Pitocin and Oxytocin: What they do and why
What is Pitocin?
It is a synthetic version of Oxytocin, the body’s natural hormone that stimulates uterine contraction and milk production. The synthetic version is put directly into the bloodstream but cannot be released into the brain as natural oxytocin is.
What are the benefits of natural Oxytocin vs synthetic?
This hormone is released naturally by a woman’s body at certain specific points in life: labor, orgasm, breast-feeding and even in small amounts when in the presence of other women. For this reason it is called the love hormone. It is what causes a bonding response.
It also strengthens the contractions of the uterus. It comes from the Greek word for “quick birth”. It causes the contractions to be strong and effective.
When it is natural and not synthetic it is released into the brain as well. This has the effects of:
– increasing pain threshold
– relaxation and calmness
– aiding in bonding with child after birth
When Pitocin is used, the contractions are strengthened without the body’s pain relief being activated. This results in a much more painful labor.
How and when is Oxytocin released in the body/brain?
The parasympathetic nervous system is the system in the body that releases Oxytocin and calms you down. One of the reasons why yoga is so effective at stress relief is because it has been shown to activate the parasympathetic nervous system.
When a mother is relaxed, and Oxytocin is being released in her system, it causes the lower uterine muscles and cervix to relax and allow room for the baby while strengthening the upper uterine muscles to expel the baby through the birth canal.
When a mother is tense, it causes the reverse effect. Her upper uterine muscles loosen and lower tighten. Blood flow is diverted from the uterus to other parts of the body because her “fight or flight” response has been turned on. When this happens and the muscles are continuing to push the baby while the cervix has closed up, labor pain is greatly increased. We are seeing this more and more in laboring women as they enter a stressful birthing environment and are given synthetic hormones to increase and augment their labors. Causing much more pain in their process.
Things that can increase stress and activate the sympathetic nervous system are: bright lights, strangers in the room or anyone who causes discomfort to the mother, words of fear, fear of their partner, threats or time limits imposed on the mother, cold temperatures, being restricted to the bed, monitors, emotional pressure, repeated vaginal exams etc.
Research suggests that use of Pitocin is one of the main factors in our increased cesarean rate. Use of pitocin, especially during a normal labor, increases your risks of needing further medical intervention and ultimately cesarean.
What is in Pitocin?
Other than the drug itself, pitocin contains a preservative called chlorobutanol. This is a derivative of chloroform. It keeps the drug in your body for up to 10 days. It has been known to cause cardiac tension and should not be in the system with too much additional fluids. However, epidurals are almost always prescribed with pitocin because the unnatural contractions are now that much more painful. In order to keep your blood pressure from dropping patients are given a lot of fluid in an IV. (Thereby increasing your risks of side effects from the pitocin and fetal distress and an emergency cesarean.)
Concerns have been raised that using artifical oxytocin, which does not cross the blood/brain barrier but does cross the placenta, may be part of the cause of the rise in autism in the US. New research suggests that treating autistic children with pitocin (direct injection into the brain) is having positive responses. This implies that we are causing a deprivation of their naturally occuring oxytocin during labor and birth- the peak time for the presence of oxytocin. By interfering with the natural cocktail of hormones that are present during labor and birth. It’s estiamted that only about 4% of births medically require pitocin. That means that something like 75% of women are getting pitocin unecessarily. (A lot of this has to do with estimated due dates and not allowing pregnancies to reach 42 weeks, and the fear of big babies- But that’s for another blog!)
Should I induce labor with pitocin?
There are a list of reasons for inducing labor that are legitimate and where the risks may be outweighed by the potential benefits. These include things like preclampsia, if the baby has had their first bowel movement prior to the water breaking and/or prior to being born, being two weeks past the due date (greater than 42 weeks). Remember there are many other ways to induce labor without pitocin (prostangladins in semen, nipple stimulation..)
