IMA , BMJ among others that criticize new labour management guidelines of health ministry.

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The IMA has strongly opposed an advisory by the Health Ministry asking states and union territories for delayed administration of the drug oxytocin to women at the time of childbirth, saying do so would push up maternal mortality.

Terming the guidelines "unacceptable", country's largest  doctors' body said they should not be followed by any conscientious doctor and demanded withdrawal of the advisory.

The standard protocol is giving oxytocin to all women within a minute of the baby’s birth as recommended by the World Health Organisation (WHO) and other obstetrics associations . 

Reputed medical journal The British Medical  Journal had too   criticised the Indian Health Ministry’s advice to delay oxytocin at childbirth. In a report published by the BMJ, doctors and maternal health experts have questioned the “ethics” and “scientific rationale” behind the Government’s advisory that asks to delay giving oxytocin until after the uterus has expelled the placenta.

In the BMJ’s report, Amar Jesani, a physician and editor of the Indian Journal of Medical Ethics, also said, “This raises questions about science and ethics. Can a government reverse established guidelines on the basis of just one or two studies? Any health policy proposed without adequate evidence would be unethical—and this one also has the potential to harm women.”

Ultimately, the BMJ report has raised questions on the ethical system behind the Government’s advisory. If such an advisory takes the form of national policy, it also has the potential to cause harm to women all over the country.

Oxytocin is a naturally occurring hormone that causes uterine contractions during labour and helps new mothers lactate.

"IMA is of the strong opinion that management of clinical situations should be left to the best practices of the profession set by the professional bodies at the national and international level," it said in a press statement.

The statement outlined that while the government has an obvious role in providing guidelines during epidemics and public health emergencies, it has very little to do with the management of clinical situations.

"According to the guidelines of WHO, active management of third stage of labour (AMTSL) mandates the use of oxytocin as the preferred choice. With the recommendations made by the government, it has opened the flood gates of mother dying in labour.

"IMA demands withdrawal of the recommendation to delay oxytocin after delivery of placenta. Mothers are bound to die of bleeding due to this recommendation," IMA national president Santanu Sen said.

According to the new recommendations, in all uncomplicated pregnancy, prophylactic oxytocin (uterotonic) should not be administered immediately after birth or with presentation of anterior shoulder at birth but only after the delivery of placenta. And also it should be administered intramuscularly to the mother only after placental delivery.

"The government seems to have confused between the two sets of procedures and should refer to the WHO list. Delayed or early cord clamping is a different procedure again left to the judgement of the obstetrician. Active management of third stage of labour (AMTXL) with oxytocin is a different issue," the body said.

According to WHO, active management of the third stage of labour is still a best practice, with the use of uterotonic (oxytocin) now the most critical element.

Delayed cord clamping (performed after 1 to 3 minutes after birth) is still recommended for all births to reduce infant anaemia while beginning essential newborn care at the same time.

Early cord clamping (< 1 minute after birth) is only recommended if a neonate is asphyxiated and needs to be moved immediately for resuscitation. Delayed cord clamping is recommended especially for preterm births and even for babies born to women living with HIV.

Dr RV Asokan, secretary general of IMA, said the government "should keep their hands away" from formulating guidelines for clinical situations. If the current guidelines are followed it would lead to floodgates of mothers dying in labour and will increase the maternal mortality in the country. 


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