WEBVTT - 205. The Syntocinon Drip 0:00:04.280 --> 0:00:07.360 Welcome to the Kick Your Expert led podcast, helping you 0:00:07.440 --> 0:00:11.840 explore and learn everything about getting pregnancy, birth, and becoming 0:00:11.840 --> 0:00:12.240 a parent. 0:00:12.600 --> 0:00:16.360 On the podcast and our online pregnancy program grow My Baby, 0:00:16.520 --> 0:00:19.520 we share my experience of helping more than four thousand 0:00:19.560 --> 0:00:20.680 babies to be born. 0:00:20.680 --> 0:00:23.360 And our experience of running a women's health clinic and 0:00:23.440 --> 0:00:24.520 parenting for boys. 0:00:24.720 --> 0:00:27.720 We're here to help everyone to feel empowered in pregnancy 0:00:27.880 --> 0:00:30.720 and birth with real life, practical information. 0:00:32.640 --> 0:00:34.760 Welcome everyone, I'm Bridgid Maloney and. 0:00:34.680 --> 0:00:36.440 I'm Obstrician doctor Patrick. 0:00:36.159 --> 0:00:38.280 Maloney, and today we're going to talk about something that 0:00:38.520 --> 0:00:42.960 everybody knows something about, and that is the drip. The 0:00:43.040 --> 0:00:46.600 sintosin is labor yes, and why some people say no, 0:00:46.880 --> 0:00:50.280 and what the evidence actually says. So I'm really I 0:00:50.320 --> 0:00:54.600 want to want to do for this one is bring 0:00:54.600 --> 0:00:57.000 to you the arguments that people might have, Okay, and 0:00:57.040 --> 0:00:59.280 then we're going to talk about the benefits so people 0:00:59.320 --> 0:01:02.720 can see what the objections might be towards the sintosinon 0:01:02.960 --> 0:01:09.200 drip and then what they can then learn about to 0:01:09.240 --> 0:01:12.759 help them make some decisions about their progress in pregnancy 0:01:12.840 --> 0:01:14.760 and labor and birth. 0:01:15.000 --> 0:01:15.200 Good. 0:01:15.800 --> 0:01:18.240 But you know, now we've said sintosin and drip and 0:01:18.280 --> 0:01:20.160 just expect everybody to know it. So let's start there. 0:01:21.040 --> 0:01:21.560 What is it? 0:01:23.160 --> 0:01:27.240 Well, the sintoson is a drug. It's called various things 0:01:27.240 --> 0:01:32.880 around the world, but it's a synthetic form of the 0:01:33.120 --> 0:01:38.560 natural laboring hormone and it helps in labor if there's 0:01:38.959 --> 0:01:42.280 a good reason why we would want the labor to 0:01:42.360 --> 0:01:48.280 either start up or to go faster and stronger, and 0:01:49.200 --> 0:01:50.960 good reason is an important. 0:01:50.520 --> 0:01:51.560 Part of that discussion. 0:01:51.560 --> 0:01:54.960 It's a drug that has to be used for valid reasons, 0:01:55.760 --> 0:01:59.040 and there are some risks in using it, so we 0:01:59.120 --> 0:02:02.520 need to be careful of how we use it. 0:02:03.920 --> 0:02:06.040 And people know the two terms, won't they They'll know 0:02:06.160 --> 0:02:09.440 induction and maybe they'll know augmentation. 0:02:09.800 --> 0:02:12.120 Yeah, so let's talk about those two things because they're 0:02:12.240 --> 0:02:15.960 very often blurred in discussions about this, and it's important 0:02:16.000 --> 0:02:23.680 that they're not so using sintosinon to induce labor. The 0:02:23.720 --> 0:02:26.119 most common scenario that I can think of would be 0:02:27.560 --> 0:02:31.560 that the waters have broken, so come to term, waters 0:02:31.560 --> 0:02:36.040 have broken, but no labor comes. When this happens a bit, 0:02:37.280 --> 0:02:44.480 and therefore there's an infection rate where bacteria from the 0:02:44.560 --> 0:02:47.680 vagina can get up into the water around the baby, 0:02:48.639 --> 0:02:53.160 and newborns do poorly when they're born infected. So after 0:02:53.320 --> 0:02:56.040 a period of time, if the labor has not come, 0:02:56.480 --> 0:02:59.240 sometimes the appropriate advice is to use some sinto to 0:02:59.240 --> 0:03:06.400 get that labor up going. And that's using sinto to induce. 