To pit or not to pit? Is pitocin the evil poison you read about on the Internet? Do doctors just use it to make you more miserable in labor, increase your chance of a poor outcome, only so they can sharpen their knives to cut the baby out of your loins? Because, really, don’t all obstetricians prefer their patients deliver by cesarean section?
I admit pitocin is widely used in labor and delivery departments throughout the nation. The good news is that it is a relatively safe drug.
Pitocin has been used for labor induction and the treatment of protraction disorders (prolonged labor) since the early 1900s. It is a synthetic version of the pitocin secreted by the pituitary gland. It is a hormone that stimulates contractility of the muscle fibers in the uterus.
Pitocin is administered intravenously and is started at a low continuous infusion rate. It is increased about every 30 minutes since it takes that long to see its effects. The actual definition of active labor is when contractions are strong and regular enough to cause the cervix to be dilating. Therefore, pitocin is increased until the cervix is making change. The actual amount of pitocin that it takes to do this is different for everybody. Some people require only small doses before experiencing strong contractions, other people may have large doses and still not be experiencing strong enough contractions. Once the contractions are strong enough, then the pitocin infusion may stay at the same rate. Many people believe that pitocin causes more painful labor. However, if the pitocin infusion is adjusted properly and maintained at a steady state once an adequate rate to effect change is accomplished, then the contractions should be just as strong, and therefore just as painful, as if a woman goes into labor on her own. An induction may seem a bit more arduous and prolonged, since one is in the hospital throughout the entire duration and more focused on the process, however.
The complication with pitocin use that may give it a bad rap is that of hyperstimulation of the uterus. This is when the uterus is contracting too frequently or too long of a duration. The concern with this occurring is that blood flow to the fetus may be decreased during too strong, too frequent or too long contractions. This is why fetal monitoring of the heart rate is performed during labor and the induction process. If the baby is not tolerating these contractions, the pitocin can be easily decreased or turned off altogether. Pitocin has a short half life of 3-4 minutes, so the level in the blood stream will quickly fall, usually resulting in improvement of the baby’s heart rate.
Another concern with contractions being too strong is that of rupture of the uterus. This is actually an irrational concern. Uterine rupture with the use of pitocin in women who have not had a prior cesarean section is essentially unheard of with only a couple reported cases in the world, and with much higher doses than are used in our hospital.
The beneficial effects are many. Pitocin allows labor to be induced, especially when there is a medical complication of pregnancy where delivery is beneficial for the welfare of the mother or baby. It can help improve pregnancy outcome by allowing for a vaginal delivery and also by increasing time to delivery when delays may be more detrimental. Delays in delivery could result in an increased infection rate, such as when the water has already broken; worsening of certain obstetric disease states, such as preeclampsia; and increased uterine fatigue with resulting decrease in effectiveness of contractions which could result in arrest of the labor process and hemorrhage after delivery.
In my opinion, the absolute best way for delivery is for a patient to go into labor on her own and for there to be no complications during pregnancy or labor. However, we can’t just make that happen and there are times when it is not wise to wait for labor to occur spontaneously. Pitocin allows me to take care of a patient to the best of my ability WHEN I need to intervene. If all is going well, then intervention is not necessary and I certainly don’t implement treatments on my patients without reason.
A final word on elective inductions…
An elective induction is when labor is chosen to be induced due to non-medical reasons. These reasons may be that the patient lives far from the hospital or has a history of rapid labor & delivery so is afraid she won’t make it to the hospital in time. (Most women don’t really want their husbands delivering the baby while pulled over on the side of the highway)
Other reasons may be to ensure that the father of the baby can be present. I see this often when my patient’s husband is in the military and will be back from deployment for a short period of time. Sometimes, it is simply for convenience, such as the mother is feeling uncomfortable or to help with scheduling around other family member’s schedules & getting help with her other children. Elective induction has been approved by the American College of Obstetricians and Gynecologists. However, there are guidelines of which I strongly adhere. A patient should not undergo an elective induction prior to 39 weeks, as studies have found important neurologic development still takes place during the last few weeks of pregnancy. Also, if a patient has an unfavorable cervix (hasn’t started to dilate or efface), especially if this is her first pregnancy, an elective induction should not be performed. Instead, it is better to wait for the cervix to become more favorable, or the chance of a failed induction and need for cesarean section increases. If the cervix remains unfavorable and the patient doesn’t go into spontaneous labor by 41 weeks, an induction may then be recommended due to the risk of a post-dates pregnancy, which now becomes a medical indication.
So there you have it – pitocin summed up in a nutshell. Hopefully, this helps clear some of the confusion surrounding this common medication.
- Dr. Shelly Messer