Hey there, my name’s Phil. My wife Ana and I recently had our first child at the Northern Beaches Hospital in the north of Sydney, NSW. Below you’ll find the story of our experience, what we discovered, and some things for you to consider.
Ana’s labour was induced with Syntocinon (synthetic oxytocin) due to prelabor rupture of membranes and being GBS positive. As I watched the midwife administer the Syntocinon intravenously, I was intrigued that the dose, which had started at 15ml/h, was increased to 30ml/h after 40 minutes, and then increased to 60ml/h another 40 minutes later. This seemed like a big increment, especially since Ana’s contractions had become regular and were occurring about 3-4 times within a 10 minute period.
Less than 30 minutes later, Ana was in immense pain, far worse than the worst pain she had previously experienced. After fighting through a few contractions, she finally called for an epidural. While her pain had subsided somewhat, her contractions were still very strong, and the midwives were encouraged by how quickly her cervix was starting to dilate, which to me indicated it was happening too rapidly. Shortly thereafter, we were alerted to the fact that the baby’s heart rate was showing some decelerations on the CTG monitor. The midwives attached a fetal scalp clip for more accurate monitoring, and in case it was due to positional distress, began to slowly move Ana to her left and right side. After a few attempts without success, the emergency button was pressed, and the room was filled with around 15 doctors and nurses to make an emergency delivery due to foetal bradycardia (sustained fetal heart rate less than 110 beats per minute).
Thankfully, the baby was delivered with few further complications and is now happy and healthy, while Ana’s recovery is ongoing.
Having requested all the clinical information for Ana’s hospital admission (something I would encourage everyone to do), I began to look into the possible causes of the emergency delivery, and Ana’s rapid onset of immense pain. I felt that her labour had been brought on much too rapidly, so I focused my attention on her induction. The records confirmed the dosage and increments of Syntocinon that I had recalled, so I asked the manufacturer of Syntocinon for the Product Information (available here) and was shocked by what I discovered. After converting the milliunits/minute from the product information, into millilitres/hour used by the hospital, it became apparent that the increase in dosage that Ana had received was more than double the maximum increment according to the Australian Product Information for Syntocinon (see image 1).
Image 1: Screenshot of Syntocinon product information showing the dosage regimens for induction of labour.
Method of calculation: Using the recommended concentration of infusion solution of 10IU Syntocinon in 1 litre of infusion fluid (as per Ana’s case), an infusion rate of 1-4mU/minute equates to 0.1-0.4mL/minute as per the Syntocinon Product Information (see image 2). Multiplying this by 60 minutes gives us the mL/hour figure (used by the hospital) of 6-24mL/hour. Therefore, a quick calculation for converting mU/min to mL/h in this solution is to simply multiply the mU/min by 6.
Image 2: Screenshot of Syntocinon product information showing the preparation of infusion solution for calculation conversions.
By taking the higher figure of 2 milliunits/minute, the increment of Syntocinon that should not be exceeded equates to 12 mL/hour. Ana’s dose of Syntocinon was increased from 30mL/h to 60mL/h, an increment of 30mL/h or more than double the maximum.
Reading further through the Syntocinon Product Information revealed some complications which may arise through the overdose of Syntocinon, the first of which listed was foetal bradycardia (image 3).
Image 3: Screenshot of Syntocinon product information showing the overdose symptoms, including foetal bradycardia.
The source of dosage information
Having made this discovery, I was quick to alert the hospital via email including all the evidence described above. I was surprised to receive a response citing a NSW Health ‘Policy Directive’ which was being used by the Northern Beaches Hospital and presumably others across NSW. The Policy Directive link I was sent is available online here which includes a table of dosage regimens for Syntocinon. To my shock, it was exactly as the hospital had administered, at increments of more than double the maximum (image 4). What’s more, NSW Health were recommending a dose of double the recommended maximum. While the Policy Directive lists references at the end of the document, there are curiously no references in regards to the dosage.
Image 4: Screenshot of NSW health ‘Policy Directive’ PD2011_075 showing incremental dosgae regimen.
I subsequently contacted the Minister for Health, the Hon. Brad Hazzard MP, and the NSW Agency for Clinical Innovation (ACI) who were the author branch of the Policy Directive. The ACI is currently considering my query to provide a formal response. If you filled in the form above and asked to be kept updated, I will email you the details of their response.
Curious as to how other states recommend using Syntocinon, I looked up the Induction of Labour protocol from Safer Care Victoria, the “peak state authority for quality and safety improvement in healthcare”. This information can be found online here. Their dosage regimens are inline with the Product Information for Syntocinon in the initial stages of induced labour (image 5).
Image 5: Screenshot of Safer Care Victoria ‘Induction of labour’ protocol showing dosage regimen of Syntocinon.
Viatris, the pharmaceutical company who own Syntocinon, were very interested in what they called the ‘off-label use’ of Syntocinon by the hospital. They asked me to provide some more information so they could document the case and have it reviewed by their relevant internal departments.
While I’m awaiting the formal response from ACI, I’m trying to gather as much anecdotal evidence surrounding people’s experience with labour as possible, particularly those who were induced with Syntocinon in NSW. You can help by filling in the form above, and sharing this page with as many people as you can.
NSW Health are due to review their Policy Directive on the 28th of November, 2023, so it would be great to be able to share some of this data with them so they can make better recommendations.
I’m collecting this information to try to make labour a better experience, especially for those induced with Syntocinon/oxytocin. I hope to be able to share some insights with NSW Health who are set to review their Induction of Labour Policy Directive in November 2023, so they can make better recommendations.
I can assure you that any information submitted via this form will never be used for anything other than to make labour a better experience, and will never be used for advertising or be sold. You can also opt to remain anonymous, in which case your name will not be required. Your email address and post code are needed to make sure submissions are unique and valid.
Submissions are stored in a protected database on a secure web server, and the site is protected by an SSL certificate providing encryption. For more information about any of this, feel free to give me a call on 0404 165 288.
Lessons and things for you to consider
There is so much information to take in when you’re expecting a baby, and it’s impossible to be prepared for every scenario. Despite having attended weekend birthing classes, made a birthing plan, and educated ourselves on a variety of birth procedures, we knew we had to rely on health professionals to make their best judgements in certain situations. No process is perfect, and what works for some people might not work for others. What’s important is to keep reviewing processes to make better decisions in the future.
I would highly recommend submitting a ‘Request for Information’ form to your hospital to receive all of your medical records of your labour. Most hopitals have a form you can download from their website or request via email, and should only cost you printing fees and postage (about $40 or so).
Some things we learned from our experience are:
- Ask questions
- Do your own research
- Speak up
- Take care of yourself if you don’t feel like you’re being taken care of
I hope this information has been informative and our story can be of help to others. I would greatly appreciate it if you can fill in the form by clicking below.