0:03:06.560 --> 0:03:09.680 So to bring about a labor where there is not one, Okay, 0:03:09.800 --> 0:03:11.520 because the water's breaking, that doesn't count. 0:03:11.680 --> 0:03:14.079 Can I just talk about the water's breaking? So I mean, 0:03:14.280 --> 0:03:19.160 if somebody's picked up this episode because they've been told 0:03:19.200 --> 0:03:21.519 that they should think about having an induction, and they're 0:03:21.520 --> 0:03:24.080 going to have that induction started by the drip and 0:03:25.360 --> 0:03:29.480 they're hearing for the first time that water's breaking, don't 0:03:29.520 --> 0:03:32.720 necessarily equate to the start of labor. That is at 0:03:32.720 --> 0:03:34.320 odds to every single. 0:03:34.040 --> 0:03:37.400 Movie, every movie you've ever seen. That's right, that's not 0:03:37.440 --> 0:03:39.480 how it's done. So the winter, the waters break, the 0:03:40.480 --> 0:03:43.160 big strong contractions come. That's not how it really works. 0:03:44.480 --> 0:03:51.080 There's often several hours, there's sometimes days, and there can 0:03:51.120 --> 0:03:56.720 be weeks weeks. Yeah, so those events are not necessarily 0:03:56.760 --> 0:04:03.040 one immediately following the other. Infection is in that scenario 0:04:03.600 --> 0:04:07.800 is the potential problem. And if we look, for example, 0:04:08.040 --> 0:04:10.680 at somebody whose waters have been broken for twenty four 0:04:10.680 --> 0:04:15.000 hours and there's still no labor. We have to weigh 0:04:15.080 --> 0:04:19.400 up the risks of doing nothing and letting that situation 0:04:19.520 --> 0:04:24.240 continue versus the risks of intervening by starting up a 0:04:24.279 --> 0:04:28.159 sintos not drip, And too often the discussion of risk 0:04:29.160 --> 0:04:33.640 concentrates on the risk of the intervention and ignores the 0:04:33.760 --> 0:04:35.360 risks if we don't do the. 0:04:37.000 --> 0:04:40.120 That is so true. So we've talked about induction with 0:04:40.200 --> 0:04:42.600 the drip, what about augmentation with the drip? 0:04:42.800 --> 0:04:45.200 Augmentation is different. So that's when a labor is up 0:04:45.240 --> 0:04:49.360 and going but doesn't seem to be progressing well. And 0:04:49.440 --> 0:04:54.440 this is you know, there's all sorts of arguments about 0:04:54.480 --> 0:04:57.159 how fast a labor should go and what's optimal and 0:04:57.200 --> 0:05:00.680 what's best and so forth, but everybody agrees that we should. 0:05:00.360 --> 0:05:02.160 Have some progress at some point. 0:05:02.560 --> 0:05:07.640 So for labor has really stalled, Let's say we get 0:05:07.640 --> 0:05:12.080 to about four centimeters, examine the woman again later on 0:05:12.120 --> 0:05:15.200 and find that there's been no progress in the intervening time, 0:05:15.240 --> 0:05:17.279 and in fact, when we look at the contractions that 0:05:17.279 --> 0:05:20.599 have happened in the four hours between those examinations, there's 0:05:20.640 --> 0:05:23.520 really been no useful progress at all. But also no 0:05:24.680 --> 0:05:29.800 really strong contractions either. Yeah, they've petered right off. And 0:05:30.120 --> 0:05:38.800 we knew from observations that historically that those people the 0:05:39.160 --> 0:05:42.320 outcomes were poor for those women and those babies, and 0:05:42.400 --> 0:05:45.000 labors that went on for a particularly long period of 0:05:45.040 --> 0:05:53.240 time and were left to progress entirely without intervention, the 0:05:53.320 --> 0:05:56.840 outcome for those women and those babies was poor. And 0:05:56.960 --> 0:06:02.520 so when we look at the really disturbing data for 0:06:02.600 --> 0:06:08.320 obstetric outcomes prior to the middle of the twentieth century, 0:06:07.600 --> 0:06:12.599 the group that needed help and weren't getting it were 0:06:13.120 --> 0:06:17.120 were women in particularly prolonged labors. 