Tuesday, July 22, 2008

Advantages and Disadvantages of Pitocin in 3rd Stage Labor

In my last blog entry I wrote about things that disappointed us about the policies of our hospital. We were surprised to learn that our OB insists that her patients use a hep-lock in case of medical emergencies (4% of births). Scott and I feel determined that we don't need one. If our birth does result in a "medical emergency" (aka. the need for a C-section), we learned that I should be "knocked out" through the administration of anesthesia with inhalational agents anyway. The hep-lock will still be unnecessary.

The other big thing that disappointed us (that I promised to follow up on in the last blog) is our hospital's use of pitocin, a synthetic hormone, in third stage labor. This has different effects from the use of pitocin in second stage labor, which I will discuss briefly, first.

Many mothers are administered pitocin during first stage labor if the delivery is "failing to progress." (This drug is also often used to induce labor if the baby is overdue.) Studies show that this drug is used most often after a woman has been given an epidural, which can retard her labor considerably. If the labor slows too much, the doctors recommend the pitocin to stimulate stronger contractions of the uterus to push the baby out more quickly. Sometimes the use of pitocin is quite painful (as it is meant to stimulate stronger and more frequent contractions) that can override the numbing effects of the epidural. Unfortunately, if the pain is too much, a mother will be administered another stronger epidural, which, in turn, might cause her to need even more pitocin. Putting the harm that this MIGHT cause the baby aside, this "downward spiral" or "snowball effect" of epidural -> pitocin -> epidural -> pitocin can easily put the fetus in distress. If overused, the unborn baby can start to develop a fever, altered heart rate, and other symptoms, which lead more and more doctors to diagnose the need for emergency c-section deliveries. (A description of the snowball effect as highlighted in the recent movie, The Business of Being Born, is discussed in this review.)

We (Dad and I) are hoping to avoid this kind of scenario by having a natural childbirth. Of course this "downward spiral" is only ONE of the many reasons why we have elected to TRY to avoid the meds at the hospital - especially during the first and second stages of labor, before the baby has been delivered.

In addition to the first two stages, we would like to avoid as many unnecessary interventions as possible during the third stage, which involves the delivery of the placenta. Although many hospitals now use pitocin as a matter of procedure to help the third stage along, we have decided that we would prefer not to have this drug administered. Our doctor, unfortunately, does not see why we wouldn't want this intervention. (Although it is a common request nowadays to forgo the pit during stage 3, as indicated by a birth plan toolkit on the ever-popular web site, babycenter.com, our doctor said that she has "never ever heard of such a thing.") She argues that administering pitocin is hospital policy, and that there is no reason why we should object to something that is so "harmless." She argues that pitocin is "exactly" like the natural hormone, oxytocin, that our body already produces, so how can it be problematic.

I have been doing a lot of reading on this. And I agree that there are certainly medical benefits to using pitocin in 3rd stage labor if the mother fails to deliver the placenta naturally. (Pitocin can help her avoid bleeding out, for example.) But I have also come across compelling arguments that claim that use of this synthetic hormone is only necessary in rare emergency situations. The fact that our hospital insists on delivering it to all women no matter their need only suggests to me that the hospital is just trying to wrap up the deliveries quickly (time is money, and quick turn overs are advantageous to the business-side of hospital policy), without having to look back, waiting for slower, more natural deliveries, and, worse yet, worrying about the potentiality of law suits.

While there are certainly risks during 3rd stage labor (as there are at all stages of childbirth!), I have come to find that there are also risks to using pitocin. I will list the potential disadvantages that I have found (and my sources) so far here: (this list is far from exhaustive, and I would love to hear about additional problems/risks that might be included)
  1. Sometimes the effects of this hormone shot can actually trap the placenta inside the uterus. The mother then has to be put under sedation while the doctor goes in after the placenta and scrapes it out of her. (McCutcheon-Rosegg, 182)

  2. Second-time mothers can have unnecessarily violent post-partum contractions with this hormone that are often reported as more uncomfortable than labor. (182)

  3. In a natural (drug-free) childbirth followed by immediate breastfeeding, stimulation of the nipples and suckling stimulate the body's natural hormone, oxytocin, in turn causing the uterus to contract after the placenta out. Oxytocyin is the body's natural form of pitocin. If everything functions properly (which it does 96% of the time), the new mother does not need the synthetic hormone. Unnecessary shots of this fake hormone can give the woman a painful “double whammy” of artificial contractions on top of natural ones. It is a nuisance that can be avoided. (224-25)

  4. Because pitocin is an anti-diuretic, its use can lead to water intoxication, which in turn brings about an irregular heart beat, hypotension, nausea and vomiting, excessive swelling, and difficulty nursing. (England and Horwitz, 253)

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