As I near the end of the prenatal visits with patients, I often hear “Whatever you do, I hope I don’t need pitocin,” but when I ask why, there’s never really a clear answer. It’s usually that they heard from someone who had a friend who had a cousin, or they read online that someone said it was bad. With this blog, I hope to help sort some of the fact from fiction.
What is pitocin? Here’s the fancy answer: “it’s a nonapeptide protein.” That’s the one you can use to sound smart. Here’s the simple answer: it’s the synthetic form of oxytocin, which is a hormone released by your very own pituitary gland. Oxytocin is produced in response to labor and helps stimulate contractions, and it also is released during breastfeeding. Those cramps you have while breastfeeding? You can thank pitocin.
Why does your ob/gyn use this medication? There are 2 main reasons: it can be used to increase the strength of contractions, and it can also be given after delivery to help prevent bleeding (it helps the uterus contract and squeeze blood vessels closed). During labor, you might think, “My contractions are plenty strong on their own, thank you very much,” but occasionally they aren’t. Generally, the ideal strength of contractions that are strong enough to change the cervix in a timely manner without being so strong as to stress out your baby is 200-300 MVUs. The strength of the contractions can be measured with an internal monitor placed beside the baby called an IUPC, and this monitor helps the nurse adjust the medication into the appropriate range to achieve the contraction strength noted above. This can help the labor progress in the optimal timeframe to help minimize the chance of intrauterine infection and decrease the chance of cesarean section once your labor has started or your water has broken. Pitocin can also be used to stimulate contractions in order to initiate labor when medically indicated. During inductions when the cervix is unfavorable (ie closed and not thinned), this is the time when we may see an increase in the need for cesarean delivery with pitocin. However, sometimes deliveries are medically indicated in patients with an unfavorable cervix, such as in patients with certain blood pressure issues, diabetes or other situations where to continue pregnancy has greater risk to mom/baby than ending it. Without pitocin, though, medically indicated deliveries in patients with an unfavorable cervix would almost certainly have to be via cesarean delivery.
Is it safe? Oxytocin is unavoidable during labor and breastfeeding, and your body has been designed to utilize this hormone in both cases. When used at doses to obtain appropriate strength of contractions, both mom and baby tend to tolerate this medication well. Even if the baby shows some element of stress, the half life of pitocin is only 3-5 minutes, so the effects end shortly after the medication is stopped. Additionally, medications such as terbutaline can also be used to relax the uterus if needed. Lastly, oxytocin used immediately after delivery decreases the chance of hemorrhage. Postpartum hemorrhage is the leading cause of maternal death worldwide and the main reason that the maternal mortality rate is 239 per 100,000 in developing countries vs only 12 per 100,000 in developed countries.
Are there any other options? At this time, pitocin tends to be the most effective and safest option that we have. Some researchers have looked into the use of nipple stimulation to release natural oxytocin to stimulate labor, but at this time, there has been limited success, probably due to the fact the nurses’ hands must have gotten really tired ;) Besides, there’s really only so much that lanolin can do for the breasts after a long labor like that!
So, while not all pregnancies require pitocin, it may be required during labor or after delivery. When dosage is titrated to the optimal contraction strength, pitocin is often the most effective method to help obtain a safe outcome for mom and baby. And for us, this helps us to reach our ultimate goal, which is to conclude the pregnancy with a healthy, happy mom and baby :)
Nick
What is pitocin? Here’s the fancy answer: “it’s a nonapeptide protein.” That’s the one you can use to sound smart. Here’s the simple answer: it’s the synthetic form of oxytocin, which is a hormone released by your very own pituitary gland. Oxytocin is produced in response to labor and helps stimulate contractions, and it also is released during breastfeeding. Those cramps you have while breastfeeding? You can thank pitocin.
Why does your ob/gyn use this medication? There are 2 main reasons: it can be used to increase the strength of contractions, and it can also be given after delivery to help prevent bleeding (it helps the uterus contract and squeeze blood vessels closed). During labor, you might think, “My contractions are plenty strong on their own, thank you very much,” but occasionally they aren’t. Generally, the ideal strength of contractions that are strong enough to change the cervix in a timely manner without being so strong as to stress out your baby is 200-300 MVUs. The strength of the contractions can be measured with an internal monitor placed beside the baby called an IUPC, and this monitor helps the nurse adjust the medication into the appropriate range to achieve the contraction strength noted above. This can help the labor progress in the optimal timeframe to help minimize the chance of intrauterine infection and decrease the chance of cesarean section once your labor has started or your water has broken. Pitocin can also be used to stimulate contractions in order to initiate labor when medically indicated. During inductions when the cervix is unfavorable (ie closed and not thinned), this is the time when we may see an increase in the need for cesarean delivery with pitocin. However, sometimes deliveries are medically indicated in patients with an unfavorable cervix, such as in patients with certain blood pressure issues, diabetes or other situations where to continue pregnancy has greater risk to mom/baby than ending it. Without pitocin, though, medically indicated deliveries in patients with an unfavorable cervix would almost certainly have to be via cesarean delivery.
Is it safe? Oxytocin is unavoidable during labor and breastfeeding, and your body has been designed to utilize this hormone in both cases. When used at doses to obtain appropriate strength of contractions, both mom and baby tend to tolerate this medication well. Even if the baby shows some element of stress, the half life of pitocin is only 3-5 minutes, so the effects end shortly after the medication is stopped. Additionally, medications such as terbutaline can also be used to relax the uterus if needed. Lastly, oxytocin used immediately after delivery decreases the chance of hemorrhage. Postpartum hemorrhage is the leading cause of maternal death worldwide and the main reason that the maternal mortality rate is 239 per 100,000 in developing countries vs only 12 per 100,000 in developed countries.
Are there any other options? At this time, pitocin tends to be the most effective and safest option that we have. Some researchers have looked into the use of nipple stimulation to release natural oxytocin to stimulate labor, but at this time, there has been limited success, probably due to the fact the nurses’ hands must have gotten really tired ;) Besides, there’s really only so much that lanolin can do for the breasts after a long labor like that!
So, while not all pregnancies require pitocin, it may be required during labor or after delivery. When dosage is titrated to the optimal contraction strength, pitocin is often the most effective method to help obtain a safe outcome for mom and baby. And for us, this helps us to reach our ultimate goal, which is to conclude the pregnancy with a healthy, happy mom and baby :)
Nick
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