0:06:18.000 --> 0:06:19.720 You say that thing about you know, you can't let 0:06:19.760 --> 0:06:22.120 to some set or something. 0:06:22.400 --> 0:06:24.760 Oh, yeah, it's a bit of a slip thing. Yeah, 0:06:24.760 --> 0:06:26.800 a bit of a flippant old thing. But it's basically 0:06:26.839 --> 0:06:34.280 that the labors there is there's compelling data that that 0:06:35.000 --> 0:06:39.480 a progressive labor is a good one. So our augmentation 0:06:39.880 --> 0:06:42.240 is using the sintosin on to make a slow labor 0:06:42.320 --> 0:06:42.720 hurry up. 0:06:43.480 --> 0:06:45.640 We got to mention at the start that some countries 0:06:45.680 --> 0:06:48.000 call it different things, don't they there's pittocin. 0:06:48.520 --> 0:06:51.480 It's the same thing, it's just different because. 0:06:51.240 --> 0:06:54.880 It is one of the most widely obstetric drugs used 0:06:55.240 --> 0:06:56.120 in the world, isn't it. 0:06:56.440 --> 0:07:01.359 Yeah, And the careful and sensible and safe use of 0:07:01.400 --> 0:07:05.280 that drug is one of the many reasons why the 0:07:05.400 --> 0:07:12.440 data for pregnant women improved so dramatically in around about 0:07:12.440 --> 0:07:16.160 the middle of last century, and why and why it's 0:07:16.200 --> 0:07:18.640 never been safer to have a baby. 0:07:19.360 --> 0:07:22.400 All Right, So I've looked at the arguments. I've done 0:07:22.440 --> 0:07:28.240 my research akaa, Google research good and I got these 0:07:28.240 --> 0:07:30.440 from Reddit okay. 0:07:30.320 --> 0:07:33.200 So Journal, the International Journal of Excellence. 0:07:33.280 --> 0:07:36.600 YEA number one argument that I found was that the 0:07:36.880 --> 0:07:39.600 contractions are more painful and in intense. So people say 0:07:39.640 --> 0:07:43.680 things like they got really intense really quickly, I didn't 0:07:43.720 --> 0:07:48.440 get a break between contractions, and people who had it, 0:07:48.560 --> 0:07:52.000 you know, had it and also had a birth without it, 0:07:52.040 --> 0:07:55.240 said that the contractions were a lot worse than natural contractions. 0:07:55.680 --> 0:08:01.160 Yes, So let's let's divide those up into a few 0:08:01.160 --> 0:08:07.360 different things to examine. Firstly, the contractions that we're talking 0:08:07.400 --> 0:08:11.720 about that help us in our first labor to get 0:08:12.680 --> 0:08:16.200 from zero to ten and let the baby out. 0:08:17.280 --> 0:08:20.160 They hurt and useful. 0:08:20.240 --> 0:08:28.680 Contractions are painful, very painful, and so to say, if 0:08:28.720 --> 0:08:32.679 we're talking about sintosinon made my contractions more painful. 0:08:32.360 --> 0:08:36.360 Cause it did. That is what it's supposed to do. 0:08:37.760 --> 0:08:43.240 And mostly when we're when someone says I had one 0:08:43.320 --> 0:08:46.360 labor with it and one label without it, she's comparing 0:08:46.400 --> 0:08:49.439 her first labor with her second, which we've discussed elsewhere 0:08:49.480 --> 0:08:52.760 on the podcast. Is not comparing apples with apples. So 0:08:52.880 --> 0:08:57.960 the first labor is long and difficult, and second and 0:08:58.000 --> 0:09:05.040 subsequent labors on average a better. So it's particularly particularly 0:09:05.120 --> 0:09:10.480 fraught to compare one with the other. So if we 0:09:10.760 --> 0:09:14.040 make a better and safer comparison, which is between, say, 0:09:14.080 --> 0:09:16.680 for in terms of the quality of our data, between 0:09:16.679 --> 0:09:18.480 a big group of women who have sintoson in a 0:09:18.480 --> 0:09:21.199 certain clinical scenario and a big group of women who 0:09:21.200 --> 0:09:26.200 have sintosinon who don't have sintoson in the same scenario, 0:09:26.559 --> 0:09:30.760 say stalled labor at four centimeters, then we know the 0:09:30.760 --> 0:09:34.400 sinti group is to better outcomes what we don't want 0:09:34.400 --> 0:09:37.640 to do. But they will also have more painful contractions, 