Oxytocin in Postpartum Hemorrhage
Objective: Use oxytocin only for postpartum atony as protocol writes — after fundal massage, never for an undelivered pregnancy bleed.
Why This Is Hard
Home birth, baby crying, mom soaking the bed. Crews look for TXA and forget the fundus. ACOG: atony is the leading cause of PPH. Mechanical massage first. Uterotonics if authorized.
- Baby out. Feel the fundus if trained. Massage a boggy uterus.
- Oxytocin IM/IV per protocol only after delivery of the fetus. This site does not publish units.
- Do not give oxytocin for third-trimester bleeding with the baby still in.
Field Rules (Education)
- Atony: soft, boggy fundus, ongoing bleeding after delivery.
- Massage is a procedure, not a suggestion.
- Oxytocin is the usual first uterotonic in hospital and in some EMS protocols. Others use TXA as well — different job (antifibrinolytic vs uterotonic).
- Placenta still in, inverted uterus, trauma are different pathways. Do not yank the cord. Destination OB-capable.
Field Pitfalls
- Oxytocin before the baby is out.
- TXA instead of massage.
- Packing the vagina.
Practice
60-second drill
Partner: delivered 20 minutes ago, boggy fundus, soaking. Order of operations: massage, med, destination.
Related: Vaginal bleeding, TXA.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ACOG postpartum hemorrhage — fundal massage and uterotonics; protocol owns oxytocin
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.