By the time Emily Theys got to 41 weeks pregnant with her first child, the baby was showing no signs of coming out. Theys was only a couple of centimeters dilated and not fully effaced, and her doctor predicted that her baby was on the bigger side (while Theys has a smaller frame). An induction was ordered. On the morning of the induction, the doctor started the Pitocin drip at 7 a.m. You may have heard of Pitocin inductions—and horror stories and tales of success alike—but before you agree to a Pitocin induction, it’s important to know what Pitocin is and how it can affect your labor and birth.
What is Pitocin and how does it work?
Pitocin is the synthetic form of oxytocin, the naturally occurring hormone thought to control—at least in part—uterine contractions (in addition to being the “love hormone”!). Pitocin works by causing the uterine muscles to contract periodically, causing the contractions required for vaginal delivery. Pitocin is administered through an IV and is increased gradually until the patient is in labor, explains Sara Twogood, MD, an OB-GYN and assistant professor at the Keck School of Medicine of the University of Southern California. The dose is usually increased every 30 to 60 minutes. The dosage often varies from woman to woman: “Some women will need a very little dose and some will need the maximum dose,” explains Twogood. “We can’t predict that ahead of time. I usually tell women that with their first baby, we anticipate delivery about 24 to 36 hours after the induction starts. For women with their second, third, fourth babies, the induction process is usually a lot faster.” The fetal heart rate, uterine contractions, and patient are monitored to ensure the baby is tolerating the contractions and the dose is adjusted as needed. (That said: Pitocin won’t work unless your cervix is favorable—meaning you have a relatively high Bishop Score and your cervix is soft and effaced.)
Pitocin and C-Sections: Are they related?
When Theys’ Pitocin induction started, she was immediately hooked up to a monitor. By the middle of the afternoon her water broke. Although she was having contractions—she could see them on the monitor—she couldn’t feel anything, despite not having an epidural. She’d expected to endure the Pitocin with no additional drugs (“I have a high pain threshold!”), but soon it became unbearable. She kept at it by watching the monitor so she could see when a contraction was coming. “It helped because I could see when it was going to end. But soon they became really unbearable, like sharp lightning pains to my gut and through me. I was doubled over, clenching onto something.” Over the next few hours, with the Pitocin turned down, Theys never dilated to more than 9 centimeters and, 24 hours after her water broke, she was rushed into an emergency c-section. [pullquote align=”center”]“I think Pitocin sometimes gets a bad reputation, but looking at it from this perspective can be helpful.” —Sara Twogood, MD[/pullquote] Theys is far from the only one who’s been induced with Pitocin only to end up in the operating room. A 2004 study showed that of over 1,600 women who had Pitocin used either to induce labor or to augment spontaneous labor, the former group had a higher-than-average c-section rate. However, according to Twogood, the main reason Pitocin is associated with an increased risk for c-sections has more to do with the indication for Pitocin than the Pitocin itself, assuming Pitocin is being used safely. In other words, Pitocin is used to augment labor when it is is not progressing as expected. “Labor not progressing as expected is associated with an increased risk for a cesarean,” she says. “Using Pitocin in this scenario can help decrease the need for a cesarean. I think Pitocin sometimes gets a bad reputation, but looking at it from this perspective can be helpful.” Rosemary Dardick, mom of 3-year-old Ella, in L.A., was administered Pitocin—and it did lead to a vaginal birth. Dardick was induced on her due date because she had started to show signs of preeclampsia; her induction process started with misoprostol, which barely did anything. The next day her doctors tried to induce labor with a balloon (also known as a Foley bulb)—a procedure she wound up enduring twice. “Those were awful from start to finish,” she says. “They hurt while they were being inserted and the first one hurt coming out too. The second one worked faster than the first. Ella was sunny side up and it wasn’t clear if she was going to be able to turn herself around.” [pullquote align=”center”]“The main—and intended—effect of Pitocin is painful uterine contractions.” —Sara Twogood, MD[/pullquote] After receiving Pitocin, however, Dardick’s contractions progressed very quickly. “Whereas before I would mainly be able to tell I was having a contraction by looking at the monitor, I definitely felt them after the Pit,” she says. “The epidural was awful and I still have lingering effects from it, but I can’t imagine laboring without it after the Pitocin.” The dosage was turned up and down for Dardick, too. “They tried to labor me down for an hour or so Monday morning so I’d be able to rest for a bit, but after two days of prodding, Ella was suddenly ready to go immediately,” she says. “In fact, the nurse almost delivered Ella because the doctors couldn’t get to my room fast enough. So while the inducement lasted a long time, I was only in active labor for about 30 minutes. She’d turned herself around and was no longer sunny side up.”