0:09:37.679 --> 0:09:43.080 of course they will. We're restoring painful contraction, which of 0:09:43.120 --> 0:09:45.920 course is going to lead to pain. What we want 0:09:45.920 --> 0:09:49.080 it to lead to is contractions that are effective and 0:09:49.160 --> 0:09:55.800 put that labor back on track. The comment that somebody 0:09:55.840 --> 0:09:57.559 made there about I didn't get enough of a rest 0:09:57.600 --> 0:10:02.200 between my contractions, that is a POTENTI chull red flag 0:10:02.240 --> 0:10:07.080 that the sinto may have been used incorrectly. So when 0:10:07.160 --> 0:10:11.199 we are in labor, good strong labor, the baby's getting 0:10:11.200 --> 0:10:15.600 oxygen when we're not contracting and not when we are. 0:10:16.240 --> 0:10:20.920 So there needs to be a long contract a long 0:10:22.600 --> 0:10:28.160 gap between contractions to refill the store of oxygen that's 0:10:28.160 --> 0:10:32.000 sitting in that no man's land between the placenta and 0:10:32.000 --> 0:10:34.920 the baby, so that the baby there's. 0:10:34.760 --> 0:10:38.640 Some for the for the baby to use right throughout 0:10:38.679 --> 0:10:39.319 the cycle. 0:10:39.720 --> 0:10:42.480 And what would happen if somebody said that, you know, 0:10:43.160 --> 0:10:45.319 in between contractions, they put their hand up and they 0:10:46.040 --> 0:10:48.920 you know, I'm not getting a break here. Well, firstly 0:10:48.920 --> 0:10:51.280 you would hope that somebody would realize that the contractions 0:10:51.280 --> 0:10:56.000 are coming to hard and fast. But secondly, can they say, 0:10:56.200 --> 0:10:58.040 you know, can I turn the drip down or can 0:10:58.080 --> 0:10:59.120 the drip be turned down? 0:10:59.280 --> 0:11:02.640 Yeah, so this is not something that we need to 0:11:02.640 --> 0:11:08.160 rely on on a guesswork here. When a sintoson infusion 0:11:08.240 --> 0:11:10.600 is running in Australia, there's two things that should be happening. 0:11:10.600 --> 0:11:13.360 One is that that person should have a midwife with 0:11:13.440 --> 0:11:16.920 them at all times. This is a potentially dangerous struck. 0:11:17.000 --> 0:11:20.559 It can be overdone, overused and lead lead to very 0:11:20.559 --> 0:11:23.800 poor outcomes. But that doesn't mean that if it's used 0:11:23.840 --> 0:11:28.120 properly and safely, it isn't excellent. So what we we 0:11:28.559 --> 0:11:30.440 want someone with that with that woman at all times. 0:11:30.600 --> 0:11:32.520 And one of the things that attendant should that that 0:11:32.520 --> 0:11:35.480 that that attendant to the birth should be looking for 0:11:36.800 --> 0:11:42.280 is whether the whether the sintocinon is being used at 0:11:42.320 --> 0:11:46.400 a drip rate, so the dose to bring about what 0:11:46.440 --> 0:11:49.200 we're looking for, which is a certain number of painful 0:11:49.280 --> 0:11:53.480 contractions every ten minutes with a nice gap in between 0:11:55.559 --> 0:11:57.400 to restore the pool of. 0:11:57.480 --> 0:12:01.280 Oxygen in a way that can be used by the baby. 0:12:03.559 --> 0:12:06.240 It sort of leads to the next argument because if 0:12:06.240 --> 0:12:10.520 they're more painful, people say, you start the drip and 0:12:10.600 --> 0:12:14.440 you have created the cascade of interventions. And for first 0:12:14.440 --> 0:12:17.880 time listeners, cascade of interventions people mean sort of like 0:12:17.880 --> 0:12:22.880 the drip. More pain epidural leads to instrumental birth and 0:12:23.000 --> 0:12:25.960 cesarean birth then, you know, so people think that you 0:12:26.360 --> 0:12:29.080 open the floodgates for all that intervention happening. 0:12:29.280 --> 0:12:35.480 Yeah, it's an interesting idea. There is a lot of 0:12:35.600 --> 0:12:39.960 anecdotal evidence that the cascade of interventions exists as a phenomenon. 