A simple alternative to parenteral oxytocics for the third stage of labor

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Abstract
To determine the effect of nipple stimulation on uterine activity during the third stage of labor. Randomized controlled study comparing; (i) 15 min of nipple stimulation (n = 6), (ii) routine syntometrine injection (n = 3), (iii) no action/control (N = 5). Uterine activity was continuously measured using the placenta as an in-situ hydrostatic bag connected to a pressure transducer. Compared to controls uterine pressure was higher during nipple stimulation (103 mmHg vs. 70.8 mmHg, P = 0.04). The duration of the third stage and blood loss tended to be reduced with nipple stimulation compared to controls (20.3 vs. 12.3 min) and (257 vs. 166 ml) respectively but was not significant. Similar differences were observed between syntometrine and control groups. For women in developing countries where parenteral oxytocics are not available, nipple stimulation might reduce the incidence of postpartum hemorrhage. A larger trial now seems warranted.