NEW DELHI: An advisory issued by the Union Health and Family Welfare Ministry to states last week to follow “Gujarat model” of childbirth, which involves delayed administration of life-saving drug oxytocin to women, has triggered a fresh controversy.
The advisory sent out to all states on physiological cord clamping, which advocates cutting the umbilical cord between mother and child after natural childbirth only after the placenta is out of mother’s body on its own — also mentioned that Prophylactic Oxytocin be given to women only after the placenta is delivered.
This particular point in the advisory, however, is in contradiction with the World Health Organisation guideline also adopted by India, which directs that oxytocin be given to all women in case of normal deliveries within a minute of childbirth to reduce the risk of postpartum haemorrhage by up to 70 per cent.
Postpartum haemorrhage is one of the leading causes of deaths of women in India during childbirth, causing over 1.2 lakh deaths annually.
The directive by the Centre is based on a randomised controlled trial that studied the impact of physiological cord blood clamping on about nearly 450 women and babies in Dharmpur in Balsar, Gujarat, apart from a small number in a hospital in Kolkata, which claimed to have shown benefits for newborns such as early initiation of breastfeeding, increased iron stores, better immunity and cognitive and developmental outcomes.
The study which was later adopted by many districts in the state has been hailed as “one of the best practices under the National Health Mission” in the advisory.
Presently adopted guideline on cord clamping, as prescribed by the WHO in 2007, says that it should be clamped within 1-3 minutes of childbirth after the pulse cessation.
“What we did in Gujarat was taking women and babies as close to completely natural childbirth practised before 17th century and it was a joyful experience for not only women but also healthcare professionals,” said Dr Arun Singh, an advisor with the Centre on Rashtriya Bal Swasthya Karyakram and principal investigator of the study.
The move, however, has evoked sharp reactions from maternal health experts who said that while the intervention related to delayed cord clamping is non-controversial, delayed administration of oxytocin could be potentially dangerous for millions of women.
“Postpartum haemorrhage does not happen in every woman post-delivery but it’s difficult to predict in which case it will occur,” said Dr Matthews Mathai, who was previously with the World Health organisation and currently works with the Liverpool School of Tropical Medicine, UK.
“It’s like wearing a seatbelt to prevent a possible mishap,” Dr Mathai added.
He also questioned the ethics of the study in which nearly 200 women were exposed to increased risk of haemorrhage.
Dr Subhasri of CommonHealth pointed out that the study which has been quoted in the advisory is based on a very small number of women and cannot be used to change the current standard guidelines.
Silent killer
Postpartum haemorrhage is one of the leading causes of deaths of women in India during childbirth, causing over 1.2 lakh deaths annually. While it does not happen in every woman post-delivery, it’s difficult to predict in which cases it will occur.