Pit: Inductions

This is #3 in a series of posts about pitocin. Check out #1 here and #2 here.

Inductions are a hot topic in the “birth world.” Are the necessary? Sometimes, absolutely. Are their unnecessary ones? Sometimes, absolutely. This post isn’t going to be about whether or not your induction is/was necessary, instead, I would encourage you to check out ACOG’s stance on inductions, as well as head over to Evidence Based Birth and check out her posts about inductions (they are awesome, and so thorough). What this post IS going to be about is pitocin during inductions, and other induction options that you might have. I say “might” because every situation is different, every care provider is different, and every hospital is different. As always, we are not care providers, so please discuss anything that you read here with your provider regarding your specific situation.

Inductions happen for many, many reasons. All induction methods are not equal, but one thing that IS something every woman who is facing induction should consider is her Bishop Score. The Bishop Score is a scoring system that providers can use to determine how likely an induction is to succeed, and also the liklihood of spontaneous pre-term labor. The Bishop Score is determined by scoring from 0-3 each of the following: cervical dilation (0-10 cm), cervical effacement (0-100%), cervical consistency (firm to soft), cervical position (anterior to posterior), and fetal station (how high the baby is in the pelvis).¹ For a great chart with this scoring system on it, check out Wikipedia. The higher a woman’s score, the greater chance of a successful induction (successful meaning ending in a vaginal delivery). A score of 8 or higher is generally considered to be favorable for induction. If a woman’s score is not “favorable,” it does not mean that she will be unable to have a successful induction, it just means it’s less likely. If you have a lower Bishop score, and are facing an induction, have a chat with your care provider to see what options you might have to make your chances of an successful induction better (waiting, for example, or possibly going home if induction doesn’t start labor).

If you and your provider agree that an induction is the best course of action for you, make a plan for how you would like your induction to proceed. You have options about how to start the induction process. These include a cervix ripening suppository, if necessary, which often takes more than one day to make an effect on the cervix. Cervidil and Cytotec are both used to help soften the cervix, but we strongly encourage you to look into the medical indications for using cytotec. If you choose a cervical ripening suppository, you will be checked into the hospital and stay (usually overnight) while the suppository is in place. Sometimes these cervical ripeners also start contractions, in which case you may need nothing else to get labor going! After doing the cervical suppository, often pitocin is the next option. Pitocin is usually started off slowly, and increased as labor goes on. Sometimes if a woman’s body appears to take over all by herself, pitocin is turned off. If your cervix appears favorable for induction, but you want to avoid pitocin, another option  is AROM (artificial rupture of membranes). This is sometimes done in addition to pitocin is the pitocin doesn’t seem to be doing the job on its own, but could also be done without pitocin. This basically means that your care provider will break your water, which hopefully signals to your body to start contractions. Another option for starting an induction is a Foley bulb catheter. This is a catheter that is inserted into the opening of the cervix. The catheter is slowly filled with water to dilate the cervix. Once the cervix is dilated to 3 centimeters, the catheter falls out or is taken out, and hopefully will have encouraged a woman’s body to start contractions and continue the dilation process.

Inductions do not always have to be an all-or-nothing process. We have all had clients and know others personally who have gone in to attempt an induction, have it not work, and leave to come back and try another day. Pitocin can be turned off and the induction can be halted, as long as a woman’s water is not broken. Once a woman’s water is broken however, the induction needs to proceed forward due to the risk of infection for the longer the induction process goes on. Have the discussion about what you would like to do if the induction does not work ahead of the induction, so that you and your care provider are on the same page.

There are also more “natural” methods for potentially inducing labor. We are not endorsing any of these, and none have been scientifically proven to work, however they are options that you can talk to your care provider about, should you be interested in them. The first, and most often recommended method of starting labor is by having sex. The prostaglandins from semen can help ripen the cervix, and an orgasm causes contractions of the uterus, which can also start labor. This will only work if a woman’s body is ready to go into labor, however. Having sex at the end of pregnancy is not going to put you into labor if your body is not ready for it! Other options are nipple stimulation (manual or breast pump) and taking castor oil. There are also plenty of opinions about which foods can also induce labor– we have never seen any of these necessarily work, but many of them are worth a shot (spicy foods, pineapple…you name it 🙂 ) Natural methods of labor induction can be used in addition to medical options for induction, as long as you have the discussion with your care provider ahead of time.

Next up in our blog series about pitocin, we’ll be discussing pitocin during labor for augmentation, as well as pitocin used postpartum. Stay tuned!

 

¹https://en.wikipedia.org/wiki/Bishop_score
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Pit: Oxytocin vs. Pitocin

This is #2 in a series of posts about pitocin. Check out the first one here!

pitocin

Oxytocin, AKA the “love hormone,” is a hormone released in a woman’s body during sex, childbirth, breastfeeding, and plays a HUGE role in our bodies. It promotes bonding between partners and children, gets labor started, signals to the baby’s brain in utero that it’s about to be born, helps regulate fear and anxiety, produces an anti-depressant like effect, can inhibit drug addition and help with withdrawal symptoms, and in one study, the missing oxytocin recepter gene was linked to autism (source). WOW. Talk about a powerful hormone! Since this is a blog hosted by doulas, we’re going to focus here on the effects of oxytocin and pitocin during labor, delivery, and postpartum.

We still aren’t sure what exactly kicks labor into gear, but there are many postulations. Regardless of what starts labor, oxytocin is the critical hormone during labor and delivery. Oxytocin signals to the uterus to start contracting by increasing oxytocin receptors in the uterus, and keeps contractions going strong during labor. (Without sufficient oxytocin receptors, the uterus does not contract efficiently). It also helps reduce fear and anxiety, which is crucial during labor and delivery. Oxytocin is present in small amounts at the beginning of labor, and peaks at delivery, giving mom a sense of euphoria when baby is born, which immediately helps mom bond with her baby. It also contributes to the ejection of the placenta, and helps the uterus clamp down after birth, preventing postpartum hemorrhage.