Side Effects of Pitocin
Remember Theys’ horrific contractions? She wasn’t wrong that they were truly unbearable. “The main—and intended—effect of Pitocin is painful uterine contractions,” says Twogood. “It’s thought these contractions are more painful and stronger than spontaneous labor contractions, but this is clearly very difficult to study and know.” In addition to extremely painful contractions, for some women, Pitocin can cause water retention. Other side effects may be skin flushing, fast heart rate, nausea, or vomiting. But Twogood is quick to point out that most women tolerate Pitocin very well.
Why Doctors Induce With Pitocin
“Inductions are usually recommended when the risks of continuing the pregnancy are higher than the risks of induction and delivery of the baby,” explains Twogood. This means that the baby is premature but continuing the pregnancy is too dangerous. Some other indications include preeclampsia, chronic hypertension, gestational or pre-gestational diabetes, cholestasis of pregnancy, placental insufficiency, concern about fetal well-being or fetal growth restriction, low amniotic fluid, intrauterine infection, premature and/or prelabor rupture of membranes, twins, or going past your due date. Many doctors rely on other medications or methods to induce labor before getting to Pitocin. The most common ones? Cervidil, transcervical balloon catheter, misoprostol (or Cytotec), and rupturing the membranes. “Membrane sweeping, nipple stimulation, and castor oil may help, and I use these techniques when we are trying to coax spontaneous labor,” Twogood says, “but they are not as effective as the other techniques so I don’t rely on them solely when induction is medically indicated.”
Risks of Pitocin Induction for Mom
You can’t move around.
Once on Pitocin, you have to stay in bed and be strictly monitored, which means no more wandering around, sitting on a birthing ball, or any of the other laboring techniques you may have learned.
You can’t eat anything.
This is because you risk asphyxiation if you need an emergency c-section—which requires going under anesthesia.
It might not work.
According to the Mayo Clinic, 75 percent of inductions end in a vaginal delivery—which means that 25 percent end in emergency c-sections, like Theys’.
Too strong contractions can tear the uterus.
This is more of a problem for women who are opting for VBACs (vaginal birth after c-section).
Risks of Pitocin Induction for Baby
Some babies don’t react well to the intense contractions that come along with Pitocin, which can lower their her heart rates, sometimes necessitating an emergency c-section. As for other effects on the baby after birth, Twogood says, “Pitocin does cross the placenta and may have similar effects as in the mother, but that is rare. Newborns to mothers who received Pitocin during labor are not treated or evaluated differently than newborns who were not exposed, and there’s no evidence or link to adverse neonatal outcomes.”
Pitocin Use After Delivery
Sometimes the uterus won’t stop bleeding after birth, so Pitocin is used to stop the bleeding by “squeezing down on the raw blood vessels exposed as the placenta is released.”
Pitocin and Autism: Is there a link?
According to the American College of Obstetrics and Gynecology, there is no causal link between the Pitocin and autism spectrum disorder (ASD). A document endorsed by the Society for Maternal–Fetal Medicine states that “although the cause of ASD is unclear, it demonstrates a strong genetic predisposition and multifactorial influences. A wide variety of exposures, including many perinatal factors, have been linked to ASD but the suggested associations in many cases are weak, inconsistent, or both among studies, and cannot be equated with a cause and effect relationship ”