Debunking the dangers of pitocin
When used correctly, pitocin can be very helpful for progressing labor.
Over the past year or so, I've noticed a growing number of pregnant patients and their partners who go into in an absolute panic when I say the word “pitocin.”
Pitocin is the synthetic form of oxytocin, which is a powerful hormone that helps us in many ways. Low levels of oxytocin are released frequently – when we hug others, when we play with our pets, and when we have sex, particularly with orgasm. It is often referred to as the trust or cuddle hormone.
Oxytocin is released during breastfeeding and is believed to help a new mother bond with her infant. But in regards to pregnancy, most people know it as the labor hormone. During labor, oxytocin stimulates powerful uterine contractions, which help get the baby out of the uterus.
In obstetrics, pitocin is most often given through an IV drip to induce or augment labor in a controlled medical environment. This is the part that seems to invoke fear and loathing among my pregnant patients.
There is a time and a place for pitocin. If a woman has gone about two weeks past her due date or has another medical reason for induction of labor, pitocin is the drug of choice to stimulate uterine contractions. Sometimes a laboring woman's contractions slow down, space out, or stop altogether. Often this patient will require just a small amount of pitocin to help labor progress. In any circumstance, pitocin should be given slowly, and only the minimum dose needed to induce or augment the labor should be administered. It is also commonly used immediately postpartum to help the uterus contract and prevent hemorrhage. Pitocin can be a true lifesaver in the face of a postpartum hemorrhage.
If you do a Google search on “pitocin labor induction,” you'll find some terrifying tales. It is no wonder that people are afraid of this drug. I will admit, if administered inappropriately, pitocin can cause contractions that are too frequent and too strong. This often results in fetal distress, necessitating intrauterine resuscitation, forceps delivery, vacuum delivery, or even cesarean section. I remember in my early days of nursing, some doctors wanted to increase the pitocin dose given to the patient until the baby was either delivered or in distress. I shudder when I think of those days.
I truly believe that most of pitocin's bad reputation is because of inappropriate use by obstetricians. Labor should not be induced or even augmented for provider or patient convenience. If a woman is not close to her due date and if her cervix is not soft and stretchy, it will take a much higher dose of pitocin to get labor started and keep it going.
Women worry that labor contractions will be more painful with pitocin – and they probably are. But labor, whether it is natural or induced, will be painful for the majority of women. On the other hand, I have witnessed many women having calm, medication-free births despite the use of pitocin.
Pitocin is a helpful drug when used judiciously to induce post-term pregnancies or for medical inductions of labor. When given intravenously, very small doses can be quickly effective. As I often explain to my patients, one of my favorite things about IV pitocin is that once stopped, it leaves the system very quickly. If there are negative effects, stopping the drip immediately often leads to rapid improvements.
Robyn Carlisle, MSN, CNM, works as a full-scope midwife in Philadelphia.