NEW YORK (Reuters Health) Aug 27 - Intraumbilical vein oxytocin injections can reduce blood loss during the third stage of labor, a new study in the online September Obstetrics & Gynecology shows.

Oxytocin injections also significantly shortened the third stage of labor, and reduced the likelihood that a placenta would not be delivered after 15 minutes.

Postpartum hemorrhage is much more common in the developing world, while another complication of the third stage of labor, retained placenta, has a high case fatality rate in rural communities, Dr. Kemal Gungorduk of Mardin Women and Children Hospital in Mardin, Turkey, and colleagues write. The World Health Organization recommends active management for the third stage of labor, including injection of oxytocin within 2 minutes of delivery, early umbilical cord clamping, and cord traction, to prevent postpartum hemorrhage.

Injecting oxytocin into the umbilical vein would deliver the hormone directly to the placenta and uterine wall, Dr. Gungorduk and his team add, but little research has been done into whether this approach would be helpful in reducing blood loss.

To investigate, the researchers randomly assigned 412 women who were delivering a baby vaginally, all of whom were undergoing active management of the third stage of labor but did not have risk factors for postpartum hemorrhage, to receive 20 international units of oxytocin in 26 milliliters saline solution or 30 ml saline only.

Mean estimated blood loss in the oxytocin group was 195.3 ml, compared to 288.3 ml in the placebo group. Eight women, or 3.9 percent, in the placebo group experienced blood loss greater than 500 milliliters, compared to one woman (0.5 percent) in the oxytocin group.

Average time in the third stage of labor was 4.5 minutes in the oxytocin group and 7.9 minutes in the placebo group. Fifteen minutes after delivery, 4.4 percent of women in the placebo group had still not delivered the placenta, compared to none of the women in the oxytocin group. No adverse outcome from injections was observed during the study.

The reductions in blood loss are "particularly significant for countries in which anemia, caused by either nutritional or environmental factors, is prevalent among pregnant women," Dr. Gungorduk and colleagues write. "In these cases, even a relatively small reduction of postpartum blood loss is clinically relevant."

They conclude: "Larger studies involving high-risk populations and in low-risk populations in other institutions with different cesarean delivery rates and epidural anesthesia are necessary to confirm this finding."

Obstet Gynecol. Posted online September 2010.

Oxytocin Levels May Increase for New Mothers and Fathers

Deborah Brauser 

August 26, 2010 Although past animal studies have "repeatedly implicated" oxytocin in parent-infant bonding, "its role in the development of human parenting has received less attention and no research has addressed the involvement of [oxytocin] in the transition to fatherhood," report the study authors.

For the study, investigators evaluated 80 cohabitating couples (160 parents) from central Israel and their firstborn infants (37 boys, 81.2% by vaginal births) 6 weeks post partum during home visits. A total of 128 of these parents were assessed again 6 months after their child's birth. In addition to measuring each parent's plasma oxytocin levels at both timepoints, parenting behavior was monitored, videotaped, and coded for patterns.

Results showed that, although the oxytocin levels increased in both mothers and fathers between the 2 study timepoints, the fathers' levels were not significantly different from the mothers' at either point. In addition, "oxytocin showed high intra-individual stability across the first 6 months of parenting and the [levels] of husband and wife were interrelated at both assessments," report the study authors.

Finally, the oxytocin levels were associated with parent-specific styles of interaction. The levels were higher in mothers who provided more affectionate parenting — including gazing at the infant, expression of positive affect, and affectionate touch. In fathers, the levels were increased with more stimulatory contact, encouragement of exploration, and object-oriented play. The researchers note that these levels may be "linked to the behaviors each parent found the most rewarding."

Overall, "the significant rise in [oxytocin] during the first 6 months of parenting may suggest that [it] increases in parents as their relationship with the infant evolves," write the study authors. In addition, "as the functioning of the oxytocin system is disrupted in a variety of psychopathological conditions, including depression and schizophrenia, assessing the transition to parenthood under risk conditions...is required to provide a broader perspective on the biological underpinning of healthy and high-risk parenting," they conclude.

Reasons for Differences?

