#134 | Pitocin for Labor: Why and Why Not

We don't know the impact of synthetic Pitocin and blocking our own natural oxytocin or that specific downregulation of the oxytocin receptors at the time of birth and immediately postpartum, and how that wires our brain postpartum, and how that changes our emotional state. And our risk for postpartum depression and anxiety. Oxytocin enhances the Maternal Infant bonding. And that's the reason that every mammalian species has survived for millions of years, because that bonding is innate, and it's instinctual. And it comes from having oxytocin. So, we don't want to rob women of having oxytocin when they can have a better, happier, easier, safer birth.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Well, hello, hello there everyone.

We have a fun thing to talk about today.

Yeah, we're gonna do a deep dive on Pitocin also known as synthetic oxytocin, and May it never be known as what Trisha oxytocin. Oxytocin. Alright, so first we want to talk about a little bit about Pitocin, giving you the history of Pitocin. And then we're going to share some of the comments you've made with us by interacting with us on Instagram and sharing your experiences with Pitocin. So just in starting, you may be familiar with Pitocin already because it is so widely administered in childbirth today. Pitocin was first FDA approved all the way back in the 1950s. And then in 1978, an FDA advisory board removed its approval for the elective induction of labor, because of the side effects and the reactions that were occurring in many women. So think in terms of a woman saying she just doesn't want to be pregnant any longer. And she wants to be induced or a doctor saying let's get this baby out of you already. You've gone long enough, that would fall under the elective induction of labor category. Pitocin has actually never been approved for labor augmentation, also known as speeding up labor. So think of all the women you know, who have had Pitocin just to speed up labor, not FDA approved during those instances where they told where they informed when they were presented with that option. And often it wasn't even presented as an option. No doubt, the doctor just said, we're going to be speeding up your labor now we're going to give you Pitocin we're going to move things along. So when that happens, that's said to be used off label that means the drug is FDA approved, but just not for those purposes that they're using it. A study was done in 2007. In the US that showed a full 97% of the time Pitocin was administered in the US it was in fact for off label purposes. And I think this is interesting. The former president of the International Federation of OBGYN and a renowned researcher in obstetrical intervention said and this is his quote, Pitocin is the most abused drug in the world today. That's Dr. Roberto Calgary, Garcia. I now it may go without saying Trisha, but let's just say it Pitocin at times is necessary, wise and safe and appropriate.

Well, it's always with risk. So safe is relative.

Sometimes it is the safer course of action, though, depending on the circumstance. Yes. We're happy to have it, let's just say that late term preeclampsia, for example, absolutely.

Any situation where the risk of staying pregnant outweighs the risk of the Pitocin Pitocin has beneficial preeclampsia would be one reason for sure. A true case of IUGR intrauterine growth restriction would be one a true case of oligohydramnios to low fluid. Yeah, there are reasons we don't need to go through and list them all. But certainly when the risk of remaining pregnant outweighs the risk of the Pitocin you want to be induced and you grateful for Pitocin and there would be evidence out there supporting those decisions. So you would know how to get away from the rhetoric like your baby is getting too big or your pelvis looks small. And into where there is research on each situation. And Trisha just listed several there is a lot of evidence based research out there for induction so if you were looking into it, you could find that to support your decision. So, the bottom line is Pitocin can be necessary, useful, even life saving when USD ethically and appropriately, the question isn't about whether Pitocin is good or bad. It's not even about whether it's right or wrong. It's really about choice and information. How many? How come so many providers are using Pitocin freely today, these days these years for non FDA approved purposes? And are women being provided with informed consent? It's been time tested, it has not been found to be safe enough for those purposes to be FDA approved.

Okay, I will say there are tons of drugs on the market that are used for non F are used off label, right, so we take their drugs used all the time that are not FDA approved for the indication that you're using them for. But that, to me isn't the biggest point in all of this. The point in all of it is that women are not informed of the risks of Pitocin. And we see a lot of, we see a lot a lot of harm in administering Pitocin. So FDA approved or not, because do we really trust the FDA anyway? It's about being informed and it is an abused medication. overused?

