 --> 00:27:52,399 Speaker 1: get induced at thirty eight weeks and it became a 453 00:27:52,400 --> 00:27:52,880 Speaker 1: bit of a thing. 454 00:27:52,920 --> 00:27:54,840 Speaker 2: You got to raised more questions than it answered to 455 00:27:54,920 --> 00:27:59,920 Speaker 2: be honest. But no, I think I think that labor 456 00:28:00,080 --> 00:28:01,760 Speaker 2: spontaneously at term is still a good thing. 457 00:28:03,119 --> 00:28:05,959 Speaker 1: All right. Now, they're the arguments, and I'm sure there 458 00:28:05,960 --> 00:28:07,960 Speaker 1: are Moreso, as I said, just dms if you want 459 00:28:08,000 --> 00:28:13,479 Speaker 1: something discussed. But let's talk about let's just wrap it up, 460 00:28:13,520 --> 00:28:16,680 Speaker 1: pat with what the benefits are. Like. You know, we've 461 00:28:16,720 --> 00:28:19,639 Speaker 1: talked about why people wouldn't have it, and in between 462 00:28:19,680 --> 00:28:21,840 Speaker 1: you've put little bits of why you think sintosin is 463 00:28:21,840 --> 00:28:24,280 Speaker 1: a good idea. Yeah, so let's talk about some benefits. 464 00:28:24,400 --> 00:28:24,840 Speaker 3: It works. 465 00:28:24,960 --> 00:28:28,360 Speaker 2: It works. Yeah, so that is that is the bottom line. 466 00:28:28,359 --> 00:28:28,879 Speaker 3: It works. 467 00:28:30,040 --> 00:28:37,320 Speaker 2: It's the receptors within the uterus respond very very well, 468 00:28:38,040 --> 00:28:41,880 Speaker 2: and it will. It will get you back on track 469 00:28:41,960 --> 00:28:45,000 Speaker 2: if there's something wrong with your labor, and if there's 470 00:28:45,040 --> 00:28:46,880 Speaker 2: nothing wrong with your label, why are we using it 471 00:28:46,920 --> 00:28:49,720 Speaker 2: in the first place. This will get you back on 472 00:28:49,800 --> 00:28:53,600 Speaker 2: track in a lot of cases, much much more effectively 473 00:28:53,640 --> 00:28:55,400 Speaker 2: than the old all they used to have, which was 474 00:28:55,440 --> 00:28:56,200 Speaker 2: the tincture of time. 475 00:28:56,200 --> 00:28:57,880 Speaker 3: He just waited and hoped it went better. 476 00:28:58,280 --> 00:29:06,280 Speaker 2: Yeah, it is very very effective at doing that job. 477 00:29:06,880 --> 00:29:12,720 Speaker 2: Used sensibly, expertly, carefully, it's a very very good intervention. 478 00:29:13,800 --> 00:29:18,760 Speaker 1: And you mentioned that because it does help people deliver 479 00:29:18,800 --> 00:29:21,600 Speaker 1: within twenty four hours. There's actually it helps to avoid 480 00:29:21,640 --> 00:29:23,280 Speaker 1: cesarean in certain cases. 481 00:29:23,400 --> 00:29:28,960 Speaker 2: Well, that is why it's used. And so it's sort 482 00:29:29,000 --> 00:29:34,080 Speaker 2: of sometimes a little baffling to obstetric practitioners that we 483 00:29:34,360 --> 00:29:37,800 Speaker 2: just hear all the problems with it as if we're 484 00:29:37,880 --> 00:29:41,240 Speaker 2: using it for no reason. But if somebody's labor is 485 00:29:41,280 --> 00:29:44,840 Speaker 2: stuck at force entimeters, that person's going to have a caesar. 486 00:29:45,400 --> 00:29:49,120 Speaker 2: In just about every case, sintocinon is to get you 487 00:29:49,200 --> 00:29:51,960 Speaker 2: to fully so you don't need one. And that is 488 00:29:53,560 --> 00:29:57,560 Speaker 2: that's a common misunderstanding. If I have sintosin I have 489 00:29:57,920 --> 00:30:01,200 Speaker 2: a higher section rate. I don't think that's at all true. 490 00:30:01,960 --> 00:30:05,120 Speaker 2: In fact, the reason why the labor is being pushed 491 00:30:05,160 --> 00:30:10,520 Speaker 2: along is to get you to ten centimeters where a 492 00:30:10,600 --> 00:30:13,880 Speaker 2: vaginal birth only then becomes a possibility. 