“As with all obstetric conveniences, there is growing evidence that the decision to induce for non-medically necessary reasons increases risks of interventions and complications, including, but not limited to: a longer labor compared to spontaneous labor, artificial rupture of membranes, significant discomfort, epidural anesthesia or increased need of other types of analgesia, maternal fever, hypotension, prolonged second stage of labor, operative vaginal birth, episiotomy, vacuum or forceps assisted vaginal birth, fetal heart changes, shoulder dystocia (where the baby’s shoulder gets stuck behind the mother’s pelvic bones), babies born with low birth weight, need for birth by cesarean section, need for admission to the Neonatal Intensive Care Unit (NICU), jaundice that required treatment and a lengthened hospital stay (Simpson and Thorman 135) (Amis 18) (Romano and Lothian 96). “Medical induction of labor also nearly doubled the risk of overall cases of amniotic-fluid embolism, and the association was stronger for fatal cases” (Kramer et al 1444). Because due dates are not an exact science, and there can be up to a two week error window for the actual due date, a medically induced baby at 38 weeks can actually only be 36 weeks old. This is one of the reasons that babies born after elective induction can have poor outcomes such as low birth weight or jaundice requiring treatment. They were accidentally born before they have reached full maturity, which is defined as reaching 37 completed weeks (Amis 8).
Besides, adverse maternal outcomes, such as cesarean sections, there are other reasons that might warrant waiting for spontaneous onset of labor, such as the addition of escalating health care expenditures, including additional supply and labor costs, added lengths of hospital stay, and increased neonatal and maternal morbidity and mortality. Delivery with spontaneous onset of labor is significantly lower than the cost of delivering following induction, particularly those ending in a cesarean birth (Wilson 212). There is also the chance that the mother may have to an intravenous line and continuous electronic fetal heart monitoring. In many settings, the mother must stay in bed or very close to the bed, and this does not allow the mother to walk freely or change positions in response to labor contractions, possibly slowing the progress of labor. The mother may be unable to take advantage of a soothing tub bath or a warm shower to ease the pain of labor contractions. Artificially induced contractions often peak sooner and remain intense longer than natural contractions, increasing the mother’s need for pain medication (Amis 8). The afore mentioned natural interventions all help the mother to have an “easier” labor and to help the labor progress along at a natural rate. A tub bath or a warm shower can be relaxing to the mother and may even help with pain distraction. Being artificially induced removes the ability to utilize these techniques, which can lead to an increased need for pain relief in the form of medications.
When it comes to the increased cost that is associated with elective induction of labor, Romano writes that women with induced labors were twice as likely to end up having their baby by cesarean delivery and in addition to this, their baby was more likely to need to be admitted to the Neonatal Intensive Care Unit (NICU). These factors resulted in a significantly high increase in the average cost of labor (53)”
Dysnfunctional Labor and Myometrial Lactic Acidosis
To induce or not to induce?
Amis, D. “Care practice #1: labor begins on its own.” Journal of Perinatal Education 16.3 (June 2007): 16-20. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
Amis, D. “Care practices that promote normal birth #1: labor begins on it own… including commentary by Gaskin IM.” Journal of Perinatal Education 13.2 (Mar. 2004): 6-10. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
“ICEA position statement and review: induction of labor.” International Journal of Childbirth Education 18.1 (Mar. 2003): 31-40. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
Kramer, MS, et al. “Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study.” Lancet 368.9545 (21 Oct. 2006): 1444- 1448. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
Lothian, JA. “Saying “no” to induction.” Journal of Perinatal Education 15.2 (Mar. 2006): 43-45. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Moran, DE and Kallam,GB The Gift of Motherhood: Your Personal Journey Through Prepared Childbirth. Customized Communications, Inc: Arlington. 2008.