Yep. So if you know women who've had Pitocin, ask them, if they know why they had it. Ask them if their consent was provided, if they were given the option to decline, of course, you have that right whether or not you're given that option. But ask them if they knew if they were receiving it for labor augmentation or elective induction if they knew it was for non FDA approved purposes. And just because that happens all the time. It happens with cytotec as well all the time. But that's known to be harmful. It doesn't make it right. But yes, there are serious known side effects of Pitocin. You can easily look them up on the FDA website. They're widely published, but they can include anaphylactic reactions, cardiac issues, hematomas, hemorrhages, we're not saying this to instill any kind of fear where he sings to educate you that Pitocin is no light, casual decision, and it is clearly being used as such, at least in the United States. It is a medical mandate that we receive full information on all tests, drugs and procedures. This isn't the privilege. This is a law called voluntary, informed consent. But the problem is, it's not currently the practice or the culture to be offered, or for us to expect informed consent. So this is why change has to happen with us because it is not going to happen at the hospital administration level. If you think you need Pitocin. You can request a low dose. You can use Mind Body techniques to work with your body in opening and relaxing. You can say no, you can say yes, and you can change your mind last minute, you can start getting Pitocin. And then you can change your mind and say I don't want this anymore. This doesn't feel good to me. Or you can accept it with gratitude, when you know that you need it when you believe that you need it. But always asked what are the risks? What are the benefits? What are my alternatives? And declining is always an alternative? Remember, being informed is their obligation. Providing consent? Is your right. So what is Pitocin? FDA approved for Pitocin? is FDA approved for the medical induction of labor and for postpartum hemorrhage.

Do you know what's not included on that side effect list, or risk of Pitocin list? more uncomfortable? Exactly. pain, increased pain, overstimulation of the uterus contractions that are back to back contractions that don't have the normal ebb and flow and the rest in between.

And one more comment before we get into what you said about Pitocin with us that we're going to share next Pitocin should never be called oxytocin. It may sound like the word oxytocin. It was designed to sound like that it is synthetic oxytocin, but it is a far cry from oxytocin. They both contract the uterus. But only oxytocin is liquid love. Only oxytocin crosses the blood brain barrier and promotes a sense of well being. Only oxytocin enhances the Maternal Infant bonding. And that's the reason that every mammalian species has survived for millions of years, because that bonding is innate, and it's instinctual. And it comes from having oxytocin. So we don't want to rob women of having oxytocin when they can have a better, happier, easier, safer birth. Oxytocin also comes in waves, like an ebb and a flow. It's like a dance in your body, whereas Pitocin is a continuous IV drip. Oxytocin comes with no risk, you can't get too much of it. And it also works as a natural anesthesia, which is kind of the opposite of what Pitocin feels like.

Also, Pitocin actually impacts the number of oxytocin receptors in a woman's uterus at downregulate some or down regulates them or reduces them to prevent the body from being hyper stimulated to prevent the uterus from being hyper stimulated. So that this means that after a high amount of Pitocin infusion, the woman is actually at risk for higher bleeding after birth. And you saw right there in the FDA category of risks, hemorrhage is risk. And that's probably the most common problem we see with the overuse of Pitocin. But that is because when you have a lot of Pitocin, your own oxytocin can't do its job because it has to down or your body down regulates the receptors, the receptor sites. And we still, we also still don't know the emotional effects, somebody did ask about this on our page. And we don't have a tremendous amount of research on this yet, but we don't know the impact of synthetic Pitocin and blocking our own natural oxytocin or that specific downregulation of the oxytocin receptors at the time of birth and immediately postpartum, and how that wires our brain postpartum, and how that changes our, you know, emotional state, and our risk for postpartum depression and anxiety.

