C-Section Complications in Rajasthan: The Critical Role of Oxytocin

Eight women who underwent caesarean deliveries at the District Government Hospital in Paota, Jodhpur, on June 20 fell ill after surgery, prompting a fresh investigation into maternal health complications linked to C-sections in Rajasthan. Over the last couple of months, several maternal deaths have been reported from Kota, Bikaner, and Jodhpur. Initial investigations in Kota suggested that the fatalities were linked to the use of fake or substandard oxytocin — a critical drug used to induce labour and prevent blood loss after delivery.

A Caesarean section, or C-section, is a surgery used to deliver a baby through cuts made in the mother’s abdomen and uterus. It is often performed when a normal vaginal delivery may be risky for the mother or baby. In many cases, C-sections are life-saving procedures. However, like all surgeries, they can sometimes lead to complications, including infections, heavy bleeding, and adverse reactions to anaesthesia.

One of the most common complications is infection, which may occur at the surgical wound, inside the uterus, or in nearby organs. Heavy bleeding, also called postpartum haemorrhage, is another major risk. Since a C-section is a surgery, blood loss is generally higher than in a vaginal delivery. Complications related to anaesthesia can also occur.

Oxytocin is naturally secreted by the pituitary glands of mammals during sex, childbirth, lactation, or social bonding, and is sometimes called the 'love hormone'. However, it can also be chemically manufactured and is sold by pharmaceutical companies for use during childbirth. It is administered either as an injection or a nasal solution.

During a normal vaginal birth, the body releases significant amounts of natural oxytocin in response to labour. However, during a C-section, especially under spinal or epidural anaesthesia, this natural hormonal response may not be sufficient. It is standard practice to give synthetic oxytocin during a C-section to help the uterus contract strongly and consistently. These contractions are essential to reduce bleeding after childbirth and prevent postpartum haemorrhage, one of the leading causes of maternal mortality worldwide.

Oxytocin also stimulates breast milk production and aids in the separation and expulsion of the placenta, reducing the risk of complications after surgery. Dr Richa Bharadwaj, consultant obstetrician and gynaecologist at Wockhardt Hospitals, Mumbai Central, explained that the uterus acts like a natural pressure bandage. After delivery, the blood vessels where the placenta was attached remain open. Oxytocin causes the uterine muscles to tighten around these vessels, effectively reducing blood flow and preventing excessive bleeding. If the uterus remains relaxed or fails to contract adequately, blood loss can become severe.

In the Rajasthan cases, tests indicated that the oxytocin used lacked active pharmaceutical ingredients, rendering it ineffective. This has raised serious concerns about the quality of medicines supplied to government hospitals and the need for stringent regulatory oversight. The incidents underscore the critical importance of ensuring access to safe and effective medications during childbirth.