Romano, AM. “Research summaries for normal birth.” Journal of Perinatal Education 15.1 (2006 Winter 2006): 52-55. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
Romano, AM, and JA Lothian.. “Promoting, protecting, and supporting normal birth: a look at the evidence.” JOGNN: Journal of Obstetric, Gynecologic, & Neonatal Nursing 37.1 (2008 Jan-Feb 2008): 94-105. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
Simpson, KR, and KE Thorman.. “Obstetric “conveniences”: elective induction of labor, cesarean birth on demand, and other potentially unnecessary interventions.” Journal of Perinatal & Neonatal Nursing 19.2 (Apr. 2005): 134-144. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
Waldenström, U, et al. “A negative birth experience: prevalence and risk factors in a national sample.” Birth: Issues in Perinatal Care 31.1 (Mar. 2004): 17-27. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
Wilson, BL. “Assessing the effects of age, gestation, socioeconomic status, and ethnicity on labor inductions.” Journal of Nursing Scholarship 39.3 (Sep. 2007): 208-213. CINAHL with Full Text. EBSCO. 7 Mar. 2009 .
Risks of Pitocin, according to the FDA:
“Oxytocin is distributed throughout the extracellular fluid. Small amounts of the drug probably reach the fetal circulation.”
This is the FDA website for Pitocin.
All patients receiving intravenous oxytocin must be under continuous observation by trained personnel who have a thorough knowledge of the drug and are qualified to identify complications. A physician qualified to manage any complications should be immediately available. Electronic fetal monitoring provides the best means for early detection of overdosage (see OVERDOSAGE section). However, it must be borne in mind that only intrauterine pressure recording can accurately measure the intrauterine pressure during contractions. A fetal scalp electrode provides a more dependable recording of the fetal heart rate than any external monitoring system.
When properly administered, oxytocin should stimulate uterine contractions comparable to those seen in normal labor. Overstimulation of the uterus by improper administration can be hazardous to both mother and fetus. Even with proper administration and adequate supervision, hypertonic contractions can occur in patients whose uteri are hypersensitive to oxytocin. This fact must be considered by the physician in exercising his judgment regarding patient selection.
Except in unusual circumstances, oxytocin should not be administered in the following conditions: fetal distress, hydramnios, partial placenta previa, prematurity, borderline cephalopelvic disproportion, and any condition in which there is a predisposition for uterine rupture, such as previous major surgery on the cervix or uterus including cesarean section, overdistention of the uterus, grand multiparity, or past history of uterine sepsis or of traumatic delivery. Because of the variability of the combinations of factors which may be present in the conditions listed above, the definition of “unusual circumstances” must be left to the judgment of the physician. The decision can be made only by carefully weighing the potential benefits which oxytocin can provide in a given case against rare but definite potential for the drug to produce hypertonicity or tetanic spasm.
Maternal deaths due to hypertensive episodes, subarachnoid hemorrhage, rupture of the uterus, and fetal deaths due to various causes have been reported associated with the use of parenteral oxytocic drugs for induction of labor or for augmentation in the first and second stages of labor.
Oxytocin has been shown to have an intrinsic antidiuretic effect, acting to increase water reabsorption from the glomerular filtrate. Consideration should, therefore, be given to the possibility of water intoxication, particularly when oxytocin is administered continuously by infusion and the patient is receiving fluids by mouth.
When oxytocin is used for induction or reinforcement of already existent labor, patients should be carefully selected. Pelvic adequacy must be considered and maternal and fetal conditions evaluated before use of the drug.
Carcinogenesis, Mutagenesis, Impairment of Fertility
There are no animal or human studies on the carcinogenicity and mutagenicity of this drug, nor is there any information on its effect on fertility.
Animal reproduction studies have not been conducted with oxytocin. There are no known indications for use in the first trimester of pregnancy other than in relation to spontaneous or induced abortion. Based on the wide experience with this drug and its chemical structure and pharmacological properties, it would not be expected to present a risk of fetal abnormalities when used as indicated.
See ADVERSE REACTIONS in the fetus or neonate.
Labor and Delivery
See INDICATIONS AND USAGE section.
The following adverse reactions have been reported in the mother:
||Premature ventricular contractions
||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:
||Due to use of oxytocin in the mother:
|| 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.