Wednesday, November 19, 2008

The "P" Word

The P word.

Ahhh Pitocin. Many in the medical field call it “Pit”, and I think that is a suitable name. If you live in the USA, chances are that you have heard of this wonder drug. Unless you live in a cave, it’s pretty safe to say that you or somebody you know has had this drug during labor. What is it? It’s a synthetic version of oxytocin. You know, that stuff that makes you have contractions.

Pitocin is used in several ways. 1) To induce labor. 2) To speed labor up (or as some may put it, make the contractions more effective). And 3)to aid in the expulsion of the placenta during the third stage and 4) reduce bleeding/prevent hemorrhage.

I’m a firm believer in using interventions when medically necessary. BUT - (and you probably knew there would be a “but” and yes I also realize you should never start a sentence with the word but..) Why is the pitocin rate climbing to a staggering 80-98 % rate? (a 1992 survey by a medical anthropologist at the University of Texas found that 81% of women in US hospital receive Pitocin to either induce or augment labor). According to the Centers of Disease Control (CDC), the induction rate for women 15 years ago was 9.5%. My question is WHY has its use jumped up so much?  Are the uteri of women in our country incompetent? The short answer is no.

So why am I concerned? What is the big deal? I’m sure you are thinking that a healthy baby at the end of the day is the most important thing. I agree. But (yep, there’s that word again - you may as well get used to it :-), is it safe for the mother and the baby? What are the consequences, or side effects?

One of the almost guaranteed side effects, is an indirect one.. and that is increases pain. Harder contractions, longer contractions and sometimes double peaking contractions. Most women find the contractions so difficult to work through and stay on top of, that an epidural is needed.  The baby doesn’t like the harder contractions either, and often we see babies go into ‘fetal distress’ because of the effects of the Pit. Fetal distress can lead to a cesarean.  Since I'm all about trying to reduce the cesarean section in the US, I think we should save it for when it's needed -when the safety of mom or baby is at risk, and when staying pregnant is more dangerous than being induced.  Pitocin is also being linked to lower APGAR scores, and an increased need for baby to visit and possibly stay in the NICU for a while.*1 

I love this clip from "The Business of Being Born": 



Pitocin has another indirect consequence in that it interferes with the bonding process. Those who do not have pain medications, and Pitocin during birth have a wonderful balance of hormone cocktails that aid in our ability to cope with the pain and bond with our baby at birth. These hormones are also produced in high amounts and passed on to the baby. They provide us with the feelings of love, the inclination to protect, and care for our baby. When we use Pitocin, our bodies shut off our own oxytocin production to varying degress. We loose the benefits of this harmonic role our body plays in birth, and perhaps it causes a long term effect to the bonding process as well. I’m not saying that you don’t love your baby any more than the person next to you that did not have Pitocin. I’m sure you love your baby very much!  Can bonding be harder with Pitocin?  Some will say yes, it can be a side effect.  Dr. Michel Odent has been studying the hormones of labor for a really long time, and he certainly has some concerns:


video


Finally we have the question of the autism/pitocin connection. Now I am open to answers on autism. Perhaps it is not just one thing that causes it. It could be a combination of things. However, autism rates when up with the use of Pitocin rates. Pitocin blocks the love hormone that is also associated with socialization. Funny, I know a lot of autistic kids who have problems with socialization. There is a lot of discussion about the correlation between autism and Pitocin. The jury is still out here, but here are some pretty compelling articles (based on the latest research) worth viewing: 
http://www.autismspeaks.org/science/science-news/study-links-inducingaugmenting-labor-modestly-higher-autism-risk
http://www.theblueroomforum.org/f41/oxtocyn-possible-cure-being-tested-autistic-adults-296/

What are the actual (direct) side effects of the drug itself?  According to the package insert (which you can read here) here are the possible reactions: 
ADVERSE REACTIONS
The following adverse reactions have been reported in the mother:
Anaphylactic reaction
Postpartum hemorrhage
Cardiac arrhythmia
Fatal afibrinogenemia
Nausea
Vomiting
Premature ventricular contractions
Pelvic hematoma
Subarachnoid hemorrhage
Hypertensive episodes
Rupture of the uterus
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.
The following adverse reactions have been reported in the fetus or neonate:
Due to induced uterine motility:
Bradycardia
Premature ventricular contractions
and other arrhythmias
Permanent CNS or brain damage
Fetal death
Neonatal seizures have been reported
with the use of Pitocin.
Due to use of oxytocin in the mother:
Low Apgar scores at five minutes
Neonatal jaundice
Neonatal retinal hemorrhage

The thing is, Pitocin does not always cause the cervix to dilate. It causes the uterus to contract, but that does not always cause the cervix to open. Often women are labeled as “failure to progress” during an induction, simply because their cervix was not ripe enough prior to the induction.  No wonder our cesarean rate is so high!  

 My point is Pitocin is given out way too easily these days. There are risks. There are side effects. Sometimes it is necessary, and the risks still outweigh the risks of major abdominal surgery. Most of the time, it used to make it easier on the hospitals, doctors and nurses -and it gives them added protection against lawsuits (and it's our fault as a society that it has come down to our providers feeling the pressure to induce because we might sue for whatever X reason).  