Yeah, and, to that point, if your provider tells you Pitocin does across the placenta, that is false. And either they know it's false, or they don't know it's false. So I don't know which one is more forgivable, because if they don't know it's false information, how come they're not reading about this in their free time, like we are. A study was in fact done in 1996. By a Malik, he bland and Dr. Madison that was called human placental transport of oxytocin. And in there, they wrote that Pitocin can diffuse across the placenta and enter fetal circulation. This circulation into the placenta is dependent on many factors such as maternal body weight, duration of Pitocin use, of course, how much is being administered and for how long, but if a provider tells you it can't cross the placenta, that is just not so. And you know, as to calling Pitocin, oxytocin, that is such a major pet peeve of mine, I was impressed and surprised by how many medical professionals responded to us on Instagram and said, Ah, that drives me crazy in the hospital when they call it oxytocin. Because they're on to it because they know. But as I always like to say, the only way any provider can give you oxytocin is to love you, to respect you, right to give you space, and freedom and kindness and intimacy. That's the only way you're going to get oxytocin. So may you have tons of oxytocin in your labor. And it's good that Pitocin is there as an option, if you should need it. But when is it really being used appropriately? When is it not? That's what we're going to talk about next? Yeah, the point is, is really overused? Yeah, yep.

Yeah, we put that out on Instagram and said, tell us your stories about Pitocin. But before we do, we got a very nice message from a nurse who said, Thank you so much for this information. I had no idea. I've never heard this. I've worked in the industry this long and never heard any of this.

That's because one of the nurses wrote in that right there on the on the IV bag of Pitocin. It actually says oxytocin. Like it's completely mislabeled.

Yeah, they actually have the nerve to close the bag. They wish Nice try medics, you don't get to call that oxytocin.

If only there were a bio identical oxytocin right? If only they tried, and they've come as close as they can. But there was a nurse who contacted us who said, Thank you for this information. I've worked for this many years in this industry. I've never heard this. May I ask where you got all of these side effects? Because I've never heard any of these. And they're I've sent her the link there right on the FDA Pitocin page, right on the fda.gov.

What's one one Google sentence away?

It's out there, it's very easy to find there for the taking. I can't tell you how many times I've taught nurses and that they contacted me after class to say I had no idea about the side effect. And then there it is, like they open the pharmaceutical insert and read it or it's just right there available. We don't realize how easily rhetoric takes. There are things that rhetoric is just something that said without any evidence in order to influence an audience, but it's just said over and over and over. And we don't realize the impact of that by just saying the same thing over and over. Right? True. Like Pitocin doesn't cross the blood brain barrier. Well, yes, it does. But if you say that rhetoric enough, people will believe it. So let's talk about what came up on Instagram, Trisha.

So we asked people to tell us about specifically their postpartum Pitocin story, right? We were asking if they believed it was necessary.

Because there's the great debate about you know, the active management of third stage and is the injection of postpartum at the time of birth or immediately postpartum necessary.

Just one quick thing before you get into that, that Pitocin has been FDA proof for postpartum hemorrhage. And we know that postpartum hemorrhage does happen around 3% of the time. That's pretty much the consensus. All of the research comes in, showing it happens between one and 6% of the time. But it's safe to say for all intensive purposes, let's say 3% of the time, but 57% of our followers on Instagram said they received Pitocin after giving birth over concerns about postpartum hemorrhage. And you know that, you know, 57% weren’t hemorrhaging.

It’s because active active management of labor came into being some number of years ago around the time I was in midwifery school. And that was a combination of giving Pitocin at the time of birth, and clamping and cutting the cord and cord traction to deliver the placenta. And this whole three step process was meant to decrease the number of cases of postpartum blood loss greater than 1000 milliliters. It doesn't actually, it's now been shown that it doesn't actually decrease blood loss greater than 1000 milliliters. And so now it's sort of this mixed bag of you know, leaving according to act, not doing card traction, maybe doing card traction, sometimes getting Pitocin sometimes not. Right. I mean, it's you know, it's nice in theory, considering that postpartum hemorrhage is still a leading cause of death worldwide for maternal mortality. So it's a nice concept and Pitocin is great to have to tell you as a home birth midwife having Pitocin on hand is very comforting. But that doesn't mean that all women need it. And that certainly doesn't mean that all women get it without consent or without proper information. So let's let's share a little bit about what women said about their postpartum pit experience.