0:12:40.080 --> 0:12:43.079 There's less proven evidence, but let's say, let's assume for 0:12:43.160 --> 0:12:45.840 a moment that it does exist, and it probably exists 0:12:45.840 --> 0:12:49.440 in some form or another. It's very difficult in an 0:12:49.480 --> 0:12:55.480 individual case to know whether let's say, for example, we 0:12:55.520 --> 0:13:01.280 look at sintocinon used in that first example where we 0:13:01.320 --> 0:13:05.400 were giving the sinto because the labor had not come 0:13:05.440 --> 0:13:08.080 after a certain amount of time, and the big ticket 0:13:08.200 --> 0:13:11.000 intervention that the big ticket problem that we were trying 0:13:11.040 --> 0:13:15.000 to avoid was the labor taking so many hours or 0:13:15.120 --> 0:13:19.160 days longer. Sorry, the period of time that the waters 0:13:19.160 --> 0:13:21.400 were broken was going to take so many hours longer 0:13:21.920 --> 0:13:26.440 and unless unless we got on with it. So it's 0:13:26.559 --> 0:13:31.080 very very difficult to know whether the sintosinon induced labor 0:13:32.000 --> 0:13:35.760 caused more pain than that woman was going to have 0:13:36.000 --> 0:13:39.640 had she just labored spontaneous, because that is also painful. 0:13:40.720 --> 0:13:44.760 But there is an increases of women needing an epidural 0:13:44.840 --> 0:13:46.400 if they do have the sin. 0:13:48.840 --> 0:13:54.560 That is probably true, and there's certainly some studies that 0:13:54.600 --> 0:13:57.840 have found that and one of the problems might be 0:13:58.400 --> 0:14:02.120 that it comes on pretty hard fast, yeah, rather than 0:14:02.160 --> 0:14:06.560 the natural one that would creep potentially creep up on us. 0:14:06.920 --> 0:14:12.120 And if they're very severe, quite quickly, then there might 0:14:12.240 --> 0:14:14.360 be in the mind of the laboring woman more of 0:14:14.360 --> 0:14:18.000 a stuff. This is really bad and I was comfortable 0:14:18.040 --> 0:14:21.320 half an hour ago, so now I want an EPPI. 0:14:21.880 --> 0:14:24.120 Whereas the woman with the natural labor that creeps up 0:14:24.120 --> 0:14:28.880 in intensity might be more able to be used to 0:14:28.920 --> 0:14:29.800 that or withstand that. 0:14:30.880 --> 0:14:33.680 So someone that gets the drip might end up with 0:14:33.720 --> 0:14:37.160 an epidural higher chance of getting epidural, But it doesn't. 0:14:37.200 --> 0:14:39.960 An epidural doesn't lead to a higher chance of cesarean. 0:14:40.360 --> 0:14:46.760 No, that is a commonly believed thing that there is 0:14:47.000 --> 0:14:49.600 very little evidence to support that, and in fact, there 0:14:49.600 --> 0:14:52.960 are studies that don't show that at all. You've got 0:14:53.000 --> 0:14:58.880 to remember that the use of sinto in the stalled 0:14:58.960 --> 0:15:03.200 labor might be the only thing that gets you to 0:15:04.120 --> 0:15:06.920 the starting line of a vaginal birth, which is being 0:15:06.960 --> 0:15:11.200 fully dilated. Does that make sense? So I think that 0:15:11.200 --> 0:15:15.280 that if you if you are an installed labor at 0:15:15.280 --> 0:15:18.120 four centimeters and you don't and you don't, what have 0:15:18.160 --> 0:15:21.240 you got on your sinto that that's going to have 0:15:21.280 --> 0:15:25.320 a section rate if we do nothing, that approach one 0:15:25.360 --> 0:15:28.800 hundred percent because the baby can't come out through a 0:15:28.800 --> 0:15:32.040 four centimes cervix. If you have the scent, what's and 0:15:32.120 --> 0:15:35.240 all and get to fully you are at least at 0:15:35.240 --> 0:15:37.200 the starting line of a vaginal birth. 0:15:37.360 --> 0:15:39.360 And you know there's no judgment in there. You might 0:15:39.400 --> 0:15:41.880 get to four centimeters after I don't know, an eight 0:15:41.880 --> 0:15:45.560 hour labor and think, oh, well, four centimeters. They've suggested 0:15:45.600 --> 0:15:49.440 that I have sintocinin or caesarean. Yep, And you might go, 0:15:49.640 --> 0:15:52.320 I've done it already, labor, I'm going to go for 0:15:52.320 --> 0:15:52.800 a cesarean. 