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Pitocin FAQ


Pitocin is another very controversial topic in childbearing today. Oxytocin is a natural hormone produced by a woman's body (There are several ways that this is done, that we will discuss later.) that cause uterine contractions. Pitocin is the synthetic form of oxytocin.
Pitocin is generally used in two ways: 1) to induce labor, and 2) to augment (speed up) labor.
We will discuss several different aspects of pitocin in this FAQ. I will also discuss alternatives to pitocin, Active Management of Labor (AML), and some other aspects of pitocin.

Robin Elise Weiss, ICCE, CD(DONA), NACA
pregnancy.guide@about.com
http://pregnancy.about.com/



Purpose of Pitocin

What is the purpose of pitocin?

Pitocin is supposed to be used to induce labor or increase the strength or duration of contractions for the health of mother or baby. In practice it seems that pitocin is used much more frequently, even when it's usefulness and safety are still questioned.


Problems with Pitocin

Are there problems associated with the use of Pitocin?

Yes. Oxytocin, your body's natural hormone, is secreted in bursts. However, when you are given pitocin you are placed on a regulated intravenous pump, to regulate the amount of pitocin to a steady flow. Therefore, pitocin induced contractions are different from your body's natural contractions, in strength and effect.
With pitocin, the induced force of the contraction may decrease uterine blood flow (This is also done during a natural contraction, but not for as long of a period and not as close together.). Therefore, reducing the oxygen to the baby.
With pitocin you will also receive continuous electronic fetal monitoring. This is because fetal distress is more common with pitocin use and needs to be detected if it occurs.
We have also witness that pitocin can be the beginning domino in the domino effect. The IV, the infusion pump, and the continuous monitoring will confine most mothers to bed, decreasing her ability to deal with the contractions naturally. With the more painful contractions a mother is more likely to need pain medication, such as an epidural anesthesia.
Pitocin can present other hazards. For the mother these include: tumultuous labor and tetanic contractions, which may cause premature separation of the placenta, rupture of the uterus, laceration of the cervix or postbirth hemorrhage. Fetal hazards include: fetal asphyxia and neonatal hypoxia from too frequent and prolonged uterine contractions, physical injury and prematurity if the due date is not accurate.

"It DOES change the nature of the contractions. At the moment, I can't remember how, but they got worse in a way that was qualitative as well as quantitative" -Enid


Alternatives to Pitocin

Are there alternatives to using pitocin?

Sometimes there are alternatives to using pitocin, and in most instances they should be tried before resorting to the use of pitocin.

To induce labor:

  • Walking
  • Nipple Stimulation
  • Intercourse (Only if the bag of water is intact.)
  • Enemas
  • Castor Oil

Augmenting Labor:


Contraindications to Pitocin

Are there any contraindications to pitocin?

Yes. Contraindications to pitocin stimulation in labor include,
but are not limited to:

  • Fetopelvic Disproportion
  • Fetal Distress
  • Placenta Previa
  • Prior Classical Incision or Uterine Surgery
  • Active Genital Herpes Infections


Pain with Pitocin

Will there be more pain with pitocin?

About 80% of women who have had pitocin say that there is more pain with pitocin than without. Unlike natural contractions, you do not get the slow build up with pitocin induced contractions. Most women surveyed say stated that they would rather try alternatives to pitocin with their next labor.

"It was nothing like the gradual up and down they described in childbirth class. If you have to have labor induced with pitocin, imagine the worse as far as contractions. I had hoped to avoid an epidural but I believe that because of the pitocin, I had to have the epidural. I will try without next time as long as I don't need the pitocin." -Tracy

"The contractions on the pitocin were so intense and so completely different than the normal contractions. They were harsh, sudden and agonizing. I felt like I was utterly out of control and could not stand it." -Gena


When Pitocin Helps

Does Pitocin ever help?

Pitocin helps in about 5% of the cases, but only after safer alternatives have been tried and failed. Proponents of pitocin say that pitocin helps only if given to the mother before she and her uterus are exhausted. There is a critical window of opportunity during labor that pitocin will help get labor back on track. Once this has been missed, they believe that a cesarean is basically the only solution.
When inducing labor with pitocin, it works best when the uterus is ready to receive it. Giving pitocin before the uterus is ready or ripe enough to receive it is likely to produce a long drawn out, unsuccessful labor. There are natural and medical ways of ripening a cervix, both having to do with prostaglandins. Ask your doctor what you Bishop's score is before you agree to a pitocin only induction. If it is under 5, labor is likely to be unsuccessful, and you may want to inquire about prostaglandin inductions as well.


Active Management of Labor

What is Active Management of Labor? And is it successful?

Active Management of Labor (AML) was started in Dublin in 1968. It was started to help a mother's labor be efficient. This is achieved with a medical model of birth, including amniotomy (Artificial Rupture of Membranes), and pitocin augmentation.
AML has many components in Dublin. I will start with explaining their approach and then explain the American approach.
In Dublin, a woman is given classes that guarantee that she will be able to diagnose her own labor (Labor is defined as completely effaced, having painful contraction 7-10 minutes apart, or having you water broken.). When she arrives at the maternity ward she is given a student midwife who performs no clinical skills (making her a doula), that stays by the woman's side throughout labor. The midwife in charge of her care makes sure that she is progressing at the rate of 1-2 cms per hour. If not her water will be broken (if not previous done), and then she will be hooked up to pitocin (which is given at a quicker infusion, reaching maximum dose before we normally would here in the US). They will also guarantee the birth will take 12 hours or less.
98% of women delivered in 12 hours of beginning AML, and 40% were by reaching four hours. They had a cesarean rate of 5%. They had an epidural rate of 15%. They also had no apparent difference in the condition of the baby.
Sounds to good to be true? Well, this is what the Americans have done with it. First of all, they have no standard prenatal education, nor guide to define labor. In Dublin, if you are completely effaced your cervix is more likely to be receptive to pitocin, that is not a standard of American AML. We also don't provide the doula, which has been previously shown to help reduce the epidural and cesarean rates. So, AML is not the same here in the United States.


Pitocin After the Birth

Is pitocin necessary after birth?

Not on a routine basis, despite that this is a common procedure. Giving pitocin after birth is quite common. It is said to be used to get the third stage (placenta) over with quickly and prevent postpartum hemorrhage. Nature will help your body provide oxytocin on it's own if stimulated by nipple stimulation and massaging the uterus. There are times when there is no time for nipple stimulation, but this is rare, however, we are grateful for medical technology when not inappropriately used.
Ask your care provider if they routinely use pitocin after birth. If this bothers you, you can ask for more time before being given the injection or be allowed to use nipple stimulation (either by hand or by baby).


Resources

Where can I get more information?

  • The Birth Book by William and Martha Sears
  • Good Birth, Safe Birth by D. Korte and R. Scaer
  • Maternity and Gynecologic Care by Bobak and Jensen
  • Active Management of Labor by O'Driscoll, Boylan, & Meagher
  • AML by Penny Simkin (There is a tape available from ICEA and she wrote an article for Childbirth Instructor Spring 1995.)


    For more information about induction,
    please see the Induction Section of Childbirth.org.



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