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Name:
Location: Allentown, PA

I'm a Christian wife and a mom to three daughters and two sons. I'm a member of the board of directors of EmPoWeReD Birth. In my "spare time" I'm a doula, and a certified childbirth instructor.

Friday, April 21, 2006

My rant on Pitocin

I attended a birth yesterday. Second time mom, had a Pitocin induction with her first baby for medical cause, and did NOT want to "go there" again. Unfortunately the same medical cause ended up showing up again, so after an unsuccessful attempt at starting things with 3 doses of Cytotec (don't even get me started on the lack of informed consent on that one!), she was on to Pitocin.

Pitocin seems to be almost synonomous with hospital labors anymore. I wonder how many women who labor actually manage to get through without using it at some point. One client I had switched OB practices because she had been informed that when she arrived at the hospital in active labor she would be put on Pitocin. No waiting to see how labor was progressing and if it was really needed...it was just the policy of this practice to use Pitocin on all laboring women. Medical staff will often explain away any concerns with the use of Pitocin by saying that it is just a synthetic form of the same medication that your body produces. Which is true. But that doesn't mean that putting it into an IV is the same as letting your body produce it!

One of the major problems I have with the use of Pitocin is how strongly it is generally used. It is usually used at strengths MUCH greater than what the body would naturally produce. In the case of my client today, it got to nearly 3 times the strength the body would naturally produce. Here is an excerpt from the 3rd page of the package insert on Pitocin:

The initial dose should be 0.5 – 1 mU/min (equal to 3-6 ml of the dilute oxytocin solution per hour [10 units oxytocin in 1000 ml saline was suggested a few paragraphs earlier “piggy backed” with plain saline]). At 30-60 minute intervals the dose should be gradually increased in increments of 1-2 mU/min…[. Once] the desired frequency of contractions has been reached and labor has progressed to 5-6 cm dilation, the dose may be reduced by similar increments.

Studies of the concentrations of oxytocin in the maternal plasma during oxytocin infusion have shown that infusion rates up to 6 mU/min give the same oxytocin levels that are found in spontaneous labor. At term, higher infusion rates should be given with great care, and rates exceeding 9-10 mU/min are rarely required. Before term, when the sensitivity of the uterus is lower because of lower concentration of oxytocin receptors, a higher infusion rate may be required.

My client was started at a dose of 6 mU/min. That's right...she was started at a dose that 6 to 12 times the reccommended starting point. And this after getting 3 doses of Cytotec. Then the midwife put in orders for the drip rate to be increased by 2 mU every 15 minutes. The nurse seemed to get around to upping it every 30 minutes when it was first turned on, but then later in labor she was coming around after 20 minutes to increase the dose.

When I got to the hospital my client had been on Pitocin for 2 hours, and by that point she was up to 12 mU/min. So not only was she at twice the level that would be found in a natural labor, but she was definitely above that level that is supposedly "rarely required." Of course I haven't had a client yet that I've been with as a doula who got Pitocin and didn't get to this level. Sigh.

As I indicated above, they didn't stop there. This is where the nurse started showing up every 20 minutes to increase the dosage, and in short order it was at 16 mU/min. I'm not sure why, but at this point the nurse to stop increasing the Pitocin. I don't know if the midwife told her to stop because the contractions were coming more regularly, or if the nurse just got busy, or if it was because of concerns with the baby's tolerance of the Pitocin (I know that I noted at a certain point in the labor that the baby was having late decels, but I didn't want to write that in my notes, because if someone saw that they might say that I was "practicing medicine." I know that I wanted to note it somehow though, but looking back, I don't recall when exactly that was, or what I did to note it. The only thing I can come up with is a notation I made that the baby's heart rate was 104 10-minutes after the Pitocin was raised to 16.) 40 minutes passed between changes to the Pitocin level, and this change was to drop it back down to 12 mU/min. It stayed this way for the next hour, during which time the mom labored really well, contractions were coming 2 1/2 minutes apart, about 55-70 seconds long.

However, there was trouble with keeping a good reading of the baby's heart rate on the fetal monitor unless the monitor was manually held in place, and even the contractions weren't picking up well. The midwife started talking about internal monitors. We discussed options, and I pointed out to mom that since she was 5-6 cm dialated at this point, she could consider just turning the Pitocin off, then she wouldn't need the constant fetal monitor, and could use Doppler. I also offered to manually hold the monitor.

However, the midwife managed to convince her that it was imperetive that the internal monitors be placed, and part of what I think sold her on it was the promise that this would mean less fiddling around with the monitors. Yeah...okay. I've not had a doula client have an internal monitor scalp electrode placed, so I didn't have experience with that. The dang thing kept coming off! All told, she had 5 scalp electrodes placed in 4 hours. And it really irritates me that they call them a "scalp clip." I suppose that sounds better than the reality--"a corkscrew that we put into your baby's scalp." And YES, it hurts the baby! The heart rate would temporarily jump to over 200 every time one was placed.

So anyway...she got the first one placed, and what do you know, baby is having heartrate decelarations. The Pitocin was shut off STAT. After about 20 minutes things seemed to be stable with the baby, so what do they do? Turn the Pitocin back on at 6 mU/min. Didn't bother to ask the mom if she wanted them to do that. I pointed it out to her and asked her if she wanted Pitocin at this point. I don't really think she did...but I also think she didn't want to make too many waves.