0:15:52.800 --> 0:15:52.960 Oh. 0:15:53.000 --> 0:15:53.920 Sometimes people do that. 0:15:53.920 --> 0:15:54.360 That's fine. 0:15:54.440 --> 0:15:56.800 Yeah, that's also fine. But let's say the goal is 0:15:56.880 --> 0:16:00.640 vaginal birth. Let's for the sake of this discussion. Then 0:16:00.680 --> 0:16:03.040 sometimes I'll say to people, you've been laboring all night 0:16:03.360 --> 0:16:09.840 and we're still only here. I'm now proposing that to 0:16:09.880 --> 0:16:11.960 get this labor back on track and give us it 0:16:12.000 --> 0:16:15.080 and give us a tilt at getting to fully and 0:16:15.400 --> 0:16:18.080 a vaginal birth, the best course of action here is 0:16:18.080 --> 0:16:21.479 to use some sintai and try and restore adequate progress. 0:16:23.000 --> 0:16:25.200 You're already exhausted you sure you don't want an ep 0:16:25.200 --> 0:16:28.560 be upfront, Yeah, and we'll often do that. Yeah, So 0:16:28.640 --> 0:16:31.400 put in the eppy first and then ramp the scent 0:16:31.480 --> 0:16:32.280 up and see how it goes. 0:16:32.360 --> 0:16:34.560 Yeah, yeah, and then that can all sort of wear 0:16:34.680 --> 0:16:38.200 off towards the end anyway, And if your goal is 0:16:38.240 --> 0:16:41.640 to have a vaginal birth where you, you know, feel 0:16:41.680 --> 0:16:43.280 like you're not medicated, then. 0:16:43.400 --> 0:16:45.680 An unassisted vaginal birth. Yeah, that's right, then you can 0:16:45.840 --> 0:16:49.000 you can certainly do that, all right. 0:16:49.040 --> 0:16:51.480 I want to move to argument three, which is that 0:16:51.560 --> 0:16:54.000 it increases risk. And now you've touched on that. So 0:16:54.080 --> 0:16:57.640 what sort of risk is the main problem with sintasin 0:16:57.640 --> 0:16:58.080 on drips. 0:16:58.520 --> 0:16:59.960 Well, we need to look at the risks of you 0:17:00.040 --> 0:17:01.960 using it and the risks of not using it. But 0:17:02.040 --> 0:17:03.840 let's say we start with the risks of using it. 0:17:04.440 --> 0:17:09.160 Those are allergic reaction and things like that are extremely uncommon. 0:17:10.200 --> 0:17:13.080 We're talking about using it to using it in a 0:17:13.119 --> 0:17:16.720 way that over stimulates the uterus and can lead to 0:17:16.920 --> 0:17:19.400 very big contractions coming on one on top of the other. 0:17:19.920 --> 0:17:23.520 And these are typically dosing errors. So we need to 0:17:23.520 --> 0:17:27.720 be really careful. Gotta be careful on everyone you use 0:17:27.840 --> 0:17:32.680 in on particularly people had a baby before, it doesn't 0:17:32.720 --> 0:17:36.679 take much. So if someone's had a previous vaginal birth 0:17:38.359 --> 0:17:41.880 ruptures their membranes at term, and then the labor doesn't come, 0:17:43.080 --> 0:17:44.840 and that the sun comes up the next morning, we're 0:17:44.840 --> 0:17:46.080 still not in labor. And you want to use a 0:17:46.080 --> 0:17:48.280 bit of sin, you do not need much. So a 0:17:48.320 --> 0:17:53.240 whiff will get that woman into labor. And it's not 0:17:53.760 --> 0:17:57.919 like using it to in a stored labor in a 0:17:57.960 --> 0:18:01.520 primate where where really we push people pretty hard. 0:18:02.119 --> 0:18:04.520 But not too hard, because I've heard you say also 0:18:04.880 --> 0:18:07.880 that you know that someone was pushed a bit hard, 0:18:07.960 --> 0:18:11.000 or you know the senters really flogged flogged them. 0:18:11.240 --> 0:18:15.720 Yeah, yeah, yeah, yeah, whopping people along. Whereas whereas the 0:18:15.880 --> 0:18:17.720 one who's had a baby before, just to finish their thoughts, 0:18:17.720 --> 0:18:21.360 she does not need much. And and a little bit 0:18:22.000 --> 0:18:25.480 trickled in will will get her actually up and laboring 0:18:25.480 --> 0:18:28.399 pretty much by itself. We don't often