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Okay, so we asked tell us your postpartum Pitocin story. And here's what came in. I needed it to stop my bleeding. I had an unmedicated home birth. Yeah. So there's a difference between postpartum there's a difference between postpartum hemorrhage and just bleeding a lot postpartum. Right. And if you're giving birth at home, and you're far away from a hospital, if you have any concerns about bleeding, you don't want to get to the point of where you're having a true postpartum hemorrhage. So she's not necessarily in that three or 6% because she didn't necessarily have a postpartum hemorrhage, but her midwife determined that her bleeding was beyond her comfort level for being at home. So she got the, the Pitocin to prevent further bleeding. Okay, reasonable, reasonable.

Next one.

Okay. Pretty sure she stuck me in the leg with this to stop bleeding, but nothing was wrong. Okay, so there's a different scenario if you weren't actually bleeding, but they gave it to you. prophylactically. You know, she didn't sound like she knew this was coming. She didn't sound like she was informed.

And that was Pitocin. What they were sticking in your leg postpartum. For sure. It's administered? Yeah, it's administered and I am. If you already have an IV in place, if you're in the hospital and you have an IV, then it'll be given IV. And I am as intramuscular Yep. Forgive the midwife for her acronym. She doesn't realize. I don't either.

So this woman says I was at a birth center and the midwife said I needed it because I was bleeding a lot. Okay. After my first home birth, I was given a shot of Pitt after one hour and no placenta. So she this woman was given it to help birth, the placenta, is it effective for them? Well, it's effective at making the uterus contract and tract so that would, that would help so if presumably, presumably, yes. Now we know sometimes placentas can take a while. But if you're again, if you're at home and you are concerned about bleeding, or delayed placental delivery, and the uterus is you know, not it's so when the uterus is baggy, you get concerned about bleeding, so If the uterus is not doing its job and not contracting, maybe because she had a really long labor and she was just completely exhausted and her body could have needed a little extra dose, this seems like a reasonable time to offer Pitocin. Okay. I consented and placenta was delivered within minutes better than a hospital transfer. Again, homebirth being proactive, it this is up to the midwife in the in the mom to make this determination. But she was happy with it. I did not get it after birth. I'm open to the idea of needing and getting it in a situation but not routinely.

We agree. Great. Makes sense. Yeah.

All three hospital births, the 30 declined, but they gave it anyway after all natural birth.

So okay, that's a problem. That's the problem. I declined. They gave it anyway. So they know that they had not received your consent. They know they were breaking the law. They didn't have your consent. Not okay. Yep, not okay. That's why we're having this conversation. That's got to stop. I will be induced at 37 weeks certified nurse midwife said 90% of inductions and in two rounds of pit before and after birth? Well, typically Yes. If you're already getting induced with Pitocin, they're going to continue to give it to you postpartum.

Okay. And this is where the term cascade of interventions comes from. Yes, it does. Because Pitocin for the elective induction of labor, or the medical induction of labor, does increase the likelihood of postpartum hemorrhage. Now, we'll give you more Pitocin. to, to, to write, we gave you the drug that will drive up the likelihood of this. So let's just give you a little more to drive down the likelihood of this. That's exactly right. Talk about uterus overload. I do not think I needed it, but they gave it to me because it's routine at the hospital. Ding ding. Okay, routine thing. They don't like that word was given it IV postpartum because was given it during birth to speed up contractions.

Typical. Okay, that was for non FDA approved purposes, speeding up contractions. Hawai is everyone in such a damn hurry? Right? I mean, if there are situations that you might really want to expedite the birth, those are rare, but they do exist.

Because they're on the clock. We know that when you walk through those hospital doors, you're on the clock, you got to meet a certain, you know, interval of progress.

Yep. So as that laboring woman, you want to say what's the medical indication here, the duration of my labor is not a medical indication. So what medical indication is informing you of this recommendation? But doctor, I thought Pitocin hasn't been FDA approved for that purpose. Well, we use it all the time. I mean, when that? So what they'd be like, Who told you that?