So 20 minutes later the baby starts doing some NASTY decels. Down as low as 60, when usually much below 120 is "not good." I was scared. And feeling like pounding my head against the wall and screaming "you guys had a warning that this was going to happen!!! What in the world were you thinking???" Pitocin was back off again. I was honestly shocked that we weren't on the fast track to the OR. Seemed like half the available OB staff that was on the floor was in her room. Whispered instructions were given to a nurse to start counting equipment in the OR. Fortunately I will give that the OB who is the senior Dr. in the practice with the midwife is committed to avoiding cesarean, so he really worked with the baby to get the heartrate back to an acceptable range. Medication was given to stop contractions. And after about 10-15 minutes, the drama was over--at least the medical drama.

My client and her husband did really well during all of this. But understandably, it really shook them. They both cried. She was seriously wondering if continuing to labor was wise, or should she just go straight to cesarean.

Less than 30 minutes after the baby was stabilized, and while the mom is still very emotionally charged and trying to work through the "should I just have a cesarean?" question, the nurse quietly comes in and turns the Pitocin back on to 4 mU/min. BANGING MY HEAD!!!

I again let her know that the Pitocin is back on. This time she talks to the midwife about it. She isn't happy having it on. Midwife is "sweetly" insistant on the "need" to use it to get the baby out quickly. AAARGH! Mom is breaking down. She finally just can't deal with things anymore, and asks for an epidural. She REALLY didn't want one because of a previous bad experience, and she hadn't had one with her first. I really think that the emotions of the situation just left her unable to deal with things. And I don't blame her one bit. It also dawned on her that if she winded up with an emergency cesarean she would be put under general anesthesia unless she already had an epidural in place. She INSISTED that the Pitocin be turned off, so as the anesthesiologist was prepping the epidural, it was turned off.

Of course the nurse came back in and quietly turned it back on not 10 minutes later. Didn't ask Mom about it. She just asked for it to be turned off, and she didn't ask for it to be turned off because she couldn't deal with the pain, she asked for it to be turned off because she couldn't deal with the stress of wondering if it was going to make her baby crash again. But it was "only" 2 mU/min, so I think Mom just resigned herself to it when I told her it was back on. 30 minutes later it was up to 6 mU/min, then 15 minutes after that it was up to 10 mU/min.

And surprise, surprise...15 minutes later it is turned back off because of decels, and they are having her push even though she still has a lip of cervix, no urge to push, and baby is at 0 station (and in my experience, moms aren't ready to push until +2 station). I wasn't even sure she was "really" completely dialated, as she had been 8-9 cms just 30 minutes prior, and the midwife had this "let me see if I can stretch the cervix to 10" kind of hesitation before declaring her "complete."

Pushing wasn't really going well, the lip of cervix could not be reduced, and fortunately the baby's heart rate resolved, so midwife did one of the few reasonable things of the day, and told the mom to stop pushing and just rest until she felt an urge to push. Which she did an hour later, and in less than 10 minutes she pushed out her 8 lb 8 oz baby boy, Apgars of 9 & 9. But of course there was doubt as to whether she could actually push the baby out (since they expected the baby to be large, and the midwife had earlier been very insistant on how DANGEROUS it can be to deliver a large baby--never mind that she had pushed out her first baby at 8 lbs 7 oz with no incident), so the resident OB actually did the delivery (and overly agressive pulling!) so that vaccum could be used...of course she showed her strength by pushing so fast that they got the vacuum out of the package, but couldn't get it on before the head was half out (so it just laid on the bed unused--wonder if they will bill for a vacuum birth though?).

But hey, the joys of Pitocin don't end there. Despite the fact that mom had no significant bleeding, the midwife ordered that the remainder of the bag of Pitocin in saline be run into the mom. The drip rate was set at 250 mU/min. Here is what the package insert on Pitocin has to say about fast drip rates of Pitocin:

Water intoxication with convulsions, which is caused by the inherent antidiuretic effect of oxytocin, is a serious complication that may occur if large doses (40 to 50 milliunits /minute) are infused for long periods.

She was being dosed at 5 times the level that is listed on the package insert as considered a risk of causing water intoxication! And she was already seriously retaining fluid, as demonstrated by the very concentrated urine collection that had been made about 20 minutes before the birth. Of course the concentrated urine was interpretted as "she hasn't gotten enough fluid." Of course a logical person would certainly agree with that concept. (Rolling my eyes) She had "only" gotten 4 liters via IV plus what she's been drinking over the course of the last 20 hours. That is the equivalent of drinking more than 8 oz an hour around the clock--possibly closer to 12 oz, I didn't log how much she drank. Can you imagine how much you would be peeing if you drank that?

She wasn't dehydrated folks...she was OVER HYDRATED, and unable to get rid of it. But hey, the midwife ordered another bag of saline run into her.

The poor woman. She's going to have to leave the hospital with no shoes on, her feet will be so puffy.

Note: I have a Word document explaining how to figure out what dosage of Pitocin is being administered. Ask, and I'll e-mail it to you. If you are "lucky" the Pitocin is mixed as 30 Units in 500 mls of saline, then you can just read the IV pump to directly get the mU/minute. But if a different mix is used (such as the 10 Units in 1000 mls of saline that is reccommended on the package insert), then the charts I have in the Word document will help you to quickly find what dosage is being used. I STRONGLY urge pregnant women to take a copy of it and the package insert for Pitocin with them to the hospital in labor. If Pitocin is going to be used, ask the care provider if the dosing guidelines in the package insert are going to be followed, and if not, why not. Sometimes a "quick" labor is not as safe as a slow labor. Especially if your baby is thought to be compromised already, it may not really make sense to be trying to blast the baby out.

