The Role of Oxytocin in Primary Cesarean Birth Among Low-Risk Women.
Rebecca R S Clark, Nicole Warren, Kenneth M Shermock and 3 others
PMID 32930507WHAT IT FOUND
In low-risk first births with a head-down singleton, women who received more than 11,400 milliunits of oxytocin were more likely to have a primary cesarean, especially when labor was not induced.
The study could not show oxytocin caused the cesarean.
Key findings
01Women who received more than 11,400 milliunits of oxytocin during labor had higher adjusted odds of primary cesarean birth than women who received 11,400 milliunits or less.
02Among women whose labor was not induced, more than 11,400 milliunits was associated with 2.7 times more likely cesarean; among women whose labor was induced, it was not associated.
03The 11,400 milliunit threshold was high: 86% of women received 2 to 11,400 milliunits, and the cutoff fell between the 75th and 90th percentiles.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective secondary data analysis, so it can show an association but cannot prove that oxytocin dose caused cesarean birth. The 11,400 milliunit threshold was created after looking at the data, not chosen before the analysis, so it may be specific to this sample. High oxytocin dose may mark underlying labor problems such as slow progress or malposition, which themselves increase cesarean risk, and these were not measured. Four of nine geographic regions were missing oxytocin dose data, and excluded women were more likely to be younger, Black, and have cesarean births, so the sample may not represent all low-risk first births. Body mass index used admission weight rather than prepregnancy weight, and BMI information was missing for some women. All community hospitals were from one system, so comparisons between university and community hospitals should be read cautiously. The overall dose association was modest, and in induced labors higher dose was not associated with cesarean birth.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that reducing oxytocin dose will prevent primary cesarean birth. The study is observational, the dose cutoff was identified after examining the data, and high dose may reflect labor difficulties that already raise cesarean risk.