do this, but 0:18:28.440 --> 0:18:31.600 she could almost turn it off again. Yeah and and 0:18:31.640 --> 0:18:34.359 some and some of those women would be up and away. 0:18:35.960 --> 0:18:37.480 The woman having a first baby is not like that. 0:18:38.359 --> 0:18:41.520 If there's a if the labor's progressing slowly, we often 0:18:41.560 --> 0:18:43.440 need to start the center and we start a really 0:18:43.440 --> 0:18:45.760 low dose because we don't know how much we're going 0:18:45.840 --> 0:18:48.359 to need to get to get the result we're looking for. 0:18:49.600 --> 0:18:51.240 So we started off at a really low dose and 0:18:51.240 --> 0:18:54.639 then very carefully watching the watching how the woman and 0:18:54.640 --> 0:18:58.080 the baby responding to it, increase it until we get 0:18:58.280 --> 0:19:02.879 to a frequency and duration of contractions that works to 0:19:03.000 --> 0:19:05.520 actually put the labor. 0:19:05.280 --> 0:19:05.840 Back on track. 0:19:08.160 --> 0:19:11.359 All right, So is that the only risk, you know? 0:19:12.720 --> 0:19:15.720 The hyperstimulation of the uterus. 0:19:15.800 --> 0:19:18.800 Yeah, So hyperstimulation is where we get just a whole 0:19:18.840 --> 0:19:21.200 lot of contractions coming one after the other, and you think, oh, well, 0:19:21.240 --> 0:19:23.159 as long as we haven't any previous season something, the 0:19:23.240 --> 0:19:25.160 uterus is pretty strong and made a muscle, it should 0:19:25.160 --> 0:19:27.440 be fine. But it's not really about that. It's about 0:19:27.480 --> 0:19:31.679 the baby getting enough oxygen and you need a gap 0:19:31.760 --> 0:19:34.000 between contractions to ensure that that happens. 0:19:34.359 --> 0:19:36.720 And a tired uterus. I've also heard you talk about 0:19:36.720 --> 0:19:38.280 postpartum hemorrhage risk. 0:19:39.480 --> 0:19:47.320 True, the tired uterus is part of using SINTO, but 0:19:47.359 --> 0:19:50.280 it's also one of the problems with significantly prolonged labors. 0:19:50.920 --> 0:19:53.639 So we actually we may we may actually be using 0:19:53.760 --> 0:19:57.240 SINTO to avoid the sort of problems that happen if 0:19:57.280 --> 0:19:58.280 you're labor for three days. 0:19:58.400 --> 0:20:03.199 Okay, all right, I'm an argument for I heard this 0:20:03.280 --> 0:20:07.919 a lot on Reddit, and I'm just surmising that, you know, 0:20:07.960 --> 0:20:10.479 being attached to a drip or the continuous monitoring, all 0:20:10.520 --> 0:20:13.879 of a sudden, their birth has gone from feeling natural 0:20:14.280 --> 0:20:15.560 feeling medicalized. 0:20:15.840 --> 0:20:20.600 Yes, and needless to say, that's true. It is definitely true. 0:20:21.600 --> 0:20:26.320 We're having a baby in the hospital. The hospital. If 0:20:26.359 --> 0:20:33.000 things are going significantly away from a speed an efficiency 0:20:33.000 --> 0:20:35.640 that we know is associated with good outcomes, you're likely 0:20:35.680 --> 0:20:40.119 to be You're likely to be recommended intervention. Now, those 0:20:40.680 --> 0:20:46.680 interventions are not bad ideas just because they're interventions. It 0:20:46.800 --> 0:20:55.000 was interventions that that fixed the data that nature's data 0:20:55.640 --> 0:20:59.320 which was unacceptable to the people of one hundred years ago. 0:21:01.359 --> 0:21:03.680 For one percent of women who got pregnant to die 0:21:03.720 --> 0:21:09.439 from that pregnancy was unacceptable to those people. Think of 0:21:09.560 --> 0:21:15.040 the cumulity of misery. And it was interventions that fixed that. 0:21:16.800 --> 0:21:19.200 So people talk about less mobile, but you can still 0:21:19.240 --> 0:21:20.440 move around with the drip. 0:21:20.600 --> 0:21:23.920 Yep, So you can. 0:21:24.760 --> 0:21:29.880 Then we don't tend to have people walking the corridors 0:21:30.320 --> 0:21:33.240 with a drip. Because of the need for electronic fetal monitoring. 