53 Comments:

Blogger TulipGirl said...

I had pitocin with my first. PROM. Failure to progress through natural means, walking, herbs at the birthing center. . . by the guidlines/regulations my midwives had to take me to the hospital. (And yes, they were more medically minded that the other midwives I had. . .)

Anyway, I remember begging the nurse to NOT turn up the pitocin at one point. And she pointed out to me that I really was getting an uncharacteristically low dosage. I don't remember the numbers. Don't know whether it was true or not. But at the moment it made pitocin less scary for me.

7:38 PM, April 24, 2006  
Blogger Jenn said...

Hi Tulip!

My very first doula client ended up on Pitocin. And the midwife (who is now the office manager at the practice where the midwife from the birth in this post works) told her that it was a very low dosage.

Unfortunately, once I started really wondering about what the dosage "should" be, and dug out my notes from that birth, I discovered that this mom had also gotten up to 12 mU/min in very short order. Which isn't "very low" in comparison to the package insert, but rather just in comparison to what is typically used by OB's at this particular hospital. Which is REALLY scary to me.

10:08 PM, April 24, 2006  
Blogger TulipGirl said...

I'd be interested to know what "low" was. The midwife who attended at that birth is practicing now with an OB in the area, and the birthing center closed down. (Hooray--another birthing center is open, and the midwives even do homebirths!)

11:08 PM, April 27, 2006  
Anonymous Jocelyn said...

That is amazingly frustrating. It stinks that moms are in a place of such vulnerability and often feel incapable of standing up for themselves when they need to most. I know from my own hospital birth that I had to reiterate over and over and over again even though I had a birth plan.

7:59 AM, June 27, 2006  
Anonymous Talmidah said...

Hi Jenn,
My name is Sabrina Huckey and I found your blog by doing a search for "embracing motherhood." I found your interests similar to mine and I was really intrigued and I was "amen-ing" you on your post about Pitocin. I learned a lot about the drug that I didn't know--I just knew it wasn't a good thing.

I, too, am a follower of Messiah Yeshua (Jesus) and I, too, would one day love to be a doula and/or midwife and a Bradley Instructor. Right now my life is focused on raising our children and being a keeper at home, but someday when the timing is right I would love to do that. I have had our three sons at home and I'm expecting again in October. I and a friend of mine facilitate a class locally that we've formed called "Naturally Expecting." Our goal is to educate women of natural childbirth, nutrition, breastfeeding and how to create a birth plan. Our first class was spring of 2005 and we are planning to do it again this fall. We bring in speakers on the different topics (since neither one of us have any credentials except personal experience and a passion for pregnant women and their babies) and we provide any support we can to those who need it/desire it.

I have attended several friends' births just as a friend and sometimes as a labor partner/couch. I absolutely love doing that. I've always been pro-natural childbirth and pro-homebirth, but I find myself becoming more and more angry and shocked by what's happening in hospitals and also at the women (couples) who don't want to plan, are too timid to plan or who only partially plan what can/will happen to them and their baby during labor and childbirth--and these aren't dumb/ignorant/uneducated women--some are college graduates, "career women" but yet they've been so molded by our culture's dependence on and trust of the medical community that it is sad, scary and I believe harmful to women and babies that could/should be experiencing natural, safe, joyful and fulfilling labors and deliveries.

Well as you can tell I am passionate about this and I desire to be more educated and able to articulate and communicate the potential dangers of the various medical procedures and drugs that can occur during labor and delivery so that women can be more prepared for going into labor and delivery in a hospital. I loved reading about the package insert on Pitocin and I'm going to pass this info onto my friend.

Thanks for the inspiration!
Shalom,
talmidah

10:57 PM, June 29, 2006  
Anonymous Anonymous said...

I am an OB nurse, and have several years of medical experience and training. There are several choices that we have as mothers, as practicioners, as patients. It is our resposibility to be as educated as we can about our options, but to also understand that medically there are several things that drive the decisions MD's make.
It is imperative that folks understand that there is a difference between a MU and a ML when it comes to dosing pitocin. And that, unless you have had to resuscitate a newborn that can not tolerate labor, you really haven't been there.

9:45 AM, July 12, 2006  
Blogger Jenn said...

Talmidah--

Thank you for your post! I'm glad I was helpful to you.

Anonymous...

I'm not really sure of the point of your post, but obviously you aren't ready to put your name to it, so perhaps I shouldn't be spending much time on it.

Regardless, for the sake of other readers, I will...

I'm a trained chemist. I hold a bachelors degree in biochemistry, did some course work towards a masters in chemistry, and worked for 6 years in an R&D lab in the specialty chemicals industry. I probably know WAY more about different units of measure than you do. I used "microunits" and "milliliters" in my discussion appropriately.

I'm not sure why I have to resuscitate a newborn to have "been there," but since it seems to be very important to you, I'll talk about it. 90% of the time labor should go just fine, with no need for resuccitation--this according to the World Health Organization. Of the other 10%, not all of them would require newborn ressucication. If you've found that a large percentage of the births you've been at have required rescussication, perhaps you should look at the medical interventions that might be causing that. From my end, the only clients I've had who had babies who required resuscitation were cases where there had been "Pit to distress."

6:12 PM, July 29, 2006  
Anonymous Brenda said...

I apologize for the length of this, but you hit upon a major pet peeve topic of mine, based upon personal experience.

I've had pitocin inductions with two labors - both unfortunately for blood pressure issues towards the end. And, neither time was I informed of any of the risks.

