Dr. Susanna Timonen
One of the centers where the AFL®-method is used is Turku University Hospital in Turku, Finland. We have interviewed Susanna Timonen, MD PhD, who has been one of the pioneering users, and discussed her experiences with the AFL®-method in her clinic.
Dr. Timonen, when did you start using the AFL®-method and what is your experience so far?
We started 2015. For the first time we can now pay more specific attention to the status of the uterus during labor. It is actually interesting how little we know about the function of the uterus during childbirth. The contractions during labor cause changes to the otherwise quite stable environment of the fetus. Therefore, it’s very important to understand what effect the contractions have on the baby. For the uterus, labor is like a marathon. The uterine muscle becomes gradually more exhausted over time, in particular if it is forced to work too intensively without resting. With the use of oxytocin, the risk for overload is increased and the muscle may become completely exhausted before the baby is delivered. The same could happen with us if we were forced to run a marathon too fast: we would be completely exhausted before even reaching the finish line. Before the AFL®-method was introduced we had no possibility to monitor the work load of the uterus.
What is from your point of view unique with theAFL®-method?
As pointed out, this is the first time we can really measure what’s happening with the uterus during labor. Today we use oxytocin extensively and thereby increase the risk of overload-ing the uterus. With the AFL®-method we can monitor the stress of the uterine muscle and administer oxytocin correctly.
Can you please share some experiences using the AFL®-method in your department?
My clinic is in a large university hospital with many doctors and midwives. The implementation of a new method takes time and requires repetitive training sessions. This method is simple to use and the physiology behind it is rather easy to understand. By reviewing our own cases we are able to discuss the importance of the measurements and learn how to understand the AFL®-method better and make it more familiar to the staff.
Can you briefly explain in your words the correlation between oxytocin and the AFL®-method ? In other words, how would you use the AFL®-method together with oxytocin?
Oxytocin is a potentially dangerous drug if it is used incorrectly. Today one could argue that we are using it quite uncontrolled. In some delivery units in Finland more than 75% of patients are stimulated with oxytocin. It is not always a benefit for the baby to rush the birth process. Too strong and extended contractions compromise fetal oxygen supply and increase the risk of asphyxia. For the uterus, abnormal contractions increase the risk
of exhaustion and thereby the risk of a prolonged or halted progress of delivery.
By using the AFL®-method , we can control the ability of the uterine muscle to contract and administer oxytocin properly. If the mother has spontaneous contractions but there is no progress, we consider measuring the AFL level before starting oxytocin. If we have used oxytocin and there is still no progress, we will check the AFL level. If the level is high, we stop the oxytocin and wait for 1-2 hours. If the level then is normalized, we start oxytocin again if the delivery is not progressing. If the level is low, we can increase the oxytocin dose if necessary.
Can you please give us some examples of childbirth injuries which may be prevented by using the AFL®-method?
High AFL level is a risk for the baby’s wellbeing. Too strong and extended contractions impair uteroplacental circulation and thereby reduce fetal oxygen supply, which may lead to asphyxia. Furthermore, if the uterus becomes exhausted before the baby is born, it cannot push the fetus properly and the risk of operative delivery is increased. Vacuum, forceps and cesarean section increase the risk of complications for both the baby and the mother. If we can avoid unnecessary interventions by using the AFL®-method , we can reduce the risk of injuries for both the baby and the mother.
Final question, can you please give your most important recommendation when using the AFL®-method ?
Make the first AFL measurement when you consider starting to give oxytocin. During the continued augmentation, if there is no progress, continue to measure AFL. Use the published reference level to decide your actions. If the level is low, you can increase the oxytocin dosage. If the level is high, stop oxytocin and wait. If the level then is normalized, start oxytocin again if there is no progress. If the level is still high, consider an operative delivery.