How drug used to speed up births can starve a baby of oxygen
06:48 GMT, 16 October 2012
Kate was nine days overdue with Jack when she was admitted to Yeovil District Hospital
Jack Clayton is a bright seven-year-old with an impish grin who loves riding his Dartmoor pony, Harry Hoof, and playing with his four-year-old brother.
He’s into cars and computers and whizzing down slides over and over again.
But Jack’s future will be shaped by the fact he can’t feed, bath or dress himself and has limited speech.
A wheelchair user, he still wears a nappy at night, and probably always will.
Something went badly wrong when Jack was born, but it has taken a long time for his parents Kate and Stephen to prove it.
They have fought for years to get an admission that Jack’s cerebral palsy was caused by oxygen starvation during his birth.
Kate, 38, a human resources administrator, was nine days overdue when she was admitted to Yeovil District Hospital.
waters were broken, and over the following 48 hours she recalls a
succession of examinations and epidurals, fetal heart monitors and
But there was one thing Kate barely noticed.
The doctor who instructed that a drip be turned up again and again.
Kate now knows the drip contained a drug called oxytocin.
A naturally occurring hormone, the synthetic form known as Syntocinon is used routinely to kick-start or speed up labour.
It is given to about 30 per cent of women in first labour, and a smaller number having second or third babies — a total of roughly 130,000 women a year.
Gail Johnson, of the Royal College of Midwives, says it can be an invaluable tool because it acts directly on the uterus, making it contract.
/10/15/article-2218209-1584F2EA000005DC-553_634x655.jpg” width=”634″ height=”655″ alt=”Jack is into cars and computers and whizzing down slides over and over again. But his future will be shaped by the fact he can't feed, bath or dress himself and has limited speech” class=”blkBorder” />
Jack is into cars and computers and whizzing down slides over and over again. But his future will be shaped by the fact he can't feed, bath or dress himself and has limited speech
‘It saves lots of women from unnecessary Caesarean sections every day of the week.’
Under official guidelines, a woman’s contractions should not exceed three to four every ten minutes.
This is crucial because during each one the blood supply carrying the baby’s vital oxygen is cut off.
The danger of allowing contractions to come too rapidly is that there isn’t enough time for the baby to recover in between, and it is starved of oxygen.
But in Jack Clayton’s case, even when there were clear signs that he was in distress, the dose was doubled. Kate’s contractions reached six in ten minutes.
Yeovil District Hospital eventually admitted that serious mistakes were made which caused Jack’s brain damage, although it disputes that Syntocinon was a factor.
Yet while the details of a settlement were being hammered out, the family’s lawyer spotted a pattern.
Olivia Scates, of JMW solicitors, discovered the firm was handling no fewer than seven cases where there was evidence of oxytocin being linked to brain damage in babies.
Ms Scates says: ‘One of our successful cases went all the way back to a birth in 1974, but nearly 40 years on this problem is still going on. It’s a huge concern.
'Lives are being ruined — not just the child’s, but the whole family’s.’
Now a prominent obstetrician is calling for a ban on oxytocin for speeding up delivery.
Professor Philip Steer, a consultant at London’s Chelsea and Westminster Hospital, is so concerned he says the drug should be used only in the few cases where labour must be induced because the woman has a dangerous condition such as pre-eclampsia (high blood pressure), or because she is well past her due date, posing a risk to mother and child.
The problem is that when oxytocin causes contractions to occur more frequently, they also become weaker and less effective in pushing the baby out, says Professor Steer.
A wheelchair user, Jack still wears a nappy at night, and probably always will
The drug can hyperstimulate the uterus, which means the spasms come so close together that the baby is starved of oxygen.
The result is brain damage or death.
‘It’s like somebody saying the screw
is stuck, let’s hit it with a hammer, then they are surprised when the
screw gets bent,’ he says.
Steer believes the risks of the drug are often misunderstood by doctors
and midwives. He also believes they are not paying enough attention to
the changes in frequency or strength of contractions before increasing
This lack of awareness can be disastrous, as it was in the case of ten-year-old Alfie Woods.
doesn’t speak, and he has learning difficulties and behavioural
problems because he suffered brain damage caused by oxygen deprivation
during his birth.
most difficult thing for Alfie’s mother Laura to deal with is his
aggression. Laura, a petite 5ft and weighing just 6½ stone, worries her
son will soon be able to overpower her.