What can you expect if you need to be induced:

Mom can expect to have an IV (if she doesn’t have one already), and continuous fetal monitoring.  If she planned to labor in a tub, she may not be able to do this unless the hospital has wireless monitoring, and they can monitor baby well while she labors in the tub.  (It's rare, but it can happen sometimes). Contractions might be harder, so an epidural is more likely (but it's not impossible, I have had a few moms give birth without any pain meds while they were being induced). 
Remember you still have options when it comes to Pitocin - specifically how much you receive!
  You can opt to try starting your labor with Pitocin, and then turning it off once you are in a good contraction pattern (some providers would like that to be 3 minutes apart and lasting about one minute). You may or may not continue to labor on your own.  If your body does not kick, the induction process will start over.
  If you are in a good active labor pattern, and they are increasing the Pitocin, you can request that they NOT increase it so that you might be able to continue to labor without the use of pain management.  You can also request that it be turned down if you are having a hard time coping through those frequent, hard contractions.


References:
1. http://www.acog.org/About%20ACOG/News%20Room/News%20Releases/2013/Study%20Finds%20Adverse%20Effects%20of%20Pitocin%20in%20Newborns.aspx
http://www.autismspeaks.org/science/science-news/study-links-inducingaugmenting-labor-modestly-higher-autism-risk
http://www.theblueroomforum.org/f41/oxtocyn-possible-cure-being-tested-autistic-adults-296
http://abcnews.go.com/Health/study-pitocin-harm-babies/story?id=19148043
http://chriskresser.com/natural-childbirth-vi-pitocin-side-effects-and-risks
http://www.jhppharma.com/products/PI/June-11-2008/Pitocin-Full-Prescribing-Information.pdf

Another video I often show my childbirth class students:
http://www.oneworldbirth.net/videos/when-and-how-is-oxytocin-released-during-birth/

3 comments:

The Mommy Blawger said...

A great start! I look forward to reading more.

Navywifeandmom said...

Do 80-90% of women get Pit as induction or augmentation? Or does that include the "standard" Pitocin shot after birth? A lot of places it is standard for everyone to get a Pit shot after birth to prevent hemorrhage.

Of course I refused that with all my kids and just use the old-fashioned breastfeed-the-baby trick and my third stage bleeding slowed right down. Interestingly enough, supposedly women who have had as many kids as we have (I've had five total) are supposed to bleed more the more kids they have. I seem to be going in the opposite direction and bleeding LESS with each birth. I also have had three out of five of my births be precipitous (under two hours) and that also puts you at greater risk for hemorrhage but still nothing like that has ever happened to me (knock on wood, I know anything is possible).

You should post your own birth stories sometime, Trisha! You've had firsthand experience with just about every intervention out there as well as the NICU with some of your babies.

I look forward to reading more when I get time!

~The~Birth~Teacher said...

Dear Navywifeandmom,

Your question is a good one!

Like I mentioned in the post, the US government makes it hard to get our hands on any solid stats for the recent years. So I’ll give you what I have:

According to the University of Washington, approximately 20-34% of women undergoing labor induction in the United States annually. The study also states that nearly 15% of the inductions were not clinically necessary. You can read that study here:
http://pregnancy.about.com/gi/dynamic/offsite.htm?zi=1/XJ/Ya&sdn=pregnancy&cdn=parenting&tm=19&f=00&tt=14&bt=1&bts=1&zu=http%3A//pregnancychildbirth.suite101.com/blog.cfm/unnecessary_inductions

Robbie Davis-Floyd PhD did her own study and found that 81% of the women who gave birth in the hospital received pitocin during their labors.

In 1992 the CDC reported 4,065,014 births in the US.
They reported 453093 inductions and 513161 ‘stimulated labors’. Pitocin was used: 966,254 times - which is about 24%.. (Of course, this was 16 years ago!)

In 2005, there was a reported 4,138,349 births to the CDC. Of those, 4,100,608 were in the hosptial. 919,835 were induced. 23% induction rate over all. This does not include the use of Pitocin for augmentation, or third stage management. Not only that, but this was 3 years ago!
(As a side note Cesarean rate was reported at an all time high at 30.3%)

The following website has an interesting study using a survey. They did this study in 2002 - and polled 1,583 women who had given birth in the past 24 months. This study reports that:
“Most women in the survey said they experienced electronic fetal monitoring (93%), intravenous drips (86%), epidural anesthesia (63%), artificially ruptured membranes (55%), pitocin augmentation (53%), bladder catheterization (52%), and repair of episiotomy or laceration (52%). In addition, 44% of women reported having their labors induced. “
You can read the entire study/article here:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1595140

I found one OB who said that most hospitals don’t even know what a spontaneous labor is. This was dated back in 2000!

I can’t really find the numbers on augmented labors - but from what I read and seen, it is very high.

As for my own births, I have been pretty fortunate to avoid some of the bigger interventions. Out of six births, I had two episiotomies, and two vacuum extractions. I’ve had an IV in 3 of my six births, and I have had a shot of Methargine three times, as I was bleeding way too much. I should probably count AROM as I’ve had it done with all six. (Though my last three births it wasn’t done until about 20 minutes before birth). Now preterm labor..that’s another story :-)

Thanks for writing,
~Trisha