0:21:33.240 --> 0:21:34.960 We want to make sure that we're not overstressing the 0:21:35.000 --> 0:21:38.200 baby with the sinto, but certainly around the room that's fine. 0:21:38.600 --> 0:21:40.919 And is it always continuous monitoring that you need if 0:21:40.920 --> 0:21:42.639 you're on a drip or can they put it on 0:21:42.680 --> 0:21:43.399 and off a little bit? 0:21:44.440 --> 0:21:48.600 We have continuous monitoring for people on sinto, because often 0:21:48.760 --> 0:21:53.920 the first sign that that too much is being given 0:21:54.960 --> 0:21:57.520 is a change in the fetal heart rate, which is 0:21:57.560 --> 0:21:59.680 the baby saying, you know, I'm not getting enough oxygen 0:22:00.440 --> 0:22:03.080 here because you haven't given me enough of a rest 0:22:03.119 --> 0:22:08.359 between contractions fair enough. So the woman won't necessarily notice that, 0:22:08.440 --> 0:22:11.040 but baby will one might. I think you this stuff's 0:22:11.040 --> 0:22:13.840 working on cracking along here, but that's not what the 0:22:13.880 --> 0:22:19.879 baby needs. Whereas in the hyperstimulation that occurring naturally is 0:22:20.200 --> 0:22:25.000 quite uncommon for a natural labor, So that you so 0:22:25.600 --> 0:22:28.119 listen after each contraction is fine. 0:22:28.640 --> 0:22:30.440 So what about they can't go into a bath or 0:22:30.440 --> 0:22:32.359 anything like that if they're on a drip. 0:22:34.040 --> 0:22:39.760 No, but that not in our setup. But I think 0:22:39.800 --> 0:22:44.760 that that we're often using this in a scenario where 0:22:44.960 --> 0:22:49.160 things have not gone according to an entirely natural and 0:22:49.720 --> 0:23:01.879 entirely non interventional model. And you know, what, have you 0:23:01.960 --> 0:23:05.720 believed that these are interventions that are somehow forced on people. 0:23:06.560 --> 0:23:11.919 I don't believe that's commonly true. I think that the 0:23:12.080 --> 0:23:16.520 standard these days, certainly in Australia, would be to go 0:23:16.560 --> 0:23:19.760 in and sit down with that woman and her support 0:23:19.800 --> 0:23:25.560 people and say, here's where we are, here's our progress 0:23:25.640 --> 0:23:29.960 so far, and here are my concerns. And then, like 0:23:30.119 --> 0:23:34.280 any medical intervention for any reason, whether you've got a 0:23:34.520 --> 0:23:36.840 whether you've got a pimple on your nose, or or 0:23:36.960 --> 0:23:40.879 having a baby, what are the risks and benefits of 0:23:40.880 --> 0:23:43.919 the intervention you're talking about? What are the risks and 0:23:43.960 --> 0:23:45.959 benefits of doing nothing? 0:23:46.760 --> 0:23:49.879 What else have you got? And can I have some 0:23:49.960 --> 0:23:50.760 time to think about it? 0:23:50.920 --> 0:23:54.680 Yeah? I did, forget to ask if you've had the 0:23:54.760 --> 0:23:57.640 drip to start so in an induction and you get 0:23:57.640 --> 0:24:00.040 into good labor, can all of that be switched off. 0:24:01.600 --> 0:24:05.639 When you're having your first baby? It really needs to 0:24:05.840 --> 0:24:08.840 keep running and in fact the dosoten. 0:24:08.359 --> 0:24:09.639 Needs to be increased. 0:24:09.800 --> 0:24:13.920 Oh wow, so if you switch it off, it tends 0:24:13.960 --> 0:24:17.800 to go back to where it was, which was installed. Yeah, 0:24:18.000 --> 0:24:22.040 second and subsequent berths. It's not really like that. You 0:24:22.040 --> 0:24:23.879 can use a sniff and get going and you probably 0:24:23.920 --> 0:24:25.120 could switch those off. 0:24:26.920 --> 0:24:30.400 Good. All right, this is my last argument. I'm sure 0:24:30.440 --> 0:24:34.560 there's others. Email us or DMS if you think there's 0:24:34.560 --> 0:24:38.280 another argument that you want to have discussed. And this 0:24:38.320 --> 0:24:42.439 is harder because it's those that really don't trust that 0:24:42.560 --> 0:24:46.080