Speaker 1: Welcome to the Kick Your Expert led podcast, helping you
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Speaker 2: On the podcast and our online pregnancy program grow My Baby,
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Speaker 1: Welcome everyone, I'm Bridgid Maloney and.
Speaker 2: I'm Obstrician doctor Patrick.
Speaker 1: Maloney, and today we're going to talk about something that
Speaker 1: everybody knows something about, and that is the drip. The
Speaker 1: sintosin is labor yes, and why some people say no,
Speaker 1: and what the evidence actually says. So I'm really I
Speaker 1: want to want to do for this one is bring
Speaker 1: to you the arguments that people might have, Okay, and
Speaker 1: then we're going to talk about the benefits so people
Speaker 1: can see what the objections might be towards the sintosinon
Speaker 1: drip and then what they can then learn about to
Speaker 1: help them make some decisions about their progress in pregnancy
Speaker 1: and labor and birth.
Speaker 2: Good.
Speaker 1: But you know, now we've said sintosin and drip and
Speaker 1: just expect everybody to know it. So let's start there.
Speaker 1: What is it?
Speaker 2: Well, the sintoson is a drug. It's called various things
Speaker 2: around the world, but it's a synthetic form of the
Speaker 2: natural laboring hormone and it helps in labor if there's
Speaker 2: a good reason why we would want the labor to
Speaker 2: either start up or to go faster and stronger, and
Speaker 2: good reason is an important.
Speaker 3: Part of that discussion.
Speaker 2: It's a drug that has to be used for valid reasons,
Speaker 2: and there are some risks in using it, so we
Speaker 2: need to be careful of how we use it.
Speaker 1: And people know the two terms, won't they They'll know
Speaker 1: induction and maybe they'll know augmentation.
Speaker 2: Yeah, so let's talk about those two things because they're
Speaker 2: very often blurred in discussions about this, and it's important
Speaker 2: that they're not so using sintosinon to induce labor. The
Speaker 2: most common scenario that I can think of would be
Speaker 2: that the waters have broken, so come to term, waters
Speaker 2: have broken, but no labor comes. When this happens a bit,
Speaker 2: and therefore there's an infection rate where bacteria from the
Speaker 2: vagina can get up into the water around the baby,
Speaker 2: and newborns do poorly when they're born infected. So after
Speaker 2: a period of time, if the labor has not come,
Speaker 2: sometimes the appropriate advice is to use some sinto to
Speaker 2: get that labor up going. And that's using sinto to induce.
Speaker 2: So to bring about a labor where there is not one, Okay,
Speaker 2: because the water's breaking, that doesn't count.
Speaker 1: Can I just talk about the water's breaking? So I mean,
Speaker 1: if somebody's picked up this episode because they've been told
Speaker 1: that they should think about having an induction, and they're
Speaker 1: going to have that induction started by the drip and
Speaker 1: they're hearing for the first time that water's breaking, don't
Speaker 1: necessarily equate to the start of labor. That is at
Speaker 1: odds to every single.
Speaker 2: Movie, every movie you've ever seen. That's right, that's not
Speaker 2: how it's done. So the winter, the waters break, the
Speaker 2: big strong contractions come. That's not how it really works.
Speaker 2: There's often several hours, there's sometimes days, and there can
Speaker 2: be weeks weeks. Yeah, so those events are not necessarily
Speaker 2: one immediately following the other. Infection is in that scenario
Speaker 2: is the potential problem. And if we look, for example,
Speaker 2: at somebody whose waters have been broken for twenty four
Speaker 2: hours and there's still no labor. We have to weigh
Speaker 2: up the risks of doing nothing and letting that situation
Speaker 2: continue versus the risks of intervening by starting up a
Speaker 2: sintos not drip, And too often the discussion of risk
Speaker 2: concentrates on the risk of the intervention and ignores the
Speaker 2: risks if we don't do the.
Speaker 1: That is so true. So we've talked about induction with
Speaker 1: the drip, what about augmentation with the drip?
Speaker 2: Augmentation is different. So that's when a labor is up
Speaker 2: and going but doesn't seem to be progressing well. And
Speaker 2: this is you know, there's all sorts of arguments about
Speaker 2: how fast a labor should go and what's optimal and
Speaker 2: what's best and so forth, but everybody agrees that we should.
Speaker 3: Have some progress at some point.
Speaker 2: So for labor has really stalled, Let's say we get
Speaker 2: to about four centimeters, examine the woman again later on
Speaker 2: and find that there's been no progress in the intervening time,
Speaker 2: and in fact, when we look at the contractions that
Speaker 2: have happened in the four hours between those examinations, there's
Speaker 2: really been no useful progress at all. But also no
Speaker 2: really strong contractions either. Yeah, they've petered right off. And
Speaker 2: we knew from observations that historically that those people the
Speaker 2: outcomes were poor for those women and those babies, and
Speaker 2: labors that went on for a particularly long period of
Speaker 2: time and were left to progress entirely without intervention, the
Speaker 2: outcome for those women and those babies was poor. And
Speaker 2: so when we look at the really disturbing data for
Speaker 2: obstetric outcomes prior to the middle of the twentieth century,
Speaker 2: the group that needed help and weren't getting it were
Speaker 2: were women in particularly prolonged labors.
