I don?t use synto routinely for homebirths. When working at a hospital I always give the woman the option not to have the synto.
I believe that giving synto as the baby is being born is like taking some panadol at bedtime just in case you are going to have a headache in the morning.
Synto acts by causing the uterus to contract and thus helping to stop excessive bleeding and expelling the placenta.
The down side is that it will also cause the cervix to close and there is a chance of trapping the placenta inside the uterus.
Also the majority of women do not bleed excessively after birth. Synto, once injected works very quickly so why not give it if a woman starts to bleed excessively and not because there is a chance that she might.
Alan,

I am put on drip fed oxytocin after the baby is born due to a PPH I had with my 3rd baby. I've never really thought about the whole thing at all and they have *never* asked if I wanted the synto because I am Vaso-Vagal Trypanophobic. Basically, don't let me know there is a needle involved and and I suffer neither serious blood pressure spikes and falls and I am less likely to react unreasonably. Since the PPH I worked very carefully with the pathologist at my then local hospital to get me to a point where I can accept a canula from her only. The hospital was amazing in so much as they would get her in just to be able to do it for me.

However, I am now 3 hours away from that hospital and my anxiety about getting the canula has completely returned. Would it be possible for me to go back to the syntocin and uterine massage after cord traction removal? I could try and ask if they would let me see the pathologist for the canula here and see if that works, but it took a long time to train one hospital how to deal with a trypanophobic. I don't think I have the time to do it again.