493 00:30:14,920 --> 00:30:17,480 Speaker 1: All right, So you know we've got the medical world 494 00:30:17,560 --> 00:30:22,960 Speaker 1: saying it works, it's been studied lots, it can prevent escalation, 495 00:30:23,160 --> 00:30:26,240 Speaker 1: it can help people avoid cesarians. If that's what they're 496 00:30:26,320 --> 00:30:29,960 Speaker 1: up to. Why is the medical world saying one thing 497 00:30:30,400 --> 00:30:34,640 Speaker 1: and like pages and pages and pages on Reddit are 498 00:30:34,640 --> 00:30:37,320 Speaker 1: saying another thing about induction. Why do people fear it? 499 00:30:37,920 --> 00:30:40,240 Speaker 2: Well, I think it gets back to that argument about 500 00:30:40,720 --> 00:30:45,840 Speaker 2: what we are talking about when we talk about risk. 501 00:30:46,600 --> 00:30:52,840 Speaker 2: So the medical world tends to look at population level risks. 502 00:30:53,680 --> 00:30:57,360 Speaker 2: What happens to one hundred thousand women in this situation 503 00:30:58,040 --> 00:31:00,920 Speaker 2: if we do nothing compares to compared to what happens 504 00:31:00,960 --> 00:31:04,560 Speaker 2: to those women if we apply treatment ABC, which might 505 00:31:04,600 --> 00:31:10,800 Speaker 2: be sintos non augmentation of labor. And the problem with 506 00:31:11,160 --> 00:31:13,640 Speaker 2: the what we read on the internet is it tends 507 00:31:13,680 --> 00:31:18,200 Speaker 2: to be somebody's individual experience. They gave me that sinto. 508 00:31:19,480 --> 00:31:25,840 Speaker 2: It didn't work. I had an appy and then a 509 00:31:25,920 --> 00:31:30,840 Speaker 2: Caesar must have been the sinto's fault. But the sinto 510 00:31:30,920 --> 00:31:36,000 Speaker 2: was only given because labor installed. That was actually the problem. 511 00:31:36,520 --> 00:31:42,320 Speaker 2: And so that person leaves thinking it is useless. Fair enough, 512 00:31:43,520 --> 00:31:45,680 Speaker 2: then that person can get on the internet and say 513 00:31:45,720 --> 00:31:49,760 Speaker 2: to everyone else it's useless, don't do it. But in fact, 514 00:31:50,040 --> 00:31:53,240 Speaker 2: if we look at enough people, the exact opposite is true. 515 00:31:53,480 --> 00:31:58,280 Speaker 2: It's useful. And in that scenario, the evidence based thing to. 516 00:31:58,280 --> 00:32:00,520 Speaker 3: Do is to do it. 517 00:32:00,520 --> 00:32:03,760 Speaker 2: It won't always work, but if you want to know 518 00:32:03,800 --> 00:32:08,200 Speaker 2: where the data leads, it leads to the sensible use 519 00:32:08,240 --> 00:32:08,960 Speaker 2: of that intervention. 520 00:32:10,920 --> 00:32:14,040 Speaker 1: So if people are getting conflicting messages online and then 521 00:32:14,080 --> 00:32:18,440 Speaker 1: they sort of say, oh, by absolutely no, it's not 522 00:32:18,520 --> 00:32:21,400 Speaker 1: in my birth plan. I've underlined it like a hundred times, 523 00:32:21,440 --> 00:32:25,560 Speaker 1: no induction, no sintosinin And then it comes to the 524 00:32:25,600 --> 00:32:29,800 Speaker 1: situation where they are recommended to have sintosin. What are 525 00:32:29,800 --> 00:32:31,600 Speaker 1: some good questions they can ask their provider? 526 00:32:31,760 --> 00:32:34,960 Speaker 2: You have to so it's a great question. So I'm 527 00:32:34,960 --> 00:32:35,880 Speaker 2: going to I'm going. 