Language is Safety: “Any of the Following Regimens Are Appropriate”
The ACOG oxytocin table permitted 72 different protocols. When you add who makes the dose decision, that number becomes 216. We replaced all of them with one.
Labor and delivery. ObGyn. They save lives every day. They also harm patients in ways that are preventable, traceable, and fixable, if you know where to look. This series shows you exactly where to look, and by the time you finish it, you will be a more informed clinician, a more empowered patient, and a more effective advocate for the care that every woman deserves.
The Case
The patient was being induced at term. Her attending arrived, assessed her progress, decided labor was moving too slowly, and increased the oxytocin. To the upper end of the permitted range. More rapidly than the evidence supported. Within the boundaries of what the guideline allowed.
Tachysystole followed. More than five contractions in ten minutes. The fetal heart rate tracing deteriorated. An emergency cesarean was performed.
When we reviewed the case, nothing had been violated. The attending had acted within the permitted range. The documentation was complete. The guideline had been followed to the letter.
The patient had still been harmed.
When we looked at the outcomes data more broadly, the pattern was not isolated. Cases involving attending-driven dose escalation, particularly toward the upper end of the permitted range, were associated with higher rates of tachysystole, more fetal heart rate anomalies, and more emergency cesarean deliveries than cases managed conservatively at the lower end of that same range.
The guideline had not caused this. It had permitted it.
And to understand why, you need to look carefully at the table.
The Table That Looked Like Precision