For the first induction, I was a niave first time mother and I could kick myself for not knowing more. But, I trusted....

Around 8am my water was broken and I was hooked up to pitocin. No one told me how much I would be given or anything about the dosage increases. I just remember a nurse coming in every so often and pressing buttons on the machine. Well, right before noon, I convinced my hubby to go get some lunch. I had only been having what the nurses referred to as "cramps", so I figured it would be ok for him to go. About 5 minutes or so after he left, I started to have waves of intense pain (or I thought at the time, just really bad cramps). There was no break between them that I recall, they just kept coming, wave after wave. Since I had only been having "cramps", I figured that I really shouldn't complain because I was just being a baby. Plus, I figured since they had a monitor on me and no one came in, that everything must be ok. So, trying to be brave, I laid in paid panting like a dog for about 45 minutes later when a nurse came in and realized for the first time that there was a problem. She commented to me that they must not be picking my contractions up on the monitor. Now, I know that since I was an overweight person, that sometimes an internal monitor is needed to really tell what's going on.

So, the nurse turned the pitocin down from 16 to 8. Niave me thought that changes were made to make sure they could pick up my contractions, but nothing was done. Instead they gave me a little "break" and cranked it right back up. In a short period of time, I hit a point where I felt that if I didn't have an epidural, I wouldn't have the strength to make it through the rest of the labor. So, I got the epidural. If only I had known, what they would do after that...

I was ready to push around 9:15 pm ish, and I pushed the baby out in about a half hour.

Shortly after that, I had a postpartum hemorrhage. The OB worked for about 45 minutes on me, very painfully externally and internally working on my uterus to get it to contract back and stop bleeding. I had no idea this wasn't normal procedure, so I lay there in extreme pain (they had turned off the epidural earlier) but bravely only moaned in pain instead of complaining. It was only after the 45 minutes that the OB asked me if I was in pain or just feeling pressure...I guess she didn't know that I wasn't receiving epidural pain relief at that time. I told her pain and the next thing I knew I was being whisked off to the OR for a D&C.

I was told by the OB later that a small piece of the placenta had remained in the uterus.

I requested my records and learned that I had, had a 1300 cc blood loss and that the OB at the time, called this uterine atony and that she never found a piece of placenta. The pathology report also showed a complete placenta. My records showed that by the time of delivery, I had been cranked up to 30 units of pitocin. I almost feel as if the epidural gave them the license to do this and I had no knowledge. According to the package insert, the max dose is 40 and lower amounts are suggested by the manufacturer as appropriate. If I recall right, the package insert says great caution should be used whenever a dose greater than 10 is used (correct me on this number if I'm wrong). So, 30 must require an incredible amount of caution. Also, I learned from my records that the nurses had been ordered to increase the dose by 2 every 15 minutes.

Anyway, so with this second pregnancy, I was petrified that I might get pushed to agree to pitocin again. Unfortunately that happened, due to blood pressure. I spoke to the OB about my concerns and my preference to use as little pitocin as possible. She told me that pitocin can't cause a postpartum hemorrhage and I informed her that it lists postpartum hemorrhage in the package insert for the drug as a potential complication. She couldn't respond to that. After a long discussion, she begrudingly and reluctantly agreed to keep in mind my concerns about limiting the use of pitocin. And, she also agreed to allow it to be turned off to see if I would labor naturally after it all got going. But first she told me I was expressing my own medical theories without any legal training when I dared to ask her for the pitocin to be turned off during labor.

The next morning (I had a ripener used overnight to get me ready - an FDA approved one - not that cytotec), a different OB from the practice was on call. The ripener had gotten me started with my own contractions and the OB let me go for awhile to see how I would do on my own. I was so grateful for that. However, later in the day I was told that I had to have the pitocin because I was no progessing fast enough.

I begrudingly agreed because it was my understanding (and that of my two support persons) that they would only be using minimal pitocin to augment what I already had going for contractions, and that they would only increase it if it was absolutely necessary.

But then 15 minutes after the pitocin started, the nurse came in and pressed buttons. I immediately asked her what she was doing. She told me she was increasing the pitocin. I asked her how much and why. She said she was increasing it by 2 because the Dr. told her to increase it 2-4 every 15 minutes. At that point I lost it. That was potentially double the rate used when I had the first induction and a PPH. As nicely as I could, I told her that, that was not what I had agreed to.

The nurse gave me a hard time and told me I always had the right to refuse the drug and end up with a C-Section. I came close to losing it even further with that comment - I felt like I was being threatened with a C-section for asking questions and sticking up for my wishes. After some discussion, she said I could speak to the Dr. if I wanted to, and of course, I agreed to that. The nurse turned the pitocin off in the meantime.

The OB called into the room a few minutes later. My sister picked up the phone and told me it was the OB. I asked her if she could speak to the OB on my behalf. I was too afraid that I was going to break down and lose all my remaining strength. THe OB wanted to know why I didn't want to talk to her. My sister asked me that and I said was "too upset."

So, my sister spoke to the OB about my concerns. She knew them well from having discussed this with me in advance and being in the room (along with my hubby) when the pitocin discussion occurred before they turned it on.

It must have been 20 minutes of discussion on this. The OB kept giving my sister a hard time and wouldn't answer her questions about why such a high dose was being used when I had problems previously. As this went on and on (and thank God for the strength of my sister...), I laid there thinking "What am I going to do if I have to fire this OB. How does one get a new OB in the middle of a delivery?" This was all way too much stress for a women in labor with a blood pressure problem, thank you!