528 00:32:35,840 --> 00:32:37,640 Speaker 1: I know you've just set up straight in your chair, 529 00:32:37,680 --> 00:32:39,880 Speaker 1: You've got all excited, You're like this. 530 00:32:39,920 --> 00:32:43,800 Speaker 2: It's a great question. But if you're in labor, it's 531 00:32:43,800 --> 00:32:46,720 Speaker 2: too late, and that that is why you've got to 532 00:32:46,720 --> 00:32:52,400 Speaker 2: talk about this in the consulting room during the pregnancy. 533 00:32:52,600 --> 00:32:57,320 Speaker 2: So in our Grow My Baby program, we've got a 534 00:32:57,440 --> 00:32:59,640 Speaker 2: we've got a template for a birthplane. I believe in 535 00:32:59,680 --> 00:33:03,400 Speaker 2: birth I think it's really really great to get on paper. 536 00:33:03,760 --> 00:33:05,680 Speaker 3: How I hope this goes. 537 00:33:06,280 --> 00:33:09,480 Speaker 2: Yeah, but the process of making a birth plan, it's great. 538 00:33:09,760 --> 00:33:13,040 Speaker 2: Not for the plan, They're right, It's that it's for 539 00:33:13,120 --> 00:33:18,160 Speaker 2: the questions that it introduces in the mind of the patient. 540 00:33:19,000 --> 00:33:25,120 Speaker 2: So so if someone comes comes to me and says, 541 00:33:25,880 --> 00:33:31,320 Speaker 2: I don't want it in toosin under any circumstances, I'm like, okay, well, 542 00:33:31,560 --> 00:33:34,360 Speaker 2: this is your body, your choice. One hundred percent, you 543 00:33:34,800 --> 00:33:36,560 Speaker 2: will not have a drug for me that you have 544 00:33:36,600 --> 00:33:40,880 Speaker 2: not agreed to have. However, what do you want to 545 00:33:40,960 --> 00:33:45,560 Speaker 2: do if you get to five centimeters and the labor 546 00:33:45,560 --> 00:33:51,240 Speaker 2: stores and the woman will often say, I didn't know 547 00:33:51,280 --> 00:33:53,800 Speaker 2: that was a thing. I was like, that's why the 548 00:33:53,960 --> 00:33:57,680 Speaker 2: clever people invented sintosin. So let's talk now about what 549 00:33:57,720 --> 00:34:01,080 Speaker 2: we might do, because we've got some choices. You could 550 00:34:01,920 --> 00:34:06,240 Speaker 2: keep waiting and hope that we get there eventually and 551 00:34:06,280 --> 00:34:11,640 Speaker 2: that has risks and benefits. Or we could do a 552 00:34:11,719 --> 00:34:14,560 Speaker 2: Caesar then and there because we only got to five 553 00:34:14,600 --> 00:34:17,319 Speaker 2: and you can't get maybe out through five, or you 554 00:34:17,360 --> 00:34:21,919 Speaker 2: could have Sintosa. And then people go, ah, it was well, 555 00:34:22,640 --> 00:34:27,520 Speaker 2: so through learning about it, they can suddenly they can 556 00:34:27,800 --> 00:34:30,080 Speaker 2: getting back to this idea of engaging in the complexity. 557 00:34:30,360 --> 00:34:33,040 Speaker 2: They go, oh, it's not just simple enough to say no, 558 00:34:33,200 --> 00:34:37,239 Speaker 2: I don't want that because it's bad for me. Now 559 00:34:37,280 --> 00:34:39,399 Speaker 2: I can see how the use of that might get 560 00:34:39,440 --> 00:34:46,600 Speaker 2: me out of trouble. So then they go, wait. 561 00:34:46,480 --> 00:34:47,239 Speaker 3: Ever, not think about it? 562 00:34:47,320 --> 00:34:49,440 Speaker 2: Yeah, yeah, Now if that person comes back and says 563 00:34:49,440 --> 00:34:50,680 Speaker 2: I don't want to I've had a look and I 564 00:34:50,719 --> 00:34:52,840 Speaker 2: had to think, and I don't want to donder any circumstances, fine, 565 00:34:53,200 --> 00:34:55,960 Speaker 2: but you cannot escape the consequences of not having it. 566 00:34:57,320 --> 00:35:01,160 Speaker 2: You if you get into that situation, will have to 567 00:35:01,200 --> 00:35:03,359 Speaker 2: do something else, and those things will have their own 568 00:35:03,400 --> 00:35:07,160 Speaker 2: prois and CODs. Even if that's something else is nothing, 569 00:35:07,800 --> 00:35:09,120 Speaker 2: it's got its own pros. 570 00:35:08,880 --> 00:35:12,880 Speaker 1: And CODs, which must be incredibly difficult for a provider. 