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    Why Pitocin Isn't the Enemy

    IV

    “What is the first thing that pops into your head when I say the word ‘Pitocin’?” I asked one of my friends on our morning run. She immediately barked back an expletive that I dare not repeat. Having had the experience of a painful, long, slow labor, she was not a fan of the drug. I reminded her that it was the Pitocin that helped her have a vaginal delivery when her uterus refused to contract on its own. She rolled her eyes and said, “Don’t care. That ‘stuff’ is evil.”(Well, that’s not exactly what she said, but you get the gist).

    Pitocin is often spoken of with the same disdain as gluten, high fructose, and red dye #5. Most every birth plan I read has some mention of refusing Pitocin. I have seen many situations where a patient’s adamant refusal of Pitocin actually resulted in the C-section that they were so desperately trying avoid. Pitocin has been vilified on the internet to such an extent that most women have no idea that the actual purpose of Pitocin is to avoid cesarean section, infection, and hemorrhage – not to cause them unnecessary pain or get their doctor home in time for dinner.

    The uterus is a giant muscle, and in normal labor the body produces a hormone called oxytocin that causes the uterus to rhythmically contract, pushing the baby down and out through the birth canal. Pitocin is a synthetic version of oxytocin given through an IV to make the uterus contract if the body is not making enough oxytocin on its own. Pitocin has three main purposes: to help induce labor, to help stalled labor, and to treat/prevent hemorrhage.

    When labor induction becomes medically necessary, Pitocin is usually the best option. Patients often describe the contractions associated with Pitocin as being more intense, but if delivery is needed and the body hasn’t gotten the memo to start natural labor, Pitocin works well to get the job done: healthy vaginal delivery.

    When the water breaks before contractions start, there is a risk of infection which can be harmful to mom and baby. I often get patients wanting to wait indefinitely for labor to start, desiring a more natural approach and hoping to avoid the more painful contractions associated with Pitocin. This is ideal – if natural labor does kick in promptly. But, oftentimes, that is not the case. Research has shown that starting Pitocin soon after the bag of water breaks reduces the risk of infection and NICU admission significantly – without increasing risk of C-section. In the study, they defined “soon” as 2-12 hours after the water breaks – so it is reasonable, I think, to give the body some time to kick into labor, but waiting too long can lead to complications that could have been avoided.

    Pitocin is routinely used to reduce the bleeding after delivery. After I place the baby in her momma’s arms and the family stands around crying tears of joy, I allow myself a brief moment to soak in the happiness, and then with a smile still on my face, I quickly turn my attention to the placenta. As I await the placenta to exit, I pray the body will do its job and slow the massive amount of blood that was pumping to the placenta from the uterus. The empty uterus must quickly contract itself to constrict the giant uterine blood vessels and slow the bleeding. Giving Pitocin after delivery helps the uterus contract and reduces the amount of total blood loss by 100 cc.  This lessens the need for transfusions and reduces the risk of major hemorrhage by 50%. If hemorrhage does occur, then Pitocin is a first-line treatment. I have used it to save many uteruses – and lives – in my career.

    Pitocin, like any medication, can have side effects and can cause problems when used incorrectly. It does increase the amount of cramping pain after delivery. When given at too high a dose in labor it can cause the contractions to be too close together and can sometimes result in the baby’s heart rate dropping. But, much like antibiotics, just because it has been overused at times doesn’t mean there aren’t true indications.

    Some women feel like a failure of sorts if they need Pitocin and aren’t capable of having their baby “naturally.” I understand where they are coming from. I wish we didn’t need Pitocin and there were no hemorrhages or stalled labors – but there are. Labor doesn’t always go according to plan. But, luckily, we have medication that can help keep women safe and improve their chances of vaginal birth.

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