In the course of that conversation, it came out that the OB had planned to crank me all the way up to 28! She also refused my request for an internal monitor of the contractions saying it created a risk of infection.

Anyway, finally, the OB agreed to increasing the pitocin by 2 every half hour instead of every 15 minutes and that they would do frequent cervical checks to see how I was progressing that way and to stop increasing the pitocin if I was dialating well.
I agreed to that knowing that it was the best I was going to get and because it was a heck of a lot more reasonable than the original plan.

Later the OB came into apologize that she must not have explained her plan well enough to me in the beginning and that it resulted in a misunderstanding. She also started explaining more, as did the nurse (although by this time, there was a new nurse on - she was much, much nicer and more understanding). But then later the OB did let me know that I was progressing slower than I would have if I was on the doses she had wanted and how inconvenient it was for her. Tough, tough! It was Friday night, but she was the on call OB for the whole weekend and I had the right to progress more slowly and safely.

I ended up delivering this little guy at 11:01 pm. The pitocin was started around 1 or 2 pm. I had been dosed up to about 22 pitocin by that point, but it took quite awhile to get there. My husband commented at the end that we had used less than 1/2 the bag of pitocin when the last time he watched them put up as much as 3 bags for the whole day.

This delivery was much different. I pushed the little guy out in 8 or 9 minutes (he was 7 pounds, 8 ounces), and my uterus contracted immediately. There was no hemorrhage and I felt great after the delivery. I did get that rapid pitocin infusion after my uterus contracted but it was explained to me that it was done to make sure my uterus stayed contracted and to prevent me from hemorrhaging.

I'm thankful that this time I had my sister with me and had pre-arranged for her to advocate for me if I were to have any issues that I was concerned about. Part of me thought I wouldn't need it. But, I'm convinced that if I didn't fight for myself regarding the pitocin that I might have had another hemorrhage.

Anyway, I know it was a long story. Thanks for listening.

12:24 AM, November 29, 2006  
Blogger Jenn said...

Thank you for taking the time to tell us about your experience Brenda! And Kudos for standing up for yourself as you did--even using your sister since you knew she would stand up better. You are right--"tough, tough" for the OB that she was kept there longer than she wanted to be--if she didn't want long and unpredictable hours, she shouldn't have gone into obstetrics.

8:06 PM, January 11, 2007  
Anonymous Angela said...

I need some help.. I am 38 weeks pregnant and my Dr is pressuring me into being induced in a week and also on scheduling my epidural now. I am curious if it is even possible to change Dr's at this stage in the game and if it is not then how can I make her understand that this is not what I want. I have tried to talk to her about my feelings but I honestly just feel like a paycheck to her...she wants to get it over with so she can get paid. I was induced with my first baby and I was in labor for 18 hours...I don't want that to happen again. Can someone please help me with some dialog to go to my Dr with...Thanks

11:37 PM, October 15, 2007  
Anonymous April said...

I am worried that we are unknowingly allowing ourselves and our unborn children to be abused. I have done some research on the use of pitocin to start labor or to help labor go faster. I'm not saying there isn't reason to use it in some cases but in some hospitals it is being used in every case of hospital labor. Our bodies have been going into labor for thousands of years without medical intervention and so why now do so many women today have to have this forcing of their labors? I know that alot of women have pitocin labors and they think nothing of it. Everything goes fine and most have drugs to ease the pain and so they don't know what the drug is really doing to themselves or their babies. What alot of women are not aware of, are the dangers of this drug and what complications come along with it. A lot of use trust our Doctors to tell us these things. Unfortunately that is not always the case. My point here is this, The use of pitocin is being used way to often in cases that it is not medicaly necessary. To me that seems like an unjustace to women and an abuse to their bodies and their babies that would naturally have no complications without it. Maybe their labors would be slower but every body is differant but to force the labor to suit the time table of others is unhealthy, dangerous, and abusive.

8:58 AM, January 19, 2008  
Anonymous redanne said...

I just wanted to add that I had a baby girl on Aug 26, 2007 and I had Pitocin right from the start. I was told that because I wasnt feeling my contractions that I should be on this. I really had not planned on having pitocin. I trusted the doctors and what they had to say. I wish I had paid more attention to what my doses were and how often they came in to "up" it. I know that after about 3 hours on this my contractions were ontop of each other every 5 to 30 seconds and I was only dialated to 2cm. They administered an epidural and I remained at 5cm all night long. Interestingly enough they came in the morning and upped the does of pit. and wouldnt you know it, it kick started my labor again. I did have a decline in babys heartbeat in the middle of the night. They had me change the way I was lying. Seemed to help. My Baby was delivered at 1230pm and I hemorraged right after she was born. I lost 1000cc of blood and I dont remember a whole lot after that. I really wish I had researched this. I am now petrified to get pregnant again and have this happen again. Thanks for reading. I am glad I found your blog. I might add that I did have a healthy 9lb 4oz girl at 22 inches long she was a large baby.

9:29 PM, April 08, 2008  
Anonymous Anonymous said...