Speaker 1: You say that thing about you know, you can't let
Speaker 1: to some set or something.
Speaker 2: Oh, yeah, it's a bit of a slip thing. Yeah,
Speaker 2: a bit of a flippant old thing. But it's basically
Speaker 2: that the labors there is there's compelling data that that
Speaker 2: a progressive labor is a good one. So our augmentation
Speaker 2: is using the sintosin on to make a slow labor
Speaker 2: hurry up.
Speaker 1: We got to mention at the start that some countries
Speaker 1: call it different things, don't they there's pittocin.
Speaker 2: It's the same thing, it's just different because.
Speaker 1: It is one of the most widely obstetric drugs used
Speaker 1: in the world, isn't it.
Speaker 2: Yeah, And the careful and sensible and safe use of
Speaker 2: that drug is one of the many reasons why the
Speaker 2: data for pregnant women improved so dramatically in around about
Speaker 2: the middle of last century, and why and why it's
Speaker 2: never been safer to have a baby.
Speaker 1: All Right, So I've looked at the arguments. I've done
Speaker 1: my research akaa, Google research good and I got these
Speaker 1: from Reddit okay.
Speaker 2: So Journal, the International Journal of Excellence.
Speaker 1: YEA number one argument that I found was that the
Speaker 1: contractions are more painful and in intense. So people say
Speaker 1: things like they got really intense really quickly, I didn't
Speaker 1: get a break between contractions, and people who had it,
Speaker 1: you know, had it and also had a birth without it,
Speaker 1: said that the contractions were a lot worse than natural contractions.
Speaker 2: Yes, So let's let's divide those up into a few
Speaker 2: different things to examine. Firstly, the contractions that we're talking
Speaker 2: about that help us in our first labor to get
Speaker 2: from zero to ten and let the baby out.
Speaker 3: They hurt and useful.
Speaker 2: Contractions are painful, very painful, and so to say, if
Speaker 2: we're talking about sintosinon made my contractions more painful.
Speaker 3: Cause it did. That is what it's supposed to do.
Speaker 2: And mostly when we're when someone says I had one
Speaker 2: labor with it and one label without it, she's comparing
Speaker 2: her first labor with her second, which we've discussed elsewhere
Speaker 2: on the podcast. Is not comparing apples with apples. So
Speaker 2: the first labor is long and difficult, and second and
Speaker 2: subsequent labors on average a better. So it's particularly particularly
Speaker 2: fraught to compare one with the other. So if we
Speaker 2: make a better and safer comparison, which is between, say,
Speaker 2: for in terms of the quality of our data, between
Speaker 2: a big group of women who have sintoson in a
Speaker 2: certain clinical scenario and a big group of women who
Speaker 2: have sintosinon who don't have sintoson in the same scenario,
Speaker 2: say stalled labor at four centimeters, then we know the
Speaker 2: sinti group is to better outcomes what we don't want
Speaker 2: to do. But they will also have more painful contractions,
Speaker 2: of course they will. We're restoring painful contraction, which of
Speaker 2: course is going to lead to pain. What we want
Speaker 2: it to lead to is contractions that are effective and
Speaker 2: put that labor back on track. The comment that somebody
Speaker 2: made there about I didn't get enough of a rest
Speaker 2: between my contractions, that is a POTENTI chull red flag
Speaker 2: that the sinto may have been used incorrectly. So when
Speaker 2: we are in labor, good strong labor, the baby's getting
Speaker 2: oxygen when we're not contracting and not when we are.
Speaker 2: So there needs to be a long contract a long
Speaker 2: gap between contractions to refill the store of oxygen that's
Speaker 2: sitting in that no man's land between the placenta and
Speaker 2: the baby, so that the baby there's.
Speaker 3: Some for the for the baby to use right throughout
Speaker 3: the cycle.
Speaker 1: And what would happen if somebody said that, you know,
Speaker 1: in between contractions, they put their hand up and they
Speaker 1: you know, I'm not getting a break here. Well, firstly
Speaker 1: you would hope that somebody would realize that the contractions
Speaker 1: are coming to hard and fast. But secondly, can they say,
Speaker 1: you know, can I turn the drip down or can
Speaker 1: the drip be turned down?
Speaker 2: Yeah, so this is not something that we need to
Speaker 2: rely on on a guesswork here. When a sintoson infusion
Speaker 2: is running in Australia, there's two things that should be happening.
Speaker 2: One is that that person should have a midwife with
Speaker 2: them at all times. This is a potentially dangerous struck.