"It is very interesting that elevations in the same hormone were associated with different types of parenting behaviors in mothers and fathers even though the levels of oxytocin within couples were somewhat correlated," said John Krystal, MD, editor of Biological Psychiatry, in a release.

"These differences may reflect the impact of culture-specific role expectations, but they also may be indicative of distinct circuit effects of oxytocin in the male and female brain," he added.

Biol Psychiatry. 2010;68:377-382

Doing pelvic floor exercises "Kegels" the wrong way is as common a mistake as substituting a "C" for a "K" or a "K" for a "C", yet the results are glaring!

I recently discussed urinary stress-incontinence with a mother in her 70's and her daughter who is in her mid 40's. Both women began having uncontrollable urine gushes in their 40's when they laughed, sneezed, coughed and sometimes for no apparent reason other at all. Both had the problem despite having been diligent with their "CEGEL" exercises for years upon years. Both were college educated women, with Bachelor of Science and Doctorate degrees respectively.

The mother endured the issue for 20+ years before undergoing hysterectomy in her 60's. Her sole indication for hysterectomy was uncontrolled urinary incontinence. The incontinence returned approximately six months following hysterectomy.

The daughter, not wishing the same fate as mother, sought answers immediately upon recognizing the pattern of stress incontinence in her day to day life. Her primary care provider referred her to physical therapy (PT).

PT identified immediately that she was exercising the wrong set of muscles all of her adult life. She was squeezing her abdomen, thighs and buttocks over and over in repetitions of 50, 100, 150....through pregnancies, through sexual intercourse, and now in middle age, through incontinence episodes: All to NO avail. PT provided concise instruction on proper pelvic floor exercise, relaxation and biofeedback sessions which resulted in swift cessation of the problem.

When the daughter told Mom about this, Mom confessed that she had been doing her "Cegels" religiously for 40+ years and she too had been squeezing her abdomen, thighs and buttocks with no impact on her incontinence. Mother began physical therapy this week and is becoming aware of how to truly control her pelvic floor muscles. I am excited and anxious to hear of the improvements as she strengthens over time!

So how about you mothers-to-be and other women across the reproductive life-span? Are you "CEGELING" Korrectly or KEGELING at all? The pelvic floor muscles form a kind of "sling" which attaches to the pubic bone in front and tail bone in the back. This sling of muscle supports internal organs including uterus, bowels and bladder.

Picture a muscular hammock strung up from tree to tree (the pubic bone is one tree, the tail bone is the other, though the hammock is wide from end to end, not hung by ropes). In the center of the hammock there are three openings where the tubular urethra, vagina and rectum pass through the muscle to provide an exit from the body cavity.

Correct Kegel exercises move only the pelvic floor or "sling" and do not involve any movement of the abdomen, thighs or buttocks. The correct motion is like that of holding in a fart, or pinching off the flow of urine when someone walks-in on you in the bathroom. Some women experience involuntary squeezing of their vaginal muscles during orgasm...this vaginal squeezing is another good way to describe proper Kegel exercises, except with exercises, you will be consciously and deliberately squeezing.

If you have urinary stress incontinence during or after pregnancy or in peri-menopause, consider seeing a PT to re-evaluate your methods of pelvic floor exercise. CORRECT KEGELS are what make the difference!

Home Birth Supplies

Check out the new website content I posted today...Useful information for getting the house in order to all home birth families...not just my clients! 

The midwives of Country Midwife, LLC believe that health information should be freely shared and training midwives for future generations is equally important as taking care of mothers and babies in our own time. 

As part of our dedication to the future of midwifery, we will be hosting a bi-weekly midwifery study group beginning in September 2010 and running through December 2010 at Country Midwife, LLC offices in Green Bay. 

Schedule: 

Wednesday Mornings 10:00 a.m. - 1:00 p.m.

September 22nd 

October 6th and 20th

November 3rd and 17th

December 1st and 15th

Please call to register.  (920) 562-9058

The study group is free and open to anyone with interest in becoming a birth-worker, including midwifery students, doulas, lactation consultants, nursing students, and practicing midwives at any level of study or experience.