Unmonitored intrapartum oxytocin use in home deliveries: evidence from Uttar Pradesh, India.

Intrapartum use of oxytocin should entail controlled dosages administered through infusion, continual monitoring of mother and fetus and surgical back-up, since several adverse outcomes have been reported. However, in Uttar Pradesh, north India, small-scale ethnographic studies as well as a large-scale retrospective survey have established that unmonitored intramuscular oxytocin injections are commonly given to birthing mothers to augment labour by unregistered local male practitioners and auxiliary nurse-midwives employed by government during home deliveries. India's reproductive and child health policy needs to address the inappropriate use of oxytocin. Under a new 2007 policy, female government health workers at peripheral institutions are to be supplied with oxytocin to inject during the third stage of labour to prevent post-partum haemorrhage. The practice of injecting oxytocin intrapartum could readily be reinforced by this policy shift. There is an urgent need to ensure that home births are safer for mothers and babies alike, since India's current policy goals of raising the numbers of institutional deliveries, ensuring skilled attendance at birth and improving referrals for emergency obstetric care cannot be met in the foreseeable future. In a context of enduringly high infant and maternal mortality, especially in Uttar Pradesh and other large northern states, the question of whether or not inappropriate use of oxytocin is contributing to maternal and newborn morbidity and mortality deserves further research.