571 00:35:13,000 --> 00:35:16,160 Speaker 1: If that person goes, absolutely, do I I'm saying no 572 00:35:16,280 --> 00:35:21,640 Speaker 1: to that particularly intervention, Yes, and the risks and benefits 573 00:35:22,600 --> 00:35:28,840 Speaker 1: in your in the practitioner's mind really doesn't equate, like 574 00:35:28,880 --> 00:35:31,640 Speaker 1: the risks are far greater, yes, and you think, well, 575 00:35:31,719 --> 00:35:34,560 Speaker 1: the option that this woman is now choosing is that 576 00:35:34,600 --> 00:35:36,040 Speaker 1: she wants a labor to go for. 577 00:35:37,080 --> 00:35:43,160 Speaker 2: Two days with the associated risks. This is a tricky 578 00:35:43,239 --> 00:35:50,279 Speaker 2: one because in my view, the absolute paramount consideration is 579 00:35:50,280 --> 00:35:53,760 Speaker 2: the wishes of the patient. Now, I don't think that 580 00:35:53,760 --> 00:35:57,720 Speaker 2: that can truly be determined the wishes of the patient 581 00:35:58,360 --> 00:36:03,000 Speaker 2: until the patient understands the counter argument. So I spend 582 00:36:03,000 --> 00:36:06,120 Speaker 2: a fair bit of time if I'm in a situation 583 00:36:06,280 --> 00:36:10,360 Speaker 2: like this, making sure that the person understands the counterargument 584 00:36:11,400 --> 00:36:15,200 Speaker 2: before making their final decision, and when they do, that's 585 00:36:15,239 --> 00:36:18,080 Speaker 2: the decision. So if someone wants to stay in labor 586 00:36:18,120 --> 00:36:20,840 Speaker 2: for days and days, that is okay. It hasn't happened 587 00:36:20,840 --> 00:36:23,520 Speaker 2: that many times in my career a few, but that 588 00:36:24,040 --> 00:36:27,080 Speaker 2: is okay if that's what they truly want. And some 589 00:36:27,120 --> 00:36:29,080 Speaker 2: of those people aren't in the hospital in the first place, yeah, 590 00:36:29,320 --> 00:36:31,399 Speaker 2: laboring out in the community in a way that they 591 00:36:31,440 --> 00:36:35,280 Speaker 2: feel is best for them. I don't like the idea 592 00:36:35,360 --> 00:36:39,440 Speaker 2: of people having rejected intervention and the medical point of 593 00:36:39,520 --> 00:36:43,719 Speaker 2: view without having heard it first and understood it. But ultimately, 594 00:36:43,719 --> 00:36:48,040 Speaker 2: if that's what they've decided, then that is up to them. 595 00:36:48,160 --> 00:36:51,759 Speaker 2: And my junior colleagues get very upset about this and 596 00:36:51,760 --> 00:36:56,279 Speaker 2: they feel powerless and frustrated and a bit depressed that 597 00:36:56,400 --> 00:36:59,120 Speaker 2: all of the clever interventions that they spent so long 598 00:36:59,239 --> 00:37:04,879 Speaker 2: learning about are being rejected by the patient. But ultimately 599 00:37:05,160 --> 00:37:10,320 Speaker 2: that is their decision, and sometimes that leads to people. Often, 600 00:37:11,320 --> 00:37:14,080 Speaker 2: very often that leads to that person getting away with 601 00:37:14,120 --> 00:37:15,879 Speaker 2: it and feeling clever that. 602 00:37:15,840 --> 00:37:18,520 Speaker 1: They had a natural birth and only took twelve hours. 