Stopping Oxytocin in Active Labor May Cut Cesarean Risk by 20 Percent, Study Finds

Julia Whitley, Washington University School of Medicine in St. Louis, St. Louis, MO, and colleagues analyzed data from 15 randomized controlled trials involving 5,734 women who received oxytocin for labor induction or augmentation. The review compared outcomes between those who continued oxytocin into the active phase of labor and those for whom it was discontinued once active labor began.

The analysis compared outcomes between continued and discontinued oxytocin use during active labor, focusing primarily on cesarean delivery rates. Secondary outcomes included postpartum hemorrhage, blood loss, infections, Apgar scores, umbilical arterial pH, need for therapeutic hypothermia, NICU admissions, neonatal resuscitation, and mortality. The risk of bias was assessed using Cochrane Handbook guidelines, and the meta-analysis was conducted using Review Manager 5.4.1 and StataSE 16.

Key Findings:

• Discontinuing oxytocin during active labor was linked to a 20% reduction in the risk of cesarean delivery (RR 0.80).
• A lower incidence of uterine tachysystole was observed in patients who stopped oxytocin (RR 0.45).
• The risk of non-reassuring fetal heart rate tracings was also reduced with oxytocin discontinuation (RR 0.64).
• The duration of active labor increased by an average of 30.38 minutes, and the second stage of labor extended by about 6.32 minutes.
• The authors noted that while pooled data indicated potential benefits, the reliability of some included studies raised concerns regarding the overall trustworthiness of the results.

While the results point to promising benefits, the authors cautioned that some of the included studies had concerns regarding data reliability, which could influence the overall interpretation.

“The duration of oxytocin discontinuation in active labor wasn’t reported in any of the included trials,” the authors noted. “Still, we accounted for total oxytocin dosage and overall administration time wherever available.”

In conclusion, discontinuing oxytocin during the active phase of labor may slightly prolong labor by about 30 minutes, but it shows promising clinical benefits. The approach was linked to a 20% lower risk of cesarean delivery, along with reduced chances of uterine tachysystole and non-reassuring fetal heart rate patterns.

"While the findings suggest that this strategy could support safer and more effective labor management, the overall evidence should be interpreted with caution due to concerns about the quality of some of the included studies," the authors concluded.

Reference:

WHITLEY J, BURD J, DOERING M, Kelly J, Frolova A, RAGHURAMAN N, Reduced risk of cesarean delivery with oxytocin discontinuation in active labor: a systematic review and meta-analysis, American Journal of Obstetrics and Gynecology (2025), doi: https://doi.org/10.1016/j.ajog.2025.03.015.