Speaker 2: It can be overdone, overused and lead lead to very
Speaker 2: poor outcomes. But that doesn't mean that if it's used
Speaker 2: properly and safely, it isn't excellent. So what we we
Speaker 2: want someone with that with that woman at all times.
Speaker 2: And one of the things that attendant should that that
Speaker 2: that that attendant to the birth should be looking for
Speaker 2: is whether the whether the sintocinon is being used at
Speaker 2: a drip rate, so the dose to bring about what
Speaker 2: we're looking for, which is a certain number of painful
Speaker 2: contractions every ten minutes with a nice gap in between
Speaker 2: to restore the pool of.
Speaker 3: Oxygen in a way that can be used by the baby.
Speaker 1: It sort of leads to the next argument because if
Speaker 1: they're more painful, people say, you start the drip and
Speaker 1: you have created the cascade of interventions. And for first
Speaker 1: time listeners, cascade of interventions people mean sort of like
Speaker 1: the drip. More pain epidural leads to instrumental birth and
Speaker 1: cesarean birth then, you know, so people think that you
Speaker 1: open the floodgates for all that intervention happening.
Speaker 2: Yeah, it's an interesting idea. There is a lot of
Speaker 2: anecdotal evidence that the cascade of interventions exists as a phenomenon.
Speaker 2: There's less proven evidence, but let's say, let's assume for
Speaker 2: a moment that it does exist, and it probably exists
Speaker 2: in some form or another. It's very difficult in an
Speaker 2: individual case to know whether let's say, for example, we
Speaker 2: look at sintocinon used in that first example where we
Speaker 2: were giving the sinto because the labor had not come
Speaker 2: after a certain amount of time, and the big ticket
Speaker 2: intervention that the big ticket problem that we were trying
Speaker 2: to avoid was the labor taking so many hours or
Speaker 2: days longer. Sorry, the period of time that the waters
Speaker 2: were broken was going to take so many hours longer
Speaker 2: and unless unless we got on with it. So it's
Speaker 2: very very difficult to know whether the sintosinon induced labor
Speaker 2: caused more pain than that woman was going to have
Speaker 2: had she just labored spontaneous, because that is also painful.
Speaker 1: But there is an increases of women needing an epidural
Speaker 1: if they do have the sin.
Speaker 2: That is probably true, and there's certainly some studies that
Speaker 2: have found that and one of the problems might be
Speaker 2: that it comes on pretty hard fast, yeah, rather than
Speaker 2: the natural one that would creep potentially creep up on us.
Speaker 2: And if they're very severe, quite quickly, then there might
Speaker 2: be in the mind of the laboring woman more of
Speaker 2: a stuff. This is really bad and I was comfortable
Speaker 2: half an hour ago, so now I want an EPPI.
Speaker 2: Whereas the woman with the natural labor that creeps up
Speaker 2: in intensity might be more able to be used to
Speaker 2: that or withstand that.
Speaker 1: So someone that gets the drip might end up with
Speaker 1: an epidural higher chance of getting epidural, But it doesn't.
Speaker 1: An epidural doesn't lead to a higher chance of cesarean.
Speaker 2: No, that is a commonly believed thing that there is
Speaker 2: very little evidence to support that, and in fact, there
Speaker 2: are studies that don't show that at all. You've got
Speaker 2: to remember that the use of sinto in the stalled
Speaker 2: labor might be the only thing that gets you to
Speaker 2: the starting line of a vaginal birth, which is being
Speaker 2: fully dilated. Does that make sense? So I think that
Speaker 2: that if you if you are an installed labor at
Speaker 2: four centimeters and you don't and you don't, what have
Speaker 2: you got on your sinto that that's going to have
Speaker 2: a section rate if we do nothing, that approach one
Speaker 2: hundred percent because the baby can't come out through a
Speaker 2: four centimes cervix. If you have the scent, what's and
Speaker 2: all and get to fully you are at least at
Speaker 2: the starting line of a vaginal birth.
Speaker 1: And you know there's no judgment in there. You might
Speaker 1: get to four centimeters after I don't know, an eight
Speaker 1: hour labor and think, oh, well, four centimeters. They've suggested
Speaker 1: that I have sintocinin or caesarean. Yep, And you might go,
Speaker 1: I've done it already, labor, I'm going to go for
Speaker 1: a cesarean.
Speaker 3: Oh.
Speaker 2: Sometimes people do that.
Speaker 1: That's fine.
Speaker 2: Yeah, that's also fine. But let's say the goal is
Speaker 2: vaginal birth. Let's for the sake of this discussion. Then
Speaker 2: sometimes I'll say to people, you've been laboring all night
Speaker 2: and we're still only here. I'm now proposing that to
Speaker 2: get this labor back on track and give us it
Speaker 2: and give us a tilt at getting to fully and
Speaker 2: a vaginal birth, the best course of action here is
Speaker 2: to use some sintai and try and restore adequate progress.