This is Brenda again, posting an update. You might think that after having the doctor stop my hemorrhage at the first birth and having an uneventful birth with my second that my story is over and that everything is fine. I'm sure that's what my OBs think. But as of last summer, I have learned that there is a good possibility that I may have had permanent damage to my pituitary gland that may have been caused by hemorrhage. I don't mean to scare anyone but I now have some hormone deficiencies that I will have for the rest of my life. The first problem to show up was being unable to breastfeed my child (and also my second) which I later learned was because of a prolactin deficiency (a pituitary hormone). The next thing to show up was a thyroid problem, and it is pituitary based rather than based upon the thyroid gland itself. I am on thyroid replacement for this. Also, I am receiving growth hormone replacement. And, my testosterone and DHEA levels are low. I just received test results showing that my estrogen levels are below normal for a woman my age. And,my periods have been very different in timing, some too soon, some too late and others lasting 1 or 2 days longer than the 7 day period. Presently, I am watching with concern over whether I will go through an early menopause (I'm not quite 40 yet). I have seen an expert endocrinologist who believes that I may have Sheehan's Syndrome. It is reportedly very rare, but I kind of wonder with all of these pitocin births and some of the hemorrhages that may result if it is more common than they think. For instance, you will find articles that state that some women can take as long as 20 years to be diagnosed. I think it is generally thought that if you were able to breastfeed after a hemorrhage that it is highly unlikely if not impossible as almost all women from my reading who end up with Sheehan's show inability to breastfeed as their first symptom. I can't help that I am still somewhat bitter over my pitocin hemorrhage.

7:09 PM, April 22, 2008  
Anonymous Anonymous said...

Redanne, I understand your fear. If it helps, I had two pitocin births, the first resulted in hemorrhage, the second did not. But for the second they used less pitocin and increased it at a slower rate. Make sure you tell your next OB that you had the hemorrhage and you might want to see if your OB will consider less aggressive use of pitocin if you end up needing it for a second birth. And, perhaps you won't end up needing it for a second birth. Good luck to you and keep strong. If you think it might help, bring someone with you to help you discuss your concerns.

7:11 PM, April 22, 2008  
Anonymous Anonymous said...

some of you people are unbelieveable. I am an OB RN and have many years experience and it is given a 6mu at times. It also depends on how it is diluted!!! So, know your facts.

10:17 AM, May 29, 2008  
Blogger 3Sykes said...

I had pitocin with my first child. I believe they had it going for almost 30 hours. Being only 19 and not knowing a thing, I never bothered finding out what I was being given. After 30 hours of contractions that only dilated me 1 cm than I went in with, I had a c-section. Then I hemorraged and they talked about a hysterectomy. I told them to go ahead and give me one, as I never wanted to go through this again! They looked down like they had forgotten I was there! I am pregnant now and will be having a scheduled c-section. Then I am getting my tubes tied because the birthing business is just too scary.

8:01 AM, June 07, 2008  
Anonymous Anonymous said...

I was induced with Cytotec, which worked well. I was also under a medicallized midwife. I had asked her many questions concerning my hospital birth including about pitocin. She told me that I wouldn't get it unless I was hemmorraging. Well, as soon as I delivered my baby girl, guess what?! I was promptly put on pitocin to get the placenta out! I didn't konw until it had already happened and she was explaining I would have lots of swelling due to the dosage given to me. Little to say, I am not going to her with this pregnancy and am going to have a homebirth with a REAL midwife!

10:56 AM, November 26, 2008  
Anonymous Anonymous said...

Thank you for the post. I would like your chart along with the package insert for Pitocin as soon as possible. I am scheduled to be induced in one week. Thank you. stacy.11@hotmail.com

12:15 PM, March 20, 2009  
Blogger Jill--Unnecesarean said...

Hi. I quoted your comment in this post... http://www.unnecesarean.com/blog/2009/7/6/pit-to-distress-your-ticket-to-an-emergency-cesarean.html

...a few days ago. I'm sort of working backwards by giving you a heads up afterwards. Sorry.

Great post, btw.

1:21 AM, July 10, 2009  
Blogger Nursing.Birth said...

I put a link to this in my most recent post! What a story!!! And people think that I am exhaggerating!!

~Melissa
www.nursingbirth.com

6:58 AM, July 10, 2009  
Anonymous Anonymous said...

Great post! I would love a copy of your chart along with the package insert. I'm getting ready to attend my first birth as a doula, and it's likely mom will be induced due to pre-eclampsia so this information would be greatly appreciated.

Thanks!

blackberrybirth@gmail.com

8:22 AM, July 10, 2009  
Blogger SuSuseriffic said...

I would like that chart too. I wish I could be a fly on the wall of birth sometime so I can see stuff. So writing down waht happened is considered 'practicing medicine'? That stuff I am curious about too, thanks.
http://icanwesternmd.blogspot.com/2009/07/great-post-at-nursing-birth-blog.html

9:29 AM, July 10, 2009  
Blogger Sarah said...

Thanks for sharing this. I am studying to be a doula and think that Word document would be very helpful. Would you please e-mail me the chart? Thank you!
sarah at thecowarts dot org.

10:52 AM, July 13, 2009  
Blogger Taryn said...

Wonderful post!

I am a doula and think your pit chart would be very helpful! Could you email it to me at: Taryn@spiriteddoula.com

Thanks!!!

-Taryn
www.SpiritedDoula.blogspot.com

3:09 PM, July 15, 2009  
Anonymous Lucinda said...

I too, am a doula. Could you also send me the document? cinnemonn@me.com Thanks!

8:20 AM, July 17, 2009  
Anonymous Danielle said...

I would love a copy of your pit chart! Thank you for the wonderful post :)
lildabodoula@yahoo.com

11:59 AM, July 18, 2009  
Anonymous Anonymous said...

Can I please have a copy of your pit chart?

Thanks!

jamsum@embarqmail.com

7:13 PM, July 19, 2009  
Anonymous Brenda said...