603 00:37:18,680 --> 00:37:19,960 Speaker 2: Yeah, it was all great, and. 604 00:37:22,719 --> 00:37:24,920 Speaker 1: Then they get on the internet and tell everyone else to. 605 00:37:24,840 --> 00:37:28,160 Speaker 2: Do what they did. But sometimes it leads to poor outcomes, 606 00:37:28,160 --> 00:37:33,120 Speaker 2: and that is part of making a choice. What's the 607 00:37:33,160 --> 00:37:36,799 Speaker 2: decision when we do type people down? Absolutely not this 608 00:37:36,880 --> 00:37:41,280 Speaker 2: is this is not the way we do bring withdraw 609 00:37:41,400 --> 00:37:45,560 Speaker 2: care all together. Yeah. Well that's a tricky one. 610 00:37:45,640 --> 00:37:47,759 Speaker 1: Yeah yeah, but I mean that's what you know, that 611 00:37:47,840 --> 00:37:50,680 Speaker 1: case with a woman who didn't want a vaginal examination 612 00:37:50,840 --> 00:37:52,760 Speaker 1: and they were saying, well, we're not going to accept 613 00:37:52,760 --> 00:37:54,520 Speaker 1: you into the hospital, and as you have one. 614 00:37:55,320 --> 00:37:58,960 Speaker 2: A better scenario would have been that someone has the 615 00:37:59,040 --> 00:38:03,200 Speaker 2: right to come into the spit, but also to reject 616 00:38:03,280 --> 00:38:08,440 Speaker 2: things that that hospital is commending because if that, if 617 00:38:09,120 --> 00:38:12,319 Speaker 2: someone wants to do that, there's an argument that's often 618 00:38:12,360 --> 00:38:14,560 Speaker 2: made that if you, if you, if you, if you're 619 00:38:14,600 --> 00:38:16,359 Speaker 2: so clever and you know the best way to do everything, 620 00:38:16,400 --> 00:38:18,160 Speaker 2: why in the hospital in the first place. Well, that 621 00:38:18,280 --> 00:38:21,359 Speaker 2: argument falls down because that person might say, no, I 622 00:38:21,480 --> 00:38:23,640 Speaker 2: have a vision for my labor that I want it 623 00:38:23,680 --> 00:38:27,600 Speaker 2: to run like this, but if it completely goes to crap, 624 00:38:27,680 --> 00:38:29,160 Speaker 2: I want to be in the hospital where you people 625 00:38:29,160 --> 00:38:32,239 Speaker 2: can help me. So, and that's a legitimate point of view. 626 00:38:33,800 --> 00:38:35,800 Speaker 2: Our point of view is often based that prevention is 627 00:38:35,800 --> 00:38:38,880 Speaker 2: better than cure, and we'd rather prevent the postpartum hemorrhage 628 00:38:39,200 --> 00:38:42,320 Speaker 2: than have to come running and fix one. But again 629 00:38:42,480 --> 00:38:47,440 Speaker 2: that's the it's up to the patient, the informed. 630 00:38:46,960 --> 00:38:50,120 Speaker 1: Patient, informed and not scared into doing something. All right, 631 00:38:50,160 --> 00:38:52,759 Speaker 1: So in terms of the drip, they can people can ask, 632 00:38:53,360 --> 00:38:55,680 Speaker 1: why are you recommending that I have the drip? Yes, 633 00:38:56,080 --> 00:38:59,960 Speaker 1: they can ask what are the risks? What are the benefits? 634 00:39:00,160 --> 00:39:01,160 Speaker 3: Yeah? 635 00:39:01,320 --> 00:39:04,319 Speaker 2: If I do this, if I do nothing, or how 636 00:39:04,320 --> 00:39:07,520 Speaker 2: about we do something else that's not can. 637 00:39:07,360 --> 00:39:12,040 Speaker 1: Should Yeah, and that all should probably happen. You're saying 638 00:39:12,400 --> 00:39:13,840 Speaker 1: before labor. 639 00:39:14,120 --> 00:39:16,800 Speaker 2: Well, that's that's our dream, isn't it. That's what we wanted. 640 00:39:17,560 --> 00:39:19,480 Speaker 2: That's why we made the Gramma Baby Program, was to 641 00:39:19,520 --> 00:39:22,160 Speaker 2: try and get people up to a certain amount of 642 00:39:22,200 --> 00:39:26,160 Speaker 2: pregnancy literacy such that when some of these things happen 643 00:39:26,200 --> 00:39:29,799 Speaker 2: in their labor, which they do, they that they it 644 00:39:29,840 --> 00:39:30,920 Speaker 2: wasn't the first that ever hurt. 645 00:39:31,120 --> 00:39:31,319 Speaker 1: Yeah. 646 00:39:31,680 --> 00:39:38,440 Speaker 2: Yeah, And anecdotally, I think that it's great to talk 647 00:39:38,480 --> 00:39:41,120 Speaker 2: to people who already understand what the are you talking about? 