Speaker 2: You're already exhausted you sure you don't want an ep
Speaker 2: be upfront, Yeah, and we'll often do that. Yeah, So
Speaker 2: put in the eppy first and then ramp the scent
Speaker 2: up and see how it goes.
Speaker 1: Yeah, yeah, and then that can all sort of wear
Speaker 1: off towards the end anyway, And if your goal is
Speaker 1: to have a vaginal birth where you, you know, feel
Speaker 1: like you're not medicated, then.
Speaker 2: An unassisted vaginal birth. Yeah, that's right, then you can
Speaker 2: you can certainly do that, all right.
Speaker 1: I want to move to argument three, which is that
Speaker 1: it increases risk. And now you've touched on that. So
Speaker 1: what sort of risk is the main problem with sintasin
Speaker 1: on drips.
Speaker 2: Well, we need to look at the risks of you
Speaker 2: using it and the risks of not using it. But
Speaker 2: let's say we start with the risks of using it.
Speaker 2: Those are allergic reaction and things like that are extremely uncommon.
Speaker 2: We're talking about using it to using it in a
Speaker 2: way that over stimulates the uterus and can lead to
Speaker 2: very big contractions coming on one on top of the other.
Speaker 2: And these are typically dosing errors. So we need to
Speaker 2: be really careful. Gotta be careful on everyone you use
Speaker 2: in on particularly people had a baby before, it doesn't
Speaker 2: take much. So if someone's had a previous vaginal birth
Speaker 2: ruptures their membranes at term, and then the labor doesn't come,
Speaker 2: and that the sun comes up the next morning, we're
Speaker 2: still not in labor. And you want to use a
Speaker 2: bit of sin, you do not need much. So a
Speaker 2: whiff will get that woman into labor. And it's not
Speaker 2: like using it to in a stored labor in a
Speaker 2: primate where where really we push people pretty hard.
Speaker 1: But not too hard, because I've heard you say also
Speaker 1: that you know that someone was pushed a bit hard,
Speaker 1: or you know the senters really flogged flogged them.
Speaker 2: Yeah, yeah, yeah, yeah, whopping people along. Whereas whereas the
Speaker 2: one who's had a baby before, just to finish their thoughts,
Speaker 2: she does not need much. And and a little bit
Speaker 2: trickled in will will get her actually up and laboring
Speaker 2: pretty much by itself. We don't often do this, but
Speaker 2: she could almost turn it off again. Yeah and and
Speaker 2: some and some of those women would be up and away.
Speaker 2: The woman having a first baby is not like that.
Speaker 2: If there's a if the labor's progressing slowly, we often
Speaker 2: need to start the center and we start a really
Speaker 2: low dose because we don't know how much we're going
Speaker 2: to need to get to get the result we're looking for.
Speaker 2: So we started off at a really low dose and
Speaker 2: then very carefully watching the watching how the woman and
Speaker 2: the baby responding to it, increase it until we get
Speaker 2: to a frequency and duration of contractions that works to
Speaker 2: actually put the labor.
Speaker 3: Back on track.
Speaker 1: All right, So is that the only risk, you know?
Speaker 1: The hyperstimulation of the uterus.
Speaker 2: Yeah, So hyperstimulation is where we get just a whole
Speaker 2: lot of contractions coming one after the other, and you think, oh, well,
Speaker 2: as long as we haven't any previous season something, the
Speaker 2: uterus is pretty strong and made a muscle, it should
Speaker 2: be fine. But it's not really about that. It's about
Speaker 2: the baby getting enough oxygen and you need a gap
Speaker 2: between contractions to ensure that that happens.
Speaker 1: And a tired uterus. I've also heard you talk about
Speaker 1: postpartum hemorrhage risk.
Speaker 2: True, the tired uterus is part of using SINTO, but
Speaker 2: it's also one of the problems with significantly prolonged labors.
Speaker 2: So we actually we may we may actually be using
Speaker 2: SINTO to avoid the sort of problems that happen if
Speaker 2: you're labor for three days.
Speaker 1: Okay, all right, I'm an argument for I heard this
Speaker 1: a lot on Reddit, and I'm just surmising that, you know,
Speaker 1: being attached to a drip or the continuous monitoring, all
Speaker 1: of a sudden, their birth has gone from feeling natural
Speaker 1: feeling medicalized.
Speaker 2: Yes, and needless to say, that's true. It is definitely true.
Speaker 2: We're having a baby in the hospital. The hospital. If
Speaker 2: things are going significantly away from a speed an efficiency
Speaker 2: that we know is associated with good outcomes, you're likely
Speaker 2: to be You're likely to be recommended intervention. Now, those
Speaker 2: interventions are not bad ideas just because they're interventions. It
Speaker 2: was interventions that that fixed the data that nature's data
Speaker 2: which was unacceptable to the people of one hundred years ago.
Speaker 2: For one percent of women who got pregnant to die
Speaker 2: from that pregnancy was unacceptable to those people. Think of
Speaker 2: the cumulity of misery. And it was interventions that fixed that.
