Guest post by Liesel Teen – L&D Nurse and founder of Laborteen.com
Are you planning an upcoming induction for your baby? I’m so happy to be answering some of the most common questions surrounding Pitocin, and labor inductions.
I’ve been a labor and delivery nurse for over four years now, and HANDS DOWN the most common medication I administer to my patients is….you guessed it…PITOCIN.
Pitocin gets a bad rap sometimes.
Many women want nothing to do with the drug, and shudder at the thought of having artificial oxytocin administered as a means to start labor.
It CAN be unsafe in certain situations. There ARE risks surrounding this drug (for you and for your baby, which we will get into labor), but when managed by a skilled provider, Pitocin is generally very safe.
1. So…what is Pitocin, and how will I be prepped for my Pitocin induction?
Pitocin is artificial oxytocin. Plain and simple.
Oxytocin is a chemical your body naturally produces when you feel that “warm & fuzzy” sensation. It’s the feeling you get when you see a puppy, when your kid does something super cute, or when you orgasm.
It also is ONE of the chemicals that causes your uterus to contract during labor.
Once you arrive at the hospital (or birth center), you’ll be checked in and your nurse will put you on the electronic fetal monitor to see how baby’s heart rate is tracing, before getting your Pitocin drip started.
She‘ll ask you some questions about your health history, take your vital signs, and start an IV on you.
Your provider will also come to see you by this point and check your cervix. He/she will also talk to you a bit more about what interventions will be used to start your labor and the risks and benefits of each.
Generally, you have to have a favorable cervix for Pitocin to be effective at continuing to change your cervix.
This means you should be a few centimeters dilated, fairly thinned out, and your baby should be engaged in your pelvis. Many times by week 39 or 40, moms who have had babies before ALREADY have a cervix that is favorable.
If second or third-time mommies come in for induction, it’s pretty common for Pitocin to be the only induction method used.
But what if you’re a first-time mom, and your cervix is a whopping ZERO centimeters?
Depending on your provider, you may be asked to come to the hospital the night before your Pitocin induction so you can get your cervix “prepped” for the morning.
This can be done manually with a little balloon that sits in your cervix for 8-12 hours (a foley bulb), or done with an intravaginal medication that also takes a few hours to soften and open things up (Cytotec or Cervadil).
2. How long does Pitocin last?
Pitocin is an IV drip medication that is given slowly to you intravenously. In fact, when you’re first given Pitocin IV, you’re only given less than half a teaspoon per hour of the stuff.
Your nurse will increase this dosage by about 2ml/hr every 15-30 minutes, until your contractions are painful, and changing your cervix.
This usually happens when your contractions are roughly 2-3 minutes apart.
Once you are beginning to change your cervix, your nurse will leave your Pitocin drip where it’s at (no longer increasing it), and your body will continue to labor and progress until you deliver.
If your baby ever becomes stressed out, or your contractions become TOO close together, your nurse may need to turn off your Pitocin for a brief period of time or slow it down.
3. Is an induction with Pitocin more painful than natural labor?
The easy answer is “we don’t know”…but the real answer is uh probably. (In my opinion)
I’ve not had two labors personally to compare, but just in here-say from my own patients, the general consensus is that contractions that are felt during a Pitocin induction are different than contractions felt during spontaneous labor.
They are stronger than natural contractions, but this may not necessarily mean they are more painful. The best way I can describe it is that they are truly different.
There are a TON of different opinions on this one, and it’s hard to really conclusively say YES because so many women feel so many different things.
Let’s say Sally comes in to be induced, and she has a 4-hour induction and pushes her baby out in 20 minutes. Next door, Mary comes in naturally laboring for 24 hours, and pushes HER baby out in 3 hours.
I’d have to say Sally-short-labor (albeit, maybe more intense) had the easier, more manageable labor experience. She might argue that her contractions on Pitocin were much easier to tolerate over Mary who’s labored all day.
As I said, it’s a very hard question to answer, because so many different women have different experiences.
4. Do I need an epidural with a Pitocin induction?
Nope. Definitely not.
Even though as I’ve just said, women typically report contractions to be more intense when they are induced with Pitocin, this is NOT an automatic reason to receive an epidural.
It’s more up to what you what your labor experience like.
Contractions are contractions.
They are going to be painful, and you definitely shouldn’t base whether or not you get an epidural on if you are induced with Pitocin. If you are set on a natural birth, you may certainly still have one while being induced, and I’ve seen MANY mamas do it successfully.
My advice would be to do some research on your methods for pain control, read some great natural birth books, talk to other moms who’ve had natural births with Pitocin, and interview your provider.
It’s your right in labor to make the decision what you want for pain, and it’s important to never feel like you are being pressured one way or the other!
5. What are the risks of Pitocin for me and my baby?
As with any procedural type task, there are always risks.
Let’s first start off with the big risks for you, mama.
Since Pitocin is artificially making your uterus contract, there is a risk that your uterus could contract too forcefully, or too frequently and rupture.
Very infrequently does this happen, (between 0.2%- 1.5%) but it’s still scary, and still an emergency when it does.
VERY, VERY infrequently does a uterine rupture happen with Pitocin use if you’ve not had a C-section before.
Almost all induced VBAC mamas fall into 0.2%- 1.5% range, so if this is your first baby and you’ve never had a C-section before, your rate of uterine rupture is almost ZERO. (It has still happened, though, and that’s why we talk about it.)
A uterine rupture is a scary ordeal. We will usually be able to see it pretty readily on your monitor, and things will go pretty fast from here on out.
You’ll need an emergency C-section, and baby is at a much higher risk for low Apgar scores, or even possibly death.
Let’s talk about the risk for baby…
So, as I’ve mentioned…Pitocin causes your uterus to artificially contract.
If your uterus is contracting too hard or too frequent for baby, baby can get stressed out and cause changes in his/her heart rate.
***This is the main reason why you’ll be monitored during your Pitocin induction…we need to see if these changes happen***
If baby gets too stressed, he/she can drop her heart rate…and not raise it back up. If this happens, you’ll need an emergency C-section, or if you are too close to a vaginal delivery, your provider may use forceps, a vacuum, or perform an episiotomy to get baby out quickly and safely.
This leads baby to be more at risk for low Apgar scores, low oxygen levels, trauma, or even possibly death.
What’s one way we can help to avoid this happening?
Good fetal monitoring during labor, and having a skilled nurse and provider who can recognize early changes.
Usually, if things are going to turn bad, there are early signs of this happening.
Unfortunately, sometimes there aren’t any changes, and things happen without any anticipation.
Having a skilled provider who knows how to manage your Pitocin drip, and what to do in an emergency is one of the MAIN things you can do to help decrease your risk of potential bad outcomes.
Generally, Pitocin is a very safe drug when given correctly and managed well. I know those risks sound scary, but they are very infrequent.
I hope you’ve learned a thing or two about Pitocin, and how it affects your body and your baby.
Happy Inducing! 🙂