The package insert for pitocin is here:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4975

Look under Adverse Reactions and you will see Postpartum hemorrhage along with a number of other things.

7:30 PM, August 01, 2009  
Blogger Miracle Pending said...

I'm interested in the Word document. Is it still available? I'm delivering in about 3 months and want to be prepared. Thanks so much for the thoughtful and informational blog :) My email address is miraclepending@gmail.com. Thank you!

1:00 PM, August 26, 2009  
Anonymous Anonymous said...

I'd love a copy of your pit chart if it's still available. Thank you for the great post. It was a scenario I'm (unfortunately) quite familiar with and I share your frustrations!!!
jen@sundancedoula.com

12:08 AM, September 15, 2009  
Anonymous Molly McK said...

If you could email the pit chart ASAP, I would really appreciate it. I am facing a "medical" induction for GD, and I am trying to educate myself as best I can to ensure I am making good choices for myself and baby. My email is MollyKate424@hotmail.com.
Thank you!!!!!

10:26 PM, November 12, 2009  
Anonymous Anonymous said...

I am delivering in a month and would love to have the pitocin word chart too. If you can please email it to deeanag@gmail.com

1:09 AM, December 21, 2009  
Anonymous Anonymous said...

Being induced tomorrow...any way that I can get word doc pitocin chart?????THANKS!!!!!!!!!!!!!!!!!
gmarline@hotmail.com

6:50 AM, January 25, 2010  
Blogger Ieva said...

thanks for the post, could i get your dosage chart please? my Dr. recommends an induction at 39 weeks (2 weeks from now...) she explained that there are studies showing repeated stillbirth rates tend to go up after 39 weeks.... i have the right to decline an induction, but i really like this Dr. and i trust her, she said it would be very low dosage (thus i need the chart to discuss it with her before agreeing to anything). She knows i am against drugs (had Pitocin and maybe something else in addition to that and not sure at what dosages to induce my daughter at 34 weeks after i came in for a checkup and they found no heart beat... it was really horrible, if you factor out the emotional aspect, the physical pain and intensity does not come anywhere close to my first completely un-medicated birth years earlier. I seriously don't think anyone can get through Pitocin without epidural or narcotics to numb the pain). Thanks again for the post, Ieva
ikalvane@hmail.com

6:51 AM, February 11, 2010  
Anonymous Anonymous said...

Hi..if you still have the pitocin chart I would like a copy please. send to amethystbelly (at) gmail (dot) com. Thanks!

3:26 PM, March 01, 2010  
Blogger Jesse Dykhuis - Birth Doula said...

Would you please email me the word doc on pitocin dosing?
Thanks,
Jesse
jesse@duluthdoula.com

6:44 PM, March 25, 2010  
Anonymous Anonymous said...

Hello! I'd also love to have a copy of the Word doc on Pitocin dosing!

Thanks so much for the info,
Kharis
khariskennedy (at) hotmail (dot) com

4:01 PM, March 26, 2010  
Blogger VNess said...

Thank you for this post. I hope that this knowledge will keep me from having a repeat traumatic birth after being 'augmented' with 72ml/hr of pit.

Please send me a copy of the chart also.

vanessawill1224 (at) gmail (dot) com

6:37 PM, April 11, 2010  
Blogger clumsyraine said...

Please email me the chart on Pitocin dosing... I am having my first in August and I definitely want to add this to my file to be prepared! Thank you!

clumsyraine at gmail.com

10:01 PM, June 15, 2010  
Blogger firefaery said...

I just saw this same thing on TLC's A Baby story.. Mom wanted an epidural for pain. But the doctor told her that since she was still early on it would be better to wait and better use the pain meds for when she really needed it. However, what she could do, would be to give pit to get her to that point quicker. So they do, and then are able to give mom epidural, which of course slows the labor down. They let her rest, then come in and tell her they can now increase the pit cause she's not progressing much. They do that then of course baby starts having its heart rate dip, with each contraction. So mom gets oxygen and a fetal skull monitor (no real communication except "this is what we're going to do, and why" but then they increase Pit again, to get labor moving faster!! Mom almost has to go to cesarean, but is able to push the baby out. The doctor says the baby looks great, but from my view I see quite blue hands and face... Anyways.. it just made me want to scream. All during this, the mom wanted to know more about pit etc and doc just made it sound like routine, and like it was the only real answer. *bang head*

6:21 AM, July 19, 2010  
Anonymous Anonymous said...

Hi, Would you kindly send me the pit chart? My wife is expecting any day, and although we are expecting a natural non-medicated birth I always believe chance favors the prepared mind. thanks for your excellent work. Email is steltzy@gmail.com

10:15 PM, October 26, 2010  
Blogger OliveMama said...

Wow, this story is now added to my list of nightmares.

If you wouldn't mind sending the pitocin chart my way, I would appreciate it! Thanks!

toswitw@gmail.com

1:48 PM, November 01, 2010  
Anonymous Sarah said...

I would love the pitocin chart. I had pitocin with my first delivery due to increased blood pressure. On two different occasions my uterus went into a state of hyper contraction, my son's heart rate dropped, and 10 people came running into the room yelling, "Open the OR." They had my husband in scrubs and I was scared to death. Thankfully they had me get up on my hands and knees and wiggle around until the heart rate came back up. Now with pregnancy # 2 I'm 40.5 weeks and they're talking about an induction. I really wanted to avoid it this time if I could. If I must go the pit route I at least want to know what a safe and appropriate dosage is. Thank you for your help!
summernanny@yahoo.com

8:19 AM, March 28, 2011  
Anonymous lauren said...