Speaker 1: So people talk about less mobile, but you can still
Speaker 1: move around with the drip.
Speaker 3: Yep, So you can.
Speaker 2: Then we don't tend to have people walking the corridors
Speaker 2: with a drip. Because of the need for electronic fetal monitoring.
Speaker 2: We want to make sure that we're not overstressing the
Speaker 2: baby with the sinto, but certainly around the room that's fine.
Speaker 1: And is it always continuous monitoring that you need if
Speaker 1: you're on a drip or can they put it on
Speaker 1: and off a little bit?
Speaker 2: We have continuous monitoring for people on sinto, because often
Speaker 2: the first sign that that too much is being given
Speaker 2: is a change in the fetal heart rate, which is
Speaker 2: the baby saying, you know, I'm not getting enough oxygen
Speaker 2: here because you haven't given me enough of a rest
Speaker 2: between contractions fair enough. So the woman won't necessarily notice that,
Speaker 2: but baby will one might. I think you this stuff's
Speaker 2: working on cracking along here, but that's not what the
Speaker 2: baby needs. Whereas in the hyperstimulation that occurring naturally is
Speaker 2: quite uncommon for a natural labor, So that you so
Speaker 2: listen after each contraction is fine.
Speaker 1: So what about they can't go into a bath or
Speaker 1: anything like that if they're on a drip.
Speaker 2: No, but that not in our setup. But I think
Speaker 2: that that we're often using this in a scenario where
Speaker 2: things have not gone according to an entirely natural and
Speaker 2: entirely non interventional model. And you know, what, have you
Speaker 2: believed that these are interventions that are somehow forced on people.
Speaker 2: I don't believe that's commonly true. I think that the
Speaker 2: standard these days, certainly in Australia, would be to go
Speaker 2: in and sit down with that woman and her support
Speaker 2: people and say, here's where we are, here's our progress
Speaker 2: so far, and here are my concerns. And then, like
Speaker 2: any medical intervention for any reason, whether you've got a
Speaker 2: whether you've got a pimple on your nose, or or
Speaker 2: having a baby, what are the risks and benefits of
Speaker 2: the intervention you're talking about? What are the risks and
Speaker 2: benefits of doing nothing?
Speaker 3: What else have you got? And can I have some
Speaker 3: time to think about it?
Speaker 1: Yeah? I did, forget to ask if you've had the
Speaker 1: drip to start so in an induction and you get
Speaker 1: into good labor, can all of that be switched off.
Speaker 2: When you're having your first baby? It really needs to
Speaker 2: keep running and in fact the dosoten.
Speaker 3: Needs to be increased.
Speaker 2: Oh wow, so if you switch it off, it tends
Speaker 2: to go back to where it was, which was installed. Yeah,
Speaker 2: second and subsequent berths. It's not really like that. You
Speaker 2: can use a sniff and get going and you probably
Speaker 2: could switch those off.
Speaker 1: Good. All right, this is my last argument. I'm sure
Speaker 1: there's others. Email us or DMS if you think there's
Speaker 1: another argument that you want to have discussed. And this
Speaker 1: is harder because it's those that really don't trust that
Speaker 1: advice that they really needed it in the first place,
Speaker 1: you know, a questioning whether their labor was truly stalled
Speaker 1: and whether they were given enough time to wait.
Speaker 2: Yes, well that is a different question altogether, because that
Speaker 2: comes down to see I've drawn this example for the
Speaker 2: ease about discussion today about someone who's not laboring at
Speaker 2: all and has a clear infection risk and there's a
Speaker 2: clear problem with doing nothing. Where it gets more interesting
Speaker 2: is the scenario in which, for example, the induction wasn't
Speaker 2: done for a good medical reason. Yeah, so there really.
Speaker 3: Was no problem.
Speaker 2: Everyone just thought it would be more convenient how the
Speaker 2: baby that day or somebody thought it was or whatever. Well,
Speaker 2: that is different, and that, I think is where the
Speaker 2: discussion is, where the actual discussion should be parts.
Speaker 3: Do you need to be induced in first place?
Speaker 2: If you really really want to avoid intervention, come into
Speaker 2: spontaneous labor.
Speaker 1: A term easier said than done.
Speaker 2: But I'm just saying that that's really where the discussion
Speaker 2: should lie. I don't think that there's any particular problem
Speaker 2: with the careful, sensible, expert use of Sintosno, I think
Speaker 2: there's a problem with inductions. So if we look at
Speaker 2: that inductions, inductions for first babies that have a higher
Speaker 2: risk of ending in ceserrean section, Yep, yeah, we've got
Speaker 2: there's an issue there, and I think our birthing services
Speaker 2: need to be flexible enough to allow more of those
Speaker 2: women to cautiously wait.
Speaker 1: It's hard, you know, because Australia is geographically kind of challenged,
Speaker 1: and some people will have an induction because they've had
Speaker 1: to fly in to to a regional city or a city.
