Oxytocin Use During Labour: An Analysis of Canadian Medico-legal Obstetrical Case Files

We used Canadian medico-legal case data to examine patterns of oxytocin use in labour induction and augmentation and explore factors associated with adverse maternal-neonatal outcomes.

We conducted a qualitative descriptive study with thematic analysis of medico-legal events in Canada closed between 2020 and 2024. We identified 43 obstetric cases with the use of an oxytocic agent and with peer expert criticism specifically on oxytocin management. Two reviewers independently analyzed de-identified case summaries and expert reports with iterative discussion in a multidisciplinary team.

Peer criticism clustered around four recurring patterns of oxytocin misuse: failure to reduce/discontinue oxytocin in the presence of atypical/abnormal fetal heart rate or uterine tachysystole, initiation despite clear contraindications, unsafe restart after fetal heart rate decelerations, and unjustified dose escalation. Insufficient maternal and fetal monitoring was a criticism across all cases. Three intersecting themes (health care provider issues, communication breakdowns, and system limitations) often co-occurred. Overall, 70% of cases involved low-risk pregnancies and maternal morbidity occurred in 16% of cases. Catastrophic adverse neonatal outcomes occurred in 93% of the cases and were commonly attributed by causation experts to prolonged intrapartum hypoxia exacerbated by oxytocin misuse.

Medico-legal events involving oxytocin in Canada reveal recurring patterns of largely preventable oxytocin misuse embedded in cumulative breakdowns across the labour care environment rather than isolated errors. These findings support interventions such as robust oxytocin protocols, enhanced situational awareness and fetal surveillance skills, and reliable communication and escalation pathways to improve the safety of intrapartum use of oxytocin.