266 Where There Is No Doctor 2011
Medicines to control bleeding after birth or
miscarriage: Ergonovine, Oxytocin, Misoprostol
Ergonovine, ergometrine, oxytocin, and misoprostol are all medicines that cause
contractions of the uterus and its blood vessels. They are important but dangerous
drugs. Used the wrong way, they can cause the death of the mother or the child in her
womb. Used correctly, they can save lives. These are their lifesaving uses:
1. To control bleeding after childbirth. If there is heavy bleeding before or after
the placenta has come out, inject 10 units of oxytocin in the muscle (Pitocin, p. 390)
as soon as possible. If the bleeding does not stop in 15 minutes, inject another
10 units. If there is no oxytocin, you can use misoprostol (Cytotec, p. 391) instead.
For heavy bleeding after the placenta comes out, you can give ergonovine or
ergometrine (Ergotrate, p. 390). But do not use ergonovine or ergometrine before the
placenta is out.
IMPORTANT: Midwives and other health workers who help women deliver should carry
enough medicines to stop heavy bleeding if it happens. Too many mothers bleed to
death who could be saved.
2. To help prevent heavy bleeding after birth. Some authorities now recommend
giving all women a single dose of oxytocin, ergonovine, or misoprostol as described
above to prevent heavy bleeding after birth. This will prevent some dangerous
bleeding, but also treats many women with medicine when they do not need it. A
midwife who only has a little medicine may choose to save the medicine she has
for emergencies.
3. To control the bleeding of a miscarriage (p. 281). If the woman is rapidly
losing blood and medical help is far away, use oyxtocin, misoprostol, or ergonovine as
suggested above.
WARNING: The use of ergonovine, oxytocin or misoprostol to hasten childbirth or give
strength to the mother in labor is very dangerous for both her and the child. These
medicines are rarely needed before the baby is born, and then only a highly trained
birth attendant should use them.
THE USE OF MEDICINES
TO ‘GIVE STRENGTH’ TO
THE MOTHER DURING
CHILDBIRTH . . .
CAN KILL THE
MOTHER, THE
BABY, OR BOTH.
There is no safe medicine to give strength to the mother or to make the birth quicker
or easier.
If you want the woman to have enough strength for childbirth, have her eat plenty
of nutritious foods, especially during the 9 months of pregnancy (see p. 107). Also
encourage her to space a few years between her pregnancies so her body can regain
its full strength (see Family Planning, p. 283).