Monday, July 13, 2009

Pitocin and Your Birth Experience

I don't know all the medical reasons to induce or augment labor. However, I do know that post-term babies are often born with the help of pitocin. Pitocin works by stimulating uterine contractions as the natural hormone oxytocin does. Pitocin is synthetic oxytocin. Oxytocin is also released while breastfeeding. You will find a lot of bad press on pitocin but this drug does have its place in birthing.

Please be informed about getting pitocin before you go into labor because many women end up getting it by IV at some point during labor. If you are trying to do a natural birth, or stay off of meds for as long as possible, be warned that contractions with pitocin will likely be more intense than your natural contractions. This is because pitocin isn't released at the same pace as oxytocin is released in your body.

"The Context & Clinical Evidence for Common Nursing Practices During Labor" published in MCN The American Journal of Maternal Child Nursing, 2005, gives some great information about the use of this drug. Here is an excerpt:

"Each woman has individual myometrial sensitivity to oxytocin. The primary goals are to achieve adequate progress of labor using the lowest possible dose with the fewest side effects and to have continued evidence of maternal-fetal well-being. During the initial incremental phase of oxytocin administration (1.5 to 2 hours), uterine contractions will progressively increase in frequency and duration. Once the stable phase has been reached (after 3.5 to 4.5 hours of administration), any further increase in dosage will not result in more frequent normal uterine activity, but rather a risk of medication side effects such as hyperstimulation and nonreassuring fetal heart rate changes."

It continues with "The approach to intravenous oxytocin administration associated with the fewest side effects is to begin at 0.5 to 1 mU per minute and increase by 1 to 2 mU per minute at intervals no less than every 30 to 40 minutes until active labor is achieved...90% of pregnant women at term will have labor successfully induced with less than 6mU per minute of oxytocin."

In this article it is very important to note that low-dose protocols of oxytocin were safer for mom and baby. If you get a low-dose protocol, instead of a high-dose protocol, you will be less likely to have a hyperstimulated uterus (contractions coming too fast and furious) and less likely to need a C-Section or instrument delivery (such as forceps). Oxytocin/pitocin make it more likely for the baby to experience poor heart rates during labor due to hyperstimulation. C-birth becomes more likely because of the increase in poor fetal heart rates.

If you end up on an oxytocin protocol, I suggest asking to be on the lowest-dose protocol that the hospital has. At the hospital where I used to work, we had higher-dose protocol called the San Antonio Protocol. Good doctors choose this protocol in a perfectly normal, slow-progressing birth. If you are exhausted, have an epidural, and are willing to take the risk, go for the higher dose protocol. Just ask lots of questions and become as informed as you possibly can.

One last point this article made that I think is important: Nurses often follow the protocols while ignoring the clinical criteria for dose increases. If you are progressing at at least 1 cm per hour, you do not need and increase in the oxytocin rate. The rate of dilation is more important than the intensity or duration of contractions. Also, if your baby is having heart rate that isn't so good, the induction/augmentation with pitocin should be stopped.

This is a lot of information to keep in mind while dealing with the labor of your baby.  I suggest hiring a doula or making sure you have a very informed partner or friend.

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