The Truth About Pitocin and Labor Induction

Posted on June 9, 2009. Filed under: pitocin, Pregnancy | Tags: elective induction, FDA approval pitocin, induction, medical induction, pitocin, pitocin induction |

There is a difference between elective induction and medical induction. Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Reasons for medical induction include: fetal distress, pre-eclampsia, uterine infection, premature rupture of membranes and other situations where the health of the mother or baby are compromised by continuing the pregnancy. One in five pregnancies are induced in the U.S. with some hospitals reporting induction rates as high as 50%. The medical induction group appears to be in the minority, however, since the 1999 Green Journal review reported that as many as 3 out of 4 labor inductions were performed without an indicated risk. (I cannot link the article and it is 10 years old but I would be willing to bet the stats aren’t any better now as induction rates have increased). In short that means that 75% of induced pregnancies are not for medical reasons. Research has proven that elective inductions lead to higher c section rates.

I start this post discussing the differences between medical induction and elective induction because labor is often induced with a drug called Pitocin that is only approved for use in medical inductions. Pitocin is synthetic for of the hormone Oxytocin that the body releases to cause contractions. How does Pitocin play into the reasons for induction? Well, I am going to tell you but let’s start with some background info first.

Someone asked me the other day what the long term affects of Pitocin use where. I told her that it was unknown and I started thinking about Pitocin and everything that I know about it. Here’s what I knew…

It’s a chemical synthetic version of Oxytocin

It’s used for labor induction and postpartum hemorrhage

It causes contractions to be stronger, longer and closer together than normal, which leads to epidural use

It can hyperstimulate the uterus

It can cause fetal distress

It interferes with the normal flow of Oxytocin but does not replicate the emotional responses that Oxytocin create

It can cause uterine rupture

I decided that I should learn more about it as it is becoming more routinely used. Here’s what I found according to the package insert …

In the mother it can cause:

Anaphylactic reaction

Premature ventricular contractions

Postpartum hemorrhage

Pelvic hematoma

Cardiac arrhythmia

Subarachnoid hemorrhage

Fatal afibrinogenemia

Hypertensive episodes

Nausea

Rupture of the uterus

Vomiting

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug. Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.

For the baby it can cause:

Due to induced uterine motility:

Bradycardia

Low Apgar scores at five minutes

Premature ventricular contractions and other arrhythmias

Neonatal jaundice

Permanent CNS or brain damage

Neonatal retinal hemorrhage

Fetal death

Neonatal seizures have been reported with the use of Pitocin.

These are the known short term affects of use. There have been no long term or controlled studies for long term affects. Due to this the package insert says this based on recommendations from the FDA:

IMPORTANT NOTICE



Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefits-to-risks considerations, Pitocin is not indicated for elective induction of labor.

Now THIS I didn’t know. It is not even approved for use for elective induction! How many of you had routine pitocin administered in your labor? To ‘get things going’? To ‘get you over that hump’? How many of you were informed that it’s not approved for that? How many of your were told of all the risks associated with it’s use? How many of you weren’t even told it was being administered through your required routine IV?

When you think of risk vs benefit, and you are told that your baby is safer on the outside than on the inside then Pitocin induction is a risk that may not be as risky as not inducing. That makes perfect sense to me. Why would we subject ourselves and our babies to these risks for no reason other than being tired of being pregnant? Or being told that you might have a big baby? Which by the way, ACOG doesn’t even recommend induction for suspected microsomia because growth scans can be off by up to two pounds. Another common induction reason is that the pregnancy is past 40 weeks. What happened to 42 weeks before discussing induction?

Here’s what I suggest…

Learn as much as you can about induction if it’s being suggested. Learn the medical reasons and risk vs benefits of inducing or not. Find out your Bishop’s Score. The Bishop’s Score can help you understand your chances of having successful induction or failed induction. Learn about the natural induction methods and ways to get labor going. Sex and nipple stimultion and orgasms all cause the body to release oxytocin!

The c section rate in the U.S. is horrifying. Many of these unnecesarians are due to failed inductions. I haven’t discussed c sections and their risks yet but I will go ahead and leave you with this…

According to Mardsen Wagner’s interview in The Business of Being Born, he says that section rates in the 70’s in the U.S. were at 7%. It is now over 30% and no more babies are being saved than before. In fact, the U.S. ranks 28th in the WORLD for infant mortality. That means that 27 other modern countries have better out comes than the U.S. C section has become so routine in our country that most people don’t even understand the risks involved. I truly believe that the way to start lowering these incredibly high numbers is to stop the elective inductions.

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