Great article! I am 42 weeks and have an induction scheduled in 2 days (still hoping to delay further) - I would love a copy of the word pitocin chart. Thanks so much!
lauren_mcmullen (at) hotmail (dot) com

8:35 PM, October 09, 2011  
Anonymous Anonymous said...

Thank you for your article, very useful info.
I now understand that the heavy bleeding I had with my first pregnancy was actually due to the high doze of pitocin...

Can you please email me the chart as I am due in 10 weeks and would like to discuss this with my OB. Just hoping to avoid the previous trauma...

littlemoscow@msn.com

8:31 AM, October 12, 2011  
Blogger Sharon de Hinojosa (naturegirl321) said...

I wanted a natural birth. Had studied Hypnobabies and found a natural birthing clinic. Took classes and watched the business of being born. While I agree that pit is often abused and misused, when used correctly, it can be very helpful.

My water broke at 2am and I wasn't having contractions. At 4pm I went to the clinic and they sent me home to try some natural induction methods. That didn't work.

We went back at 12pm the following day, so it had been 34 hours. Contractions were off and on, but nothing big. I was only 1 cm dilated.

I choose the clinic because it was all natural, no drugs. They said I could stay or go to one of two hospitals. I stayed and luckily they used pitocin.

I got 6 drops per minute. It was never, ever turned up. I was on pit for 18 hours and probably only went through about a third of the bag.

I'm not saying it was fun, since pit makes contractions stronger, longer, and closer together, but for me it was either that or an emergency C section. My water had completely broken 34 hours before, no hospital would have risked a natural birth.

Anyways, for me, pit saved me from a C section. It was used correctly. Low dose: 6 drops per minute, never turned up and only used about a third of the bag. My opinion: all drugs can be used, abused, or misused. Lucky for me, pit was used correctly. the baby was born at 6.31am two days after my water broke. I walked out of the clinic at 2pm the same day.

No bloating, no issues. My mom had pit and she said that she felt her body being lifted off the bed. My contractions started very lightly and slowly. The last 9 hours were very hard. However, I avoided an emergency C section and was sleeping in my own bed less than 9 hours after she was born.

11:13 PM, October 22, 2011  
Blogger Sharon de Hinojosa (naturegirl321) said...

Oh, I only had 3 stitches, whereas my mom had 35. And I weighted about 3 ounces less than my baby.

11:17 PM, October 22, 2011  
Anonymous Anonymous said...

I'm a Labor and Delivery nurse. I can't tell you how appalled I am by our birthing practices. I've seen so many needless inductions with pitocin. My advice is to avoid induction unless truely medically necessary (i.e. continued pregnancy poses a great risk to life of mother or baby). If your OB recommends induction, find out why and make sure its really life threatening. Delivering a child is not a sickness! It should not be treated as such. Let your body decide when you need to go into labor! It knows best!

11:26 AM, March 23, 2012  
Anonymous Anonymous said...

Could I please have a copy of your Pitocin chart? I'm scheduled for an induction in a week and I'm really not sure that's what I want to do but the midwife is pushing for it due to the size of our baby and my age (38). Thanks so much.
weebes and then the numbers 74 at Hotmail. (No spaces)

8:28 AM, November 30, 2012  
Anonymous BeccaLee said...

Hi, I haven't read all the comments, but am wondering about the use of pitocin as a pain management tool? With my dd (17 months ago-1st birth) I ended up with something to help take the edge off-even though my birth plan told them don't offer or ask, if I wanted it I would ask for it. I was just recently looking at my statement & pitocin was listed! Labor never stalled-that I was told, as far as I can see there was no reason to have it. I was admitted at 1:30 am, dialated to 3 or 4 & having very regular contractions. Once I got the "medicine to take the edge off" contractions got 10 times worse & I couldn't handle them. Nurse informed me to "slow down your breathing" as she walked away, not bothering to show me how or anything. New nurse came on at 7:30am I was at least to 7 cm at this point, because I was told I couldn't have anymore "medicine to take the edge off" once I got past 7 cm. New nurse puts me in jacuzzi-tells me to stay there, she'll to all monitoring without me moving, helps me get my breathing under control & boom, baby is born at 10 am. I am just wondering why was I given pitocin if labor was going fine? I am going to request my records b see what the doseage was & reasoning, but just wondering what others thoughts are...
Thanks!

9:18 PM, February 15, 2013  
Blogger Ty Fondren said...

I realize that this is a SUPER old post, but I am hoping that you are still monitoring and can send me the pitocin chart. My email is tyfondren28 @ gmail.com. I had pitocin with my first and had severe vomiting (ending up requesting an epidural just to stop throwing up). The pitocin was turned down when they saw how sick it made me. I also struggled with high blood pressure during my entire pregnancy and had HUGE problems after delivery. I am wondering if the pitocin may have complicated the BP even further. I need to request my records from the birth. I had no clue what was going on. I'm pregnant with #2 now and am trying to get as much info as possible to discuss with my OB. I want to avoid pitocin at all costs.

6:45 PM, October 05, 2013  
Blogger nanci harper said...

If you are still monitoring, could you please send me the word document? Thank you. Nharper4 @ gmail dot com

12:51 AM, July 19, 2014  
Blogger Eowyn's Heir said...

I'd love the doc as well! cmtbard at yahoo dot com

11:10 PM, August 24, 2014  

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