Pitocin is a drug that is given intravenously during an induction of labor, during labor to augment (“help”) labor, and immediately postpartum. It is given continuously, and is increased manually throughout labor if deemed necessary. Oxytocin naturally comes in waves throughout labor, giving mom a break in between contractions. Pitocin, on the other hand, often causes contractions to be longer and stronger with smaller breaks in between due to the continuous nature of the IV drip. When a woman is in labor, oxytocin also works in harmony with other hormones in the body, including endorphins. With the increasing waves of oxytocin, mom’s brain is signaled to increase the level of endorphins released, helping cope with the pain and intensity of labor. Pitocin does not have this effect on endorphins (due to it not crossing the blood-brain barrier easily) which means pitocin augmented labors are often described as more painful and more intense than when labor is naturally progressing. At the end of labor, oxytocin peaks, causing the fetal ejection reflex, or Ferguson reflex–that “freight train” feeling that mom can’t fight–baby is GOING to come out. Pitocin is regulated by a pump, which means that peak is not going to happen. Once baby is born, a rush of oxytocin floods the brain, causing the new mother to immediately start bonding with her baby. The constant pump of pitocin interferes with the body’s signal to release that flood of oxytocin, so she doesn’t necessarily get that rush of “love” hormone right as she begins holding, cuddling, and nursing her baby. Oxytocin also signals the uterus to contract more, preventing excessive blood loss. One study showed that if a mother is exposed to pitocin during birth and immediately postpartum, the levels of oxytocin in her body 2 days later were actually LOWER than if she had not used pitocin. This can effect her postpartum recovery as well as her breastfeeding relationship with her new baby–both emotionally and physically, as oxytocin surge is needed to trigger milk let down.

Long-term, the same study is actually asserting that the more pitocin is used, it could actually have an effect genetically on the baby–essentially “turning off” the oxytocin recepter genes, meaning that when that baby goes to give birth as an adult, their body may not respond well to their natural oxytocin surges due to a lack of functioning oxytocin recepters.  Naturally occurring oxytocin in the mother would not have the same effect on the baby.

Pitocin, while able to physically give a desired result (assisting in functional uterine contractions), is not the same as oxytocin. It effects the mother, the baby, the labor, delivery, and postpartum time differently than it’s natural counterpart. These differences should not be taken lightly, and should be considered when discussing whether the addition of pitocin during a labor and delivery are necessary.

 

Stay tuned for part 3: Pitocin and Alternatives During Labor.

Standard Disclaimer: Doulas are NOT medical professionals, and anything that is suggested or mentioned as an option on this blog should always be discussed with your care provider.

Pit.

This is the first of 4 posts about pitocin use, and alternative options that a mom might have during induction, labor, and postpartum. 

“She’s on pit.”

“Are we doing pit?”

“Did you get the pit started?”

“Is she doing a pit induction?”

“The pit is running.”

 

Pit, or pitocin, is one of the most commonly used medical interventions in childbirth. I have seen estimated statistics as high as 60% of births using pitocin to induce or augment labor. Pitocin is used to induce labor, “speed up” labor, and routinely after birth to help prevent hemorrhage. Pitocin can cause labor patterns to be unnaturally difficult for mom and baby, often leading to other medical interventions and eventually even c-sections sometimes, that could have been avoided had pitocin not been administered in the first place. Is this always the case? Absolutely NOT. We completely recognize the need for labor induction and augmentation sometimes, and have personally seen pitocin-augmented deliveries go smoothly. But it’s not often the case, and many care providers don’t mention the difference between synthetic oxytocin (aka Pitocin) and natural oxytocin produced by mom’s body when she’s in labor. There are differences, and they effect mom and baby and labor differently. In fact, in 2013, ACOG released a statement about a study regarding Pitocin and the negative effects on newborns:

“As a community of practitioners, we know the adverse effects of Pitocin from the maternal side,” Dr. Tsimis said, “but much less so from the neonatal side. These results suggest that Pitocin use is associated with adverse effects on neonatal outcomes. It underscores the importance of using valid medical indications when Pitocin is used.” (source).

Just a few weeks ago, another study was released indicating a significant relationship between the use of pitocin and postpartum depression in mothers. The study results showed that, for women with a history of anxiety or depression, exposure to synthetic oxytocin during birth increased their chances of having postpartum depression/anxiety by 36%. In women with no previous history of anxiety or depression, their risk was increased 32%. These are not small numbers, folks. And keep in mind, this is only the percentage of women who were diagnosed and treated with medication. How many thousands of women struggle through their postpartum time with undiagnosed PPD or anxiety because they are afraid to tell anyone, or don’t even recognize it? I know I am one of them.

So, what’s a woman to do? When her care provider is suggesting induction, or her natural labor pattern is not “fast enough” or “progressing well,” or her care provider uses pitocin as standard protocol post-delivery, is she supposed to just say no and hope for the best? No! While we absolutely recognize the need for pitocin sometimes, I think we can ALL agree that it is significantly overused, and often leads to a string of events commonly called the “cascade of interventions.”

Over the next few weeks, I hope you’ll join me as I discuss some alternatives to pitocin for induction, labor augmentation, and post-birth, as well as share some resources for moms who are struggling with PPD. Stay tuned!

Standard Disclaimer: Doulas are NOT medical professionals, and anything that is suggested or mentioned as an option on this blog should always be discussed with your care provider.