Category: Research updates

Diabetes – oxytocin less effective for these women

For years now diabetes has been known to complicate birth for many women and unfortunately the incidence of ‘type two diabetes’ is increasing as our weight as a nation increases.

According to researchers at the University of Liverpool approximately 60% of diabetic women (including those who develop diabetes during pregnancy) will be unable to complete labour naturally and will require a caesarean.

Until now the reason for this has not been fully understood. Researchers have found “that contractions in women who had the disease were not as strong as those in non-diabetic women…Calcium levels in the uterus should rise to allow the muscle to contract effectively. Researchers found, however, that in women with diabetes, calcium levels are significantly reduced. “ University press release

While the result itself is useful in understanding why this is happening to so many of the 35,000 women that have diabetes during pregnancy every year, the implications for the management of diabetic labours is perhaps even more significant.

Researchers found that when uterine tissue of diabetic women was treated with oxytocin (a drug often used to assist labours that are experiencing difficulties) it was found that contractions “failed to reach the same levels of contractility as in non-diabetic women.” While more research is on-going, this finding does suggest that advice to women as they plan their birth ought to consider caesarean birth as a prophylactic option and more specifically for those wishing to attempt labour that the door is left open to switching to a caesarean during labour earlier such that they can have a caesarean before real signs of distress result in ‘critical’ surgical intervention.

Maternal requests should be supported within the NHS

NICE have issued (subject to typo corrections) the new version of the Caesarean Section Guideline. There have been a number of significant steps forward in this version. In particular the following:

  • “Recommendation 38: For all women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.” pg 12
  • “Recommendation 39: An obstetrican has the right to decline a woman’s request for a CS. If this happens, they should refer the woman to an NHS obstetrician in the same unit who will carry out the CS.” pg 12
  • NICE “agreed that it is important that women are presented with evidence based information in order that they are able to make an informed decision. The reported benefits and harms can then be discussed with each individual woman to help her make decisions based on the relative trade off between the two modes of birth interpreted in light of her own circumstances.” pg 63
  • NICE “agreed that when discussing the risks and benefits outlined in the table, the healthcare professional and woman also need to consider the woman‟s individual circumstances which affect the risks associated with vaginal birth and CS such as previous abdominal or pelvic surgery, impaired mobility from pelvic girdle pain, or care of other children. It is also important to discuss the number of future babies that the woman and her partner are planning as some risks such as placenta praevia increase with an increasing number of CS.” pg 63

Funny figures from WHO on caesareans

An excellent example of how to really assess a scientific paper.

The World Health Organisation suggested that women ‘too posh to push’ were 3 times more at risk of death or other complications than those experiencing a vaginal birth. Nigel Hawkes of Straight Statistics looks at the details and finds “WHO believes too many caesareans are done without proper cause. But in interpreting these data, the authors appear to have bent over backwards to prove the point – a classic illustration of White Hat bias. The findings should be ignored.”