Speaker 1: Even some of our people that live three hours away
Speaker 1: from bell are out.
Speaker 2: You know, Well, they're the most likely of my patients
Speaker 2: to be induced. And for those people sometimes it comes
Speaker 2: down to the risks and benefits of induction versus the
Speaker 2: risks and benefits of laboring spontaneously and being three hours
Speaker 2: from their birthing hospital. So different discussion. Yeah, but if
Speaker 2: we talk, if we want to shift the argument to
Speaker 2: somewhere where it can actually lead to better outcomes for women,
Speaker 2: it's probably shifting it shifting it over to can we
Speaker 2: get this woman to a point where she can be
Speaker 2: safely and expertly managed without inducing your labor, rather than
Speaker 2: just saying well, the only thing we can do for
Speaker 2: your madam.
Speaker 3: Mister gets going, Yeah.
Speaker 1: It's so difficult because you know you have the I've
Speaker 1: forgotten what it's called, the massive, big one where they
Speaker 1: got managed to convince people to have an induction at
Speaker 1: thirty eight weeks the trial trial. I should have known, right, Yeah,
Speaker 1: so they're saying, actually, there's less cesarean right if you
Speaker 1: get induced at thirty eight weeks and it became a
Speaker 1: bit of a thing.
Speaker 2: You got to raised more questions than it answered to
Speaker 2: be honest. But no, I think I think that labor
Speaker 2: spontaneously at term is still a good thing.
Speaker 1: All right. Now, they're the arguments, and I'm sure there
Speaker 1: are Moreso, as I said, just dms if you want
Speaker 1: something discussed. But let's talk about let's just wrap it up,
Speaker 1: pat with what the benefits are. Like. You know, we've
Speaker 1: talked about why people wouldn't have it, and in between
Speaker 1: you've put little bits of why you think sintosin is
Speaker 1: a good idea. Yeah, so let's talk about some benefits.
Speaker 3: It works.
Speaker 2: It works. Yeah, so that is that is the bottom line.
Speaker 3: It works.
Speaker 2: It's the receptors within the uterus respond very very well,
Speaker 2: and it will. It will get you back on track
Speaker 2: if there's something wrong with your labor, and if there's
Speaker 2: nothing wrong with your label, why are we using it
Speaker 2: in the first place. This will get you back on
Speaker 2: track in a lot of cases, much much more effectively
Speaker 2: than the old all they used to have, which was
Speaker 2: the tincture of time.
Speaker 3: He just waited and hoped it went better.
Speaker 2: Yeah, it is very very effective at doing that job.
Speaker 2: Used sensibly, expertly, carefully, it's a very very good intervention.
Speaker 1: And you mentioned that because it does help people deliver
Speaker 1: within twenty four hours. There's actually it helps to avoid
Speaker 1: cesarean in certain cases.
Speaker 2: Well, that is why it's used. And so it's sort
Speaker 2: of sometimes a little baffling to obstetric practitioners that we
Speaker 2: just hear all the problems with it as if we're
Speaker 2: using it for no reason. But if somebody's labor is
Speaker 2: stuck at force entimeters, that person's going to have a caesar.
Speaker 2: In just about every case, sintocinon is to get you
Speaker 2: to fully so you don't need one. And that is
Speaker 2: that's a common misunderstanding. If I have sintosin I have
Speaker 2: a higher section rate. I don't think that's at all true.
Speaker 2: In fact, the reason why the labor is being pushed
Speaker 2: along is to get you to ten centimeters where a
Speaker 2: vaginal birth only then becomes a possibility.
Speaker 1: All right, So you know we've got the medical world
Speaker 1: saying it works, it's been studied lots, it can prevent escalation,
Speaker 1: it can help people avoid cesarians. If that's what they're
Speaker 1: up to. Why is the medical world saying one thing
Speaker 1: and like pages and pages and pages on Reddit are
Speaker 1: saying another thing about induction. Why do people fear it?
Speaker 2: Well, I think it gets back to that argument about
Speaker 2: what we are talking about when we talk about risk.
Speaker 2: So the medical world tends to look at population level risks.
Speaker 2: What happens to one hundred thousand women in this situation
Speaker 2: if we do nothing compares to compared to what happens
Speaker 2: to those women if we apply treatment ABC, which might
Speaker 2: be sintos non augmentation of labor. And the problem with
Speaker 2: the what we read on the internet is it tends
Speaker 2: to be somebody's individual experience. They gave me that sinto.
Speaker 2: It didn't work. I had an appy and then a
Speaker 2: Caesar must have been the sinto's fault. But the sinto
Speaker 2: was only given because labor installed. That was actually the problem.
Speaker 2: And so that person leaves thinking it is useless. Fair enough,
Speaker 2: then that person can get on the internet and say
Speaker 2: to everyone else it's useless, don't do it. But in fact,
Speaker 2: if we look at enough people, the exact opposite is true.
