The Indian Medical Association (IMA), the body representing doctors in India, took a strong exception to the government’s recommendation to delay giving oxytocin in uncomplicated pregnancies and sought its withdrawal.
The IMA said that the government’s decision in this regard would increase the risk of maternal mortality.
“IMA demands withdrawal of the recommendation to delay oxytocin after delivery of placenta. Mothers are bound to die of bleeding due to this recommendation,” the professional body said in a statement
“IMA would also point out that the word uncomplicated pregnancy is so vague that ultimately the doctor will be made the scapegoat,” it added.
The medical body further advised government to keep its hands away from formulation guidelines for clinical situations.
“Best practices of medical profession are updated and revised by competent national and international bodies,” it added.
Oxytocin is a hormonal drug administered to induce labour, control postpartum bleeding and stimulate lactation or milk production.
What is in the Government’s advisory?
Manoj Jhalani, Special Secretary and Mission Director of the National Health Mission (NHM), Ministry of Health and Family Welfare (MoHFW), in an advisory note to all states, recommended physiological cord clamping or a deferred cord clamping till natural delivery of placenta.
The government also advised use of oxytocin or any other uterotonic to be administered only after the delivery of the placenta. It takes around 5 minutes to 15 minutes for the delivery of placenta.
The government claimed that its clinical advisory has numerous beneficial effects for the mother and child like early initiation of breast-feeding, increase in iron stores, more stem cells resulting in stronger immune system and improved development and cognitive performance of the child.
The government note added that the deferred cord clamping has been implemented in Gujarat with successful outcomes. It also cited two studies, one from India and another from New Zealand, to back its recommendation.
Why are many doctors concerned?
Doctors are worried that the delay in giving oxytocin may increase the risk of bleeding and could, in the worst case scenario, result in the death of the mother.
Currently, doctors widely practice the active management route called early cord clamping, wherein the oxytocin is given to the mother immediately in order to help contract the uterus (control bleeding), clamp the cord early while traction is applied to the cord with counter-pressure on the uterus to deliver the placenta. Early cord clamping is also recommended by the World Health Organisation.
The IMA says the active management of the third stage of labour is still a best practice, with use of uterotonic (oxytocin) and adds the decision of delayed or early clamping should be left to the obstetrician’s judgement.
To be sure, there are section of obstetricians or doctors who support the government's deferred use of oxytocin. But a larger number of doctors are concerned, saying the new guidelines will increase maternal mortality rates.
India has registered a 26.9 percent reduction in Maternal Mortality Ratio (MMR) since 2013, according to the Sample Registration System Bulletin, 2016. The maternal mortality rate is 122 for every 100,000 live births, which is still a significant number.
The government’s handling of oxytocin has also come under the scanner.
After reports of extensive oxytocin misuse by dairy farmers to increase milk production, the government restricted the manufacture and supply of oxytocin formulations for domestic use to public sector Karnataka Antibiotics starting July 1, 2018.
It also banned the import of oxytocin and its formulations. The restriction was challenged in courts and the matter is pending in the Supreme Court.
"The government's credibility on oxytocin issue is not above suspicion because of their myopic stand on the distribution and regulation of oxytocin issue before the Supreme Court," the IMA said.
"Their advisory on oxytocin cannot be delinked of the bias on regulation and distribution," it added.
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