648 00:39:41,200 --> 00:39:47,760 Speaker 1: Yeah? Great, all right everyone. Pat's mentioned our Gramo Baby 649 00:39:47,840 --> 00:39:50,520 Speaker 1: Program a couple of times now, so if you're interested 650 00:39:50,560 --> 00:39:52,520 Speaker 1: in that, there's always a link to that in our 651 00:39:52,520 --> 00:39:55,760 Speaker 1: show notes. What it is is a week by week, 652 00:39:56,680 --> 00:40:00,640 Speaker 1: really in depth information that you get to help you 653 00:40:00,719 --> 00:40:04,480 Speaker 1: in pre pregnancy, all through your pregnancy, and for the 654 00:40:04,520 --> 00:40:07,799 Speaker 1: first six weeks. You can join at any time. We 655 00:40:07,840 --> 00:40:12,080 Speaker 1: think it's really affordable to get quality, consultant level information 656 00:40:12,239 --> 00:40:14,279 Speaker 1: that's not just Pat a little bit of me in 657 00:40:14,320 --> 00:40:17,239 Speaker 1: there as a mum, but there's also other experts that 658 00:40:17,239 --> 00:40:23,440 Speaker 1: we've invited into, Like we've got an anethetist, a physiotherapist, dietitian, 659 00:40:24,040 --> 00:40:27,640 Speaker 1: lactation consultants, so all of those things really help wrap 660 00:40:27,760 --> 00:40:30,839 Speaker 1: the information that you're learning on the podcast into a 661 00:40:31,040 --> 00:40:35,799 Speaker 1: step by step, sequential lead information program. So we think 662 00:40:35,840 --> 00:40:38,040 Speaker 1: it's really great, and thousands of other people have thought 663 00:40:38,080 --> 00:40:40,319 Speaker 1: it's really great too, so the links to that are 664 00:40:40,320 --> 00:40:44,160 Speaker 1: in our show notes. So good. I'm glad we covered 665 00:40:44,160 --> 00:40:48,040 Speaker 1: the drip. It's something that does get a bit of 666 00:40:48,080 --> 00:40:51,959 Speaker 1: air time. So yes, you've got lots of knowledge. Now 667 00:40:52,360 --> 00:40:55,160 Speaker 1: take this away, digest it, talk to your support people, 668 00:40:55,239 --> 00:40:58,040 Speaker 1: talk to your partner, and see what decisions you're going 669 00:40:58,080 --> 00:41:03,080 Speaker 1: to make about induction or augmentation. Excellent, all right, everyone, 670 00:41:03,760 --> 00:41:06,600 Speaker 1: until next week, keep growing those babies and we'll be 671 00:41:06,719 --> 00:41:07,600 Speaker 1: back in your ears. Then. 672 00:41:07,840 --> 00:41:08,840 Speaker 2: Thanks for listening, everybody. 673 00:41:08,880 --> 00:41:15,600 Speaker 1: Okay, bye for now. Hey, even though doctor Pat is 674 00:41:15,719 --> 00:41:18,120 Speaker 1: well a doctor and we get lots of other doctors 675 00:41:18,120 --> 00:41:20,960 Speaker 1: and other experts on our podcast, I just need to 676 00:41:21,000 --> 00:41:25,120 Speaker 1: remind you that this podcast is for informational purposes only. 677 00:41:25,719 --> 00:41:29,240 Speaker 1: We share lots of medical insights and experience, but everything 678 00:41:29,239 --> 00:41:32,279 Speaker 1: we talk about is general in nature and may not 679 00:41:32,320 --> 00:41:36,560 Speaker 1: apply to your specific situation. Please always consult with your 680 00:41:36,600 --> 00:41:40,520 Speaker 1: own healthcare provider for your individual medical advice. When you 681 00:41:40,560 --> 00:41:41,320 Speaker 1: grow your baby