Speaker 2: It's useful. And in that scenario, the evidence based thing to.
Speaker 3: Do is to do it.
Speaker 2: It won't always work, but if you want to know
Speaker 2: where the data leads, it leads to the sensible use
Speaker 2: of that intervention.
Speaker 1: So if people are getting conflicting messages online and then
Speaker 1: they sort of say, oh, by absolutely no, it's not
Speaker 1: in my birth plan. I've underlined it like a hundred times,
Speaker 1: no induction, no sintosinin And then it comes to the
Speaker 1: situation where they are recommended to have sintosin. What are
Speaker 1: some good questions they can ask their provider?
Speaker 2: You have to so it's a great question. So I'm
Speaker 2: going to I'm going.
Speaker 1: I know you've just set up straight in your chair,
Speaker 1: You've got all excited, You're like this.
Speaker 2: It's a great question. But if you're in labor, it's
Speaker 2: too late, and that that is why you've got to
Speaker 2: talk about this in the consulting room during the pregnancy.
Speaker 2: So in our Grow My Baby program, we've got a
Speaker 2: we've got a template for a birthplane. I believe in
Speaker 2: birth I think it's really really great to get on paper.
Speaker 3: How I hope this goes.
Speaker 2: Yeah, but the process of making a birth plan, it's great.
Speaker 2: Not for the plan, They're right, It's that it's for
Speaker 2: the questions that it introduces in the mind of the patient.
Speaker 2: So so if someone comes comes to me and says,
Speaker 2: I don't want it in toosin under any circumstances, I'm like, okay, well,
Speaker 2: this is your body, your choice. One hundred percent, you
Speaker 2: will not have a drug for me that you have
Speaker 2: not agreed to have. However, what do you want to
Speaker 2: do if you get to five centimeters and the labor
Speaker 2: stores and the woman will often say, I didn't know
Speaker 2: that was a thing. I was like, that's why the
Speaker 2: clever people invented sintosin. So let's talk now about what
Speaker 2: we might do, because we've got some choices. You could
Speaker 2: keep waiting and hope that we get there eventually and
Speaker 2: that has risks and benefits. Or we could do a
Speaker 2: Caesar then and there because we only got to five
Speaker 2: and you can't get maybe out through five, or you
Speaker 2: could have Sintosa. And then people go, ah, it was well,
Speaker 2: so through learning about it, they can suddenly they can
Speaker 2: getting back to this idea of engaging in the complexity.
Speaker 2: They go, oh, it's not just simple enough to say no,
Speaker 2: I don't want that because it's bad for me. Now
Speaker 2: I can see how the use of that might get
Speaker 2: me out of trouble. So then they go, wait.
Speaker 3: Ever, not think about it?
Speaker 2: Yeah, yeah, Now if that person comes back and says
Speaker 2: I don't want to I've had a look and I
Speaker 2: had to think, and I don't want to donder any circumstances, fine,
Speaker 2: but you cannot escape the consequences of not having it.
Speaker 2: You if you get into that situation, will have to
Speaker 2: do something else, and those things will have their own
Speaker 2: prois and CODs. Even if that's something else is nothing,
Speaker 2: it's got its own pros.
Speaker 1: And CODs, which must be incredibly difficult for a provider.
Speaker 1: If that person goes, absolutely, do I I'm saying no
Speaker 1: to that particularly intervention, Yes, and the risks and benefits
Speaker 1: in your in the practitioner's mind really doesn't equate, like
Speaker 1: the risks are far greater, yes, and you think, well,
Speaker 1: the option that this woman is now choosing is that
Speaker 1: she wants a labor to go for.
Speaker 2: Two days with the associated risks. This is a tricky
Speaker 2: one because in my view, the absolute paramount consideration is
Speaker 2: the wishes of the patient. Now, I don't think that
Speaker 2: that can truly be determined the wishes of the patient
Speaker 2: until the patient understands the counter argument. So I spend
Speaker 2: a fair bit of time if I'm in a situation
Speaker 2: like this, making sure that the person understands the counterargument
Speaker 2: before making their final decision, and when they do, that's
Speaker 2: the decision. So if someone wants to stay in labor
Speaker 2: for days and days, that is okay. It hasn't happened
Speaker 2: that many times in my career a few, but that
Speaker 2: is okay if that's what they truly want. And some
Speaker 2: of those people aren't in the hospital in the first place, yeah,
Speaker 2: laboring out in the community in a way that they
Speaker 2: feel is best for them. I don't like the idea
Speaker 2: of people having rejected intervention and the medical point of
Speaker 2: view without having heard it first and understood it. But ultimately,
Speaker 2: if that's what they've decided, then that is up to them.
