By the time 40 weeks rolls around, there’s nothing most pregnant mamas want more than to meet their babies. Who can blame them, either? Pregnancy is tough on the body, and those headaches, swollen feet, and sleepless nights can really get the best of you. And when you’re feeling so vulnerable, it can be confusing if your birth plan doesn’t go quite as, well, planned.
So what do you do if your healthcare provider recommends Pitocin to medically induce?
While Pitocin can be a helpful labor tool, many healthcare providers don’t adequately explain the risks—and even the benefits!—of induction or augmentation of labor with Pitocin.
This post is not about judging or shaming any mamas who were administered Pitocin. In some cases—both before and after birth—it can be a true necessity. When I was in labor with my first baby, I needed “a hit of Pit” to continue laboring, and that intervention may have saved me from a surgical birth.
Instead, this post is about educating moms about Pitocin. Many mamas don’t even know that side effects exist. This needs to change.
What is Pitocin?
The body produces a hormone called oxytocin, also known as the love hormone ?, that helps the uterus contract during labor (its also released while nursing and during sex). Pitocin is a synthetic form of oxytocin.
But what does Pitocin do?
When labor stalls or when inducing labor with Pitocin is medically necessary (more on that below), Pitocin is used to jump start or speed up labor. When administered, Pitocin binds to oxytocin receptors in the body, causing the uterus to contract. (source) Researchers are unsure if Pitocin crosses the blood-brain barrier.
When is Pitocin Medically Necessary?
Induction is considered medically necessary when the risk of baby remaining in the womb outweighs any risks associated with induction.
Here are some times when Pitocin should be considered:
1. When certain health conditions affect mama or baby
There are a number of rare, but serious health conditions and infections—gestational diabetes, preeclampsia, intrauterine growth restriction, and more—that may make it too risky for mama to carry baby to 40 weeks or beyond.
2. Water broke, but contractions haven’t started in 24-48 hours
If mama’s water breaks and contractions don’t start within 24 hours, many practitioners will want to induce. This is based on research performed in the 1950s and ’60s suggesting the chances of infection go up dramatically if babies are born any later than 24 hours after the membranes rupture. However, new research shows that women who meet certain criteria can safely wait 48 hours for contractions to begin (expectant management). To do so, mama needs meet the following criteria:
- Term, uncomplicated, singleton pregnancy
- Fetus in vertex position (head down)
- Clear amniotic fluid
- No infections (including GBS)
- No fever
- Normal fetal heart rate
- No vaginal exam at baseline
- Keep vaginal exams to a minimum (vaginal exams increase infection risk)
3. Labor stalls
If mom is more than 6 cm or if baby is in distress, Pitocin may be needed. If labor slows or stalls, but both mom and baby are doing well (and labor was not induced and mom is less than 6 cm dilated), evidence suggests that it’s best to let birth unfold on its own.
4. After labor, if bleeding cannot be stopped
Even after birth, Pitocin causes contractions in the uterus. These contractions squeeze down on the raw blood vessels that are exposed as the placenta is released, reducing bleeding and hemorrhaging. These contractions also help the uterus contract back to it’s normal size. Therefore, Pitocin can be a great tool for managing excessive blood loss or even to push out a stubborn placenta that doesn’t want to come out.
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When Pitocin Isn’t Necessary
In a perfect world, Pitocin would only be used when medically necessary to improve outcomes for both mom and baby. In reality, Pitocin is often used without a medical reason. Some of the non-medically necessary reasons are:
Some doctors schedule inductions to avoid scheduling conflicts. There are obvious problems with this!
2. Mama goes past 40 weeks
Evidence shows there’s no reason to induce before 42 weeks when the mom and baby are healthy. The American College of Obstetrics and Gynecology (ACOG) recommends that induction should take place between 42 weeks 0 days and 42 weeks 6 days.
3. Mama is ready
Those last few weeks can be tough, and some women begin to think induction seems like a good idea (I get it!). But induction can be risky as the baby and your body may need those last few days to prepare for birth.
4. Baby is getting big
Many women are told they should induce before baby gets too big. When a baby is too big to fit through the pelvis, this is called cephalopelvic disproportion (CPD). This condition is actually very rare unless mama had a pelvic injury or was malnourished as a child. (source) Additionally, in studies, ultrasound predictions of baby’s size are historically inaccurate (by several pounds in some cases!).
That said, certain conditions like gestational diabetes can cause higher birth weight. In those cases induction is usually recommended.
Is Pitocin Being Overused?
Before Pitocin was created in 1955, if labor stalled for too long in a hospital, the next step would often be to perform a C-section. With Pitocin, women who would otherwise be resigned to surgery could birth their babies vaginally.
But today, about 40 percent of laboring women report being induced.
Most midwives and birth workers agree that statistics like that are far too high, and that Pitocin is used much too frequently today.
Another problem with Pitocin is that many moms who receive it don’t fully understand:
- why they’re being induced
- and what potential complications are associated with Pitocin
Side Effects of Pitocin
It’s important that each mom, in partnership with her healthcare provider, has the information—both the benefits and the risks—she needs to make an informed decision about whether or not Pitocin is the right intervention for her. Since we’ve already touched on all of the great things Pitocin can do during labor, let’s unpack some of the potential side effects:
1. Pitocin can lead to other interventions
As with other interventions, like epidurals, saying yes to Pitocin means you’re also saying yes to a number of other interventions including continuous fetal monitoring and IV fluids (that’s how the Pitocin gets into your body). You may also end up needing an epidural, since Pitocin contractions are more intense and more painful—especially if used for several hours.
A survey of first-time moms with term births found that 61 percent of women, who went into labor spontaneously, asked for an epidural.
In contrast, 78 percent of women who were induced asked for an epidural.
