Use of oxytocin and other injections during labor in rural municipalities of Guatemala : results of a randomized survey

In the hands of obstetricians, a synthetic analogue of oxytocin may be administered to induce labor, increase the rate of labor, or control postpartum hemorrhage. However, in the hands of traditional birth attendants, pharmacists, injectionists, or even peripheral health workers, use of oxytocin can prove deadly. Administered in the wrong amounts, through the wrong means, often unmonitored, it has resulted in the death of women through rupture of the uterus, or in the death of children through asphyxia. In the rural Guatemalan Mayan community surveyed in this study, oxytocin injection administered by traditional birth attendants was significantly associated with increased risk of intrapartum and early neonatal death. After presenting these observations, the study summarizes a systematic investigation of the frequency of oxytocin injection by untrained birth attendants during labor and delivery in rural municipalities throughout Guatemala. Findings show that intramuscular injection of oxytocin occurs in other municipalities besides that originally studied. Use of oxytocin seems to vary substantially by region, but to be highest among the indigenous Maya population of the Highlands region. Perinatal and neonatal death likewise appear to be substantially greater in this population than in the other regions studied. (Author abstract, modified)