‘He’s already kicked me in the mouth — he gets angry because he can’t say what he wants,’ she says.
Laura, previously a hairdresser, hasn’t been able to work consistently since Alfie’s birth.
She’s now a single parent and devotes herself to caring for her only child who has up to five epileptic fits a day and sleeps just two hours a night.
Laura was two weeks overdue when she arrived at Leicester’s University Hospital.
‘The main thing I remember is the doctor telling them to turn up the drip,’ she says. ‘I felt they just wanted to speed things up. It was like a cattle market, one in one out.’
Once regular contractions were established the oxytocin could have been switched off, but instead it was turned up.
When Alfie’s heart rate dipped for seven minutes, the midwife did switch off the drip.
But critically, 20 minutes later, it was started again.
The University Hospitals of Leicester NHS Trust has admitted it failed to respond appropriately to the frequency of Laura’s contractions and the baby’s heart rate.
Alfie’s legal team will now press for a package covering 24-hour care for life.
Last year, there were more than 1,000 claims against the NHS for mistakes made during childbirth. Professor Steer calculates that 70 per cent are linked to the misuse of oxytocin.
Some children suffer minor injury, others are left profoundly disabled.
Oxytocin first caught on in the Sixties as a way to speed up labour and reduce Caesareans.
‘Many people still seem to believe that using oxytocin changes the outcome and speed of labour,’ says Professor Steer.
In fact, he says, recent research shows it shortens labour by an hour or two, and does not impact on Caesareans at all.
'I don't have time to feel angry, the rest of my life is going to be a fight for Jack, to get everything he needs,' said Kate
Professor Steer believes doctors and midwives like oxytocin because it feels as though they are making a difference.
‘If the labour is a bit slow and the woman isn’t contracting that often, you put Syntocinon up and the contractions increase in frequency.
'You think you are doing something really useful that will reduce the chance of a Caesarean. Unfortunately this is not the case.’
Guidelines published by the National Institute for Health and Clinical Excellence (NICE) say oxytocin should be used only if contractions are ‘inadequate’.
Yet Ms Scates says in practice it is widely used.
‘You use it every day, nothing disastrous happens and midwives get sloppy.’
Patrick O’Brien says using a fetal heart monitor, which can show if the baby is distressed through lack of oxygen, is a safety net.
‘If too much oxytocin is given, a dip in the baby’s heart rate will show up clearly.
'This will give doctors a chance to switch off the drug before any harm is caused,’ he says.
But former midwife Lois Rowland — now working at JMW solicitors — disagrees.
‘Too often simple steps to progress labour, such as encouraging the woman to go for a walk or dimming the lights to encourage natural production of oxytocin, are not followed.
'Artificial oxytocin is the default remedy because it’s easier and quicker.’
Professor Steer and Ms Scates believe that the misuse of oxytocin costs the taxpayer millions of pounds each year.
Obstetrics accounted for the lion’s share of the £1 billion-plus NHS bill for medical negligence last year.
Professor Steer believes as much as £300 million each year could be attributable to serious injuries caused by misuse of oxytocin.
One of America’s leading hospitals, New York-Presbyterian/Weill Cornell, is introducing a strict protocol around the use of oxytocin.
It is said to have helped shave 90 per cent off the hospital’s annual bill for medical negligence.
Professor Steer is frustrated that oxytocin is still used so freely.
‘There have been hundreds of papers on this,’ he says.
‘Unfortunately, it’s one of those things that is difficult to dig out of the culture.’
Karl Olah, associate professor of obstetrics at Warwick University, believes oxytocin should be used ‘with much more caution’, and that staff should perhaps be required to go through a formal review each time it is given, instead of just taking the decision alone.
Any reform of UK systems will come too late for Jack Clayton.
‘I don’t have time to feel angry,’ says his mother Kate, ‘the rest of my life is going to be a fight for Jack, to get everything he needs.
‘It saddens me that the lessons aren’t necessarily being learned.’