Pitocin

By Jenn Riedy

The blog-o-sphere is buzzing right now about a practice called “Pit to Distress.” Apparently Keyboard Revolutionary started it all with her post, which was quickly followed by Unnecesarean the same day. Now both of these blogs are written by “lay women”–that is, “JUST” moms, not medical professionals. So I was quite happy to see one of my favorite L&D nurse blogs jump into the fray–Nursing Birth. The Nursing Birth piece should be required reading for ANY woman who is planning a hospital birth, so that she doesn’t let this happen to her.

Pitocin seems to be almost synonomous with hospital labors anymore. I wonder how many women who labor actually manage to get through without using it at some point. One client I had switched OB practices because she had been informed that when she arrived at the hospital in active labor she would be put on Pitocin. No waiting to see how labor was progressing and if it was really needed…it was just the policy of this practice to use Pitocin on all laboring women. Medical staff will often explain away any concerns with the use of Pitocin by saying that it is just a synthetic form of the same medication that your body produces. Which is true. But that doesn’t mean that putting it into an IV is the same as letting your body produce it!

I’ve seen some “interesting” things happen with Pitocin in my doula experience.

* One mom was induced with Pitocin, and just when she seemed to be making progress, the Pitocin was turned off, and she was eventually taken for a cesarean for “failure to progress.” At that point she was only 12 hours into her induction, which started at 0 cm, and she was 9 cm dialated. I never did figure out how that was failure to progress.
* One mom asked for her Pitocin to be turned off until after her epidural was in place (anesthesiologist was with another woman, and my client just didn’t know how much longer she could handle the Pit), and the nurse said that she couldn’t do that without the Dr’s consent. Funny, but I thought in America mentally competent adults could refuse any medication.
* One mom told her nurse that she didn’t want the Pitocin drip turned up any further, the nurse said something to the effect of “yeah, it’s rough stuff,” and then went over to the IV pump and began upping the dose. The father stepped up and said “she said she didn’t want it raised anymore,” and the nurse got a shocked look on her face and said “oh, I thought you were just joking.”
* One mom had not responded to multiple attempts to induce labor with prostaglandins, so was put on an IV drip of Pitocin. Her drip rate was doubled every 15 minutes, until I went out to the nurse’s station and commented to the care provider about the intensity of her contractions. The care provider said “this is what labor is” without even observing the woman’s contractions. She did come into the labor room a few minutes labor, observed a contraction, and then quietly turned the drip down. The woman went from 4 cms to 10 cms in less than 2 hours. This inspired me to research recommended Pitocin dosing, and I learned that this woman had been started on 2-4 times the recommended starting dosage, and the dose she was at when I commented to the care provider was actually 160% higher than the level of oxytocin that would “mimic natural labor.” Even the dose that it was turned back to was 20% above the level that was described as “rarely needed.” This woman also had a post-partum hemorhage.

* I’ve only had two clients have cesareans for fetal distress. Both were on Pitocin at the time.

One of the major problems I have with the use of Pitocin is how strongly it is generally used. It is usually used at strengths MUCH greater than what the body would naturally produce. In the case of my client, it got to nearly 3 times the strength the body would naturally produce. Here is an excerpt from the 3rd page of the package insert on Pitocin:

The initial dose should be 0.5 – 1 mU/min (equal to 3-6 ml of the dilute oxytocin solution per hour [10 units oxytocin in 1000 ml saline was suggested a few paragraphs earlier “piggy backed” with plain saline]). At 30-60 minute intervals the dose should be gradually increased in increments of 1-2 mU/min…[. Once] the desired frequency of contractions has been reached and labor has progressed to 5-6 cm dilation, the dose may be reduced by similar increments.

Studies of the concentrations of oxytocin in the maternal plasma during oxytocin infusion have shown 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 lower concentration of oxytocin receptors, a higher infusion rate may be required.

Water intoxication with convulsions, which is caused by the inherent antidiuretic effect of oxytocin, is a serious complication that may occur if large doses (40 to 50 milliunits /minute) are infused for long periods.