Those who had induction and epidural were 6 times more likely (a 31 percent chance) to have a c-section than those who had neither.
This survey didn’t distinguish between methods of induction so we don’t know if all of these inductions required Pitocin or not, but the large difference in epidural use in the induction group vs. the spontaneous labor group is interesting and worth considering.
2. You’re on the hospital “clock”
Additionally, when you’re on Pitocin, you’re on the clock, meaning the hospital or doctor usually expects a certain amount of progress per hour. Many hospitals use 1 cm per hour, after reaching 4 cm, as their guide (known as the Freedman’s Curve). But a recent study found that the slowest rate of dilation that is considered normal is 1/2 cm per hour—half the rate that many hospitals and doctors use.
It’s easy to believe that certain interventions, especially ones like fetal monitoring or IV fluid don’t interfere with birth and are a good “insurance plan” in case something goes wrong, but having interventions “just in case” may cause unnecessary fear and stress that can interfere with the natural labor process. As Judith A. Lothian RN, writes in an article published in the Journal of Perinatal Education:
“Catecholamines, the stress hormones, are released if the mother is fearful or if she does not feel safe and protected. Early in labor, high levels of catecholamines can slow or even stop labor… Having a deep understanding and confidence in the normal physiologic process of labor and birth and confidence in her own ability to give birth makes it easier for a woman to let go of the belief that technology and routine interventions make birth safer for mothers and babies.”
3. Longer labor
While augmentation is more likely to shorten labor (even if that means it ends in a C-section), induction with Pitocin can have the opposite effect and actually lengthen labor. One study found that women who were induced spent a considerable amount of additional time in labor, compared to women who went into labor spontaneously. The reason could be that your body or baby simply isn’t ready yet. There are some criteria that can help determine if induction will work well for you or not. Calculate your Bishop Score to see if you’re a good candidate.
If you begin labor at home, you have the freedom to go through early labor in as much or little time as you need (not to mention in the comfort of your own home). When you’re induced, you may have to go through all of early labor at the hospital—and early labor can take a long time!
4. Higher risk of C-section
Sometimes Pitocin doesn’t help the body dilate. If nothing is happening at all, you may be sent home. But in many cases, especially if mama’s water has broken, there is no turning back. In 25 percent of cases, induction isn’t successful and C-section is necessary. One study found that induction actually doubled the risk of C-section.
5. Higher risk of hemorrhage
One of the biggest benefits of Pitocin is its ability to reduce postpartum hemorrhage (PPH) by helping the uterus contract back to its normal size after delivery of the placenta. The American Academy of Family Physicians (AAFP) considers Pitocin the first and best choice for treating postpartum hemorrhage, because it has fewer side effects than other medications.
But studies indicate postpartum hemorrhage is also a side effect, because it can cause uterine rupture. The intense contractions can cause the uterus to tear in a VBAC situation or even in a uterus without scarring. Uterine rupture is a rare, but catastrophic condition that can lead to fetal and maternal death. One healthcare center found that 77 percent of their patients with uterine rupture were given Pitocin during labor.
Research suggests that another cause of postpartum hemorrhage is the continuous flow of oxytocin (Pitocin) instead of the body’s typical pulsed flow. This can make the uterus less sensitive to oxytocin, making it harder for natural oxytocin (or even Pitocin) to help stimulate the contraction of the uterus after delivery of the placenta.
6. Stronger contractions
Pitocin labor is different than natural labor. Experts agree that contractions are much longer, stronger, and closer together than natural contractions. Also, the uterus doesn’t get to completely relax in between contractions.
When the uterus is contracting so strongly for such long periods and with little break in between, babies can suffer from lack of blood flow and oxygen deprivation, causing abnormal fetal heart rate patterns and fetal distress.
7. Straining for baby
Pitocin can also cause some issues for baby. The U.S. package insert explicitly states the serious risks to baby, including:
- fetal heart abnormalities (slow heart beat, PVCs, and arrhythmias)
- low APGAR scores
- neonatal jaundice
- neonatal retinal hemorrhage
- permanent central nervous system or brain damage
- fetal death
Additionally, one study found that babies born after augmentation with Pitocin had almost three times greater risk of oxygen deprivation, which can lead to Cerebral Palsy or brain damage.
Labor induced with Pitocin was also linked to higher chances of baby being admitted to the NICU for longer than 24 hours.
The Truth About Pitocin
Pitocin can be a huge help to many mamas before, during, and after birth.
When mom is educated about both the risks and benefits of Pitocin, she can make an informed and empowered choice during her labor. If Pitocin is necessary, by all means, use it! And let go of any guilt, as it truly can help in many labors.
- When Pitocin is used well, it can help moms avoid cesarean section.
- When Pitocin is used unnecessarily, it can trigger a “cascade of interventions” that actually leads moms to cesarean section.
Most midwives and birth workers consider Pitocin to be grossly overused.
Pitocin does have a number of side effects that many moms don’t know about before they receive it.
If you do need Pitocin during labor you may consider asking the nurses what dosage you’re at (or having a support person do it for you). Ask your healthcare provider to keep your dosage as low as possible. (It’s a good idea to put this in your birth plan—just in case.)
Studies of the concentrations of oxytocin in the maternal plasma during Pitocin infusion show that infusion rates up to 6 mU/min give the same oxytocin levels that are found in spontaneous labor. At term, higher infusion rates should be given with great care, and rates exceeding 9–10 mU/min are rarely required. Before term, when the sensitivity of the uterus is lower because of a lower concentration of oxytocin receptors, a higher infusion rate may be required. (source)
But remember every patient and every situation is different. Talk to your healthcare provider and be sure everyone is on the same page before you go into your birth.
How About You?
What did your doctor tell you about Pitocin? Did you receive Pitocin before or after labor?