Quacks turn labour-inducing drug into baby killer

GADCHIROLI & CHANDRAPUR: Pitocin can be a live-saver. But in rural Maharashtra, the drug, which is used to induce labour, could be the cause for a large number of stillbirths. How: indiscriminate use by quacks who provide most of the healthcare in the impoverished countryside.

Look at the figures for Chandrapur district alone. The monthly sale of Pitocin in just this one district is about 27,000 ampoules, according to the District Druggists and Chemists Association. That’s over 3.3 lakh ampoules annually.

Chandrapur district registered about 50,000 childbirths in 2007, of which 18,000 took place in government health centres – rural hospitals or PHCs — where only five ampoules of Pitocin were used, according to the district health office.

Does that mean so much of the drug was needed for the remaining 32,000 live-child-births? “The sales figures don’t justify the  use of almost three lakh ampoules [a year],” admits a Chandrapur druggist.

At least half the 1400 stillbirths and neo-natal deaths registered in rural Chandrapur in 2007-08 fiscal year could be attributed to an overdose of Pitocin to pregnant women already in high risk categories,  according to state health officials. That’s about 700 a year or two  every day.

A well-known gynaecologist in Nagpur Dr Meena Patil says excessive and intra-muscular dose of this drug could be dangerous for the baby. “Pitocin is an old and important drug in the field of obstetrics and gynaecology, but it is to be administered extremely cautiously and slowly before the delivery.”

The drug is used to induce labour in some cases; it results in contraction of the uterus to aid delivery.

“The drug is to be given through the intravenous (IV) route and in small quantities,” explains Dr Patil. “Its administration in large quantities to a woman before the delivery may cause sudden contraction of the uterus, which will suffocate the baby.”  It could prove fatal to the mother as well.

The rate of stillbirths should ideally be half of the neo-natal death rate, but they are almost the same in Chandrapur district.

That could also be due to  misrepresentation of neo-natal deaths as stillbirths. Yet, the high stillbirths even among non-tribals  is cause for concern.

Sample this: The Devhada primary health centre in Rajura taluka recorded 21 neo-natal deaths and 19 stillbirths in 31 villages in fiscal 2007. The reason attributed for the stillbirths in almost all the cases was “suffocation”.

Importantly, all the stillbirths occurred where the deliveries were performed by quacks or unregistered medical practitioners, the PHC records show.

Quacks across Gadchiroli and Chandrapur districts, who are the main providers of healthcare as state infrastructure is skeletal, use Pitocin indiscriminately.

“It’s also misused rampantly in urban slums,” observes well-known social worker Dr Satish Gogulwar of Gadchiroli-based NGO called ‘Amhi Amchya Arogyasathi’ in Gadchiroli. Pitocin overdose to the pregnant women by the quacks is a factor in many cases of stillbirths, he says.

As in one case last year in a village in Bramhapuri taluka of Chandrapur district, an unqualified ‘doctor’ pumped eight ampoules of Pitocin into a pregnant woman in the last stages of pregnancy – all injected intra-muscular and within a span of 24 hours. The woman died with the baby in her womb, and the death was attributed by the quack to her anaemic condition.

That’s not all. Several women across the district have reported stillbirths after being given an overdose of Pitocin by quacks. “It’s a serious public health issue in rural Chandrapur,” admits district health officer Dr Vijay Kargirwar. In fact, it’s a state wide problem, particularly in rural parts where access to government healthcare is poor.
“We don’t have adequate evidence, but we suspect that excessive and rampant use of ‘Pitocin’ is leading to high stillbirths in the district and it’s no accident,” he said.

That is apart from the already high neonatal and infant mortality rate due to prevailing malnutrition and malnourishment here.

Earlier this month, Dr Kargirwar wrote to the District Chemists and Druggists Association to regulate the sale and use of Pitocin, driven by the concern over the suspected misuse or excessive use of the drug and its fatal outcome.

Where is this excessive Pitocin being used?
Apart from its overdose in a few hundred cases, health officials strongly suspect that the cases of illegal medical termination of pregnancies (MTP) or abortions are on the rise. Pitocin could be used in big quantities in MTPs, fear doctors. Some of them, health officials suspect, could be female foeticide.

Dr Kargirwar says the Food and Drug Administration needs to regulate the sale of Pitocin, a schedule-H drug. “It should not be sold without prescription”.

“What do we do? We administer Pitocin if the family becomes impatient and pushes for an early delivery,” says DN Karmankar in rural Rajura block. For the poor tribal villagers he’s a doctor, whose degree is unknown.

The Taluka Medical Officer at Devhada, Dr RG Bawane, says these quacks are neither equipped nor trained to carry out deliveries. “It’s difficult for us to keep a check on the quacks, but we do try to rein them in,” he says. “In many cases, pregnant women are brought to us when things go out of control and the quack wants to get out of the trouble,” he says.

A busy Karmankar confesses: “These days, I’ve stopped attending to the delivery calls because of strict rules. Who knows I may be held responsible for the problems arising out in pregnancy at the last moment.” There have been instances, Karmankar says, when he has paid from his pocket to the poor family members to rush the pregnant woman to a good doctor.

Only last month though, records show, a woman delivered a stillborn baby at his ‘clinic’. The baby weighed a good 2.5 kg at the time of the birth.

There’s a big network of quacks who tie-up with the dais, village midwives. The dais refer pregnant women to the quacks for a cut, instead of sending them to the PHCs.