Speaker 2: And my junior colleagues get very upset about this and
Speaker 2: they feel powerless and frustrated and a bit depressed that
Speaker 2: all of the clever interventions that they spent so long
Speaker 2: learning about are being rejected by the patient. But ultimately
Speaker 2: that is their decision, and sometimes that leads to people. Often,
Speaker 2: very often that leads to that person getting away with
Speaker 2: it and feeling clever that.
Speaker 1: They had a natural birth and only took twelve hours.
Speaker 2: Yeah, it was all great, and.
Speaker 1: Then they get on the internet and tell everyone else to.
Speaker 2: Do what they did. But sometimes it leads to poor outcomes,
Speaker 2: and that is part of making a choice. What's the
Speaker 2: decision when we do type people down? Absolutely not this
Speaker 2: is this is not the way we do bring withdraw
Speaker 2: care all together. Yeah. Well that's a tricky one.
Speaker 1: Yeah yeah, but I mean that's what you know, that
Speaker 1: case with a woman who didn't want a vaginal examination
Speaker 1: and they were saying, well, we're not going to accept
Speaker 1: you into the hospital, and as you have one.
Speaker 2: A better scenario would have been that someone has the
Speaker 2: right to come into the spit, but also to reject
Speaker 2: things that that hospital is commending because if that, if
Speaker 2: someone wants to do that, there's an argument that's often
Speaker 2: made that if you, if you, if you, if you're
Speaker 2: so clever and you know the best way to do everything,
Speaker 2: why in the hospital in the first place. Well, that
Speaker 2: argument falls down because that person might say, no, I
Speaker 2: have a vision for my labor that I want it
Speaker 2: to run like this, but if it completely goes to crap,
Speaker 2: I want to be in the hospital where you people
Speaker 2: can help me. So, and that's a legitimate point of view.
Speaker 2: Our point of view is often based that prevention is
Speaker 2: better than cure, and we'd rather prevent the postpartum hemorrhage
Speaker 2: than have to come running and fix one. But again
Speaker 2: that's the it's up to the patient, the informed.
Speaker 1: Patient, informed and not scared into doing something. All right,
Speaker 1: So in terms of the drip, they can people can ask,
Speaker 1: why are you recommending that I have the drip? Yes,
Speaker 1: they can ask what are the risks? What are the benefits?
Speaker 3: Yeah?
Speaker 2: If I do this, if I do nothing, or how
Speaker 2: about we do something else that's not can.
Speaker 1: Should Yeah, and that all should probably happen. You're saying
Speaker 1: before labor.
Speaker 2: Well, that's that's our dream, isn't it. That's what we wanted.
Speaker 2: That's why we made the Gramma Baby Program, was to
Speaker 2: try and get people up to a certain amount of
Speaker 2: pregnancy literacy such that when some of these things happen
Speaker 2: in their labor, which they do, they that they it
Speaker 2: wasn't the first that ever hurt.
Speaker 1: Yeah.
Speaker 2: Yeah, And anecdotally, I think that it's great to talk
Speaker 2: to people who already understand what the are you talking about?
Speaker 1: Yeah? Great, all right everyone. Pat's mentioned our Gramo Baby
Speaker 1: Program a couple of times now, so if you're interested
Speaker 1: in that, there's always a link to that in our
Speaker 1: show notes. What it is is a week by week,
Speaker 1: really in depth information that you get to help you
Speaker 1: in pre pregnancy, all through your pregnancy, and for the
Speaker 1: first six weeks. You can join at any time. We
Speaker 1: think it's really affordable to get quality, consultant level information
Speaker 1: that's not just Pat a little bit of me in
Speaker 1: there as a mum, but there's also other experts that
Speaker 1: we've invited into, Like we've got an anethetist, a physiotherapist, dietitian,
Speaker 1: lactation consultants, so all of those things really help wrap
Speaker 1: the information that you're learning on the podcast into a
Speaker 1: step by step, sequential lead information program. So we think
Speaker 1: it's really great, and thousands of other people have thought
Speaker 1: it's really great too, so the links to that are
Speaker 1: in our show notes. So good. I'm glad we covered
Speaker 1: the drip. It's something that does get a bit of
Speaker 1: air time. So yes, you've got lots of knowledge. Now
Speaker 1: take this away, digest it, talk to your support people,
Speaker 1: talk to your partner, and see what decisions you're going
Speaker 1: to make about induction or augmentation. Excellent, all right, everyone,
Speaker 1: until next week, keep growing those babies and we'll be
Speaker 1: back in your ears. Then.
Speaker 2: Thanks for listening, everybody.
Speaker 1: Okay, bye for now. Hey, even though doctor Pat is
Speaker 1: well a doctor and we get lots of other doctors
Speaker 1: and other experts on our podcast, I just need to
Speaker 1: remind you that this podcast is for informational purposes only.
Speaker 1: We share lots of medical insights and experience, but everything
Speaker 1: we talk about is general in nature and may not
Speaker 1: apply to your specific situation. Please always consult with your
Speaker 1: own healthcare provider for your individual medical advice. When you
Speaker 1: grow your baby