They don't care if it's FDA approved. It doesn't matter to them. Right, but it works.

Yeah, you're right. They probably wouldn't care. All right, go on. What's the next I didn't even know I got it until I got a copy of my birth records. Oof. Now that's definitely not okay. No, you feel a little dude or something. Just nothing goes in your body without you knowing about it. That's just amazing. She didn't feel it, though. Right? Isn't a kind of or do you think she is that possible? She's just distracted or -

Well, sometimes they're giving it right at the moment of birth. You may not notice it. You're immediately I mean, typically immediately after but you could be just in that place of you know, elation with your baby, that post birth, how you're not aware of anything, somebody could probably talk about overkill that they do those things. I had a birth video once that I didn't like very much to show people. It was this beautiful, gentle birth and the baby's head came out, and what the baby's head out, and the entire rest of the baby still inside of the mother. The doctor took a towel and wiped all over the baby's face and then suction the baby.

Do you know how routine that is? I was appalled was I mean finally Bob suctioning has been eliminated but that was absolutely standard. Routine standard care.

I was appalled. I mean, it's like you want you know, the baby is just saying Can I please finish being born for us? I mean, her mother went through all that effort to have that kind of birth.

I was taught I was taught to do that as a midwife in midwifery school. Bulbs, suction the baby on the perineum wipe the face. Anyway, this is why it takes a while to change and the reason that women are still having this done is because of the active management of third stage. It's still you know, the evidence now says otherwise. But it takes years and years and years for practice to change. Okay, next one says it contributed to my postpartum depression. It was wildly unnecessary and unconsented and was administered by my home birth midwife. Whoo. Oh, okay. Only as I had a hemorrhage after my natural waterbirth okay. I had a postpartum hemorrhage after my cesarean. I believe they have Pitocin to help that. Yes. It's not a shot at our facility. It gets mixed with saline and given IV we give a lot of pit we give a lot Have pit the nurse says Yeah.

So, you know, most people it sounds like most people are getting an IV, which is why they're not getting it intramuscularly. If they didn't have an IV, they'd be getting it in their in their thigh. But this sounds like 99% of people are getting an IV. I told them no, and it was still given to me.

All right. That's why we're having this conversation, guys.

Yeah, I wasn't aware if I needed it or not, but nobody said anything about my bleeding they just gave it. There we go again, not informing not consenting. homebirth. And midwife thought I lost too much blood gave pet without consent. I can understand them wanting to give it if you're at home and you're losing too much blood, but it should still not be given without your consent. I mean, that just the they need to explain to you that I want. I want to give him this medication to manage your bleeding. I'm concerned about your bleeding. May I give you this injection? I wasn't bleeding much didn't even know they gave it to me until a nurse was briefing the new nurse. So she heard that she got a medication when she briefed the next nurse nice just being talked about right in front of her. They're just talking about her. That doesn't feel good. That's terrible. Yeah, that's not

I was not given Pitocin or anything else literally pushed baby out and went home from the birth center. Wahoo. I attended a friend's first birth and she was being pressured into Pitocin. Right. As she was ready to push, she declined and her midwife said she had to give a legit medical reason why she was declining. She looked at her mom for guidance. And her midwife said no, don't look at your mother. I am asking you what your reason is, it was very traumatic as the world turns upside down. The mother has to provide a medical reason why she's saying no to a drug. This is not how this works. The provider has to provide a medical reason for why they want to give the drug. The client does not provide a medical reason for anything. The client just says yes or no. Yes, please. No. Thank you. That's it. That was really not that was really manipulative, that nurse. And then no, you will not look at your mother.

What did she say? I was traumatized. I'm asking you your reason.

Now she doesn't know her reason. It was very traumatic. Well, there you go. Big surprise. What How was she supposed to come up with a reason? Other than I don't want it? How was she supposed to come up the medical reason? Right. I mean, give me a break. Come on. That was not that was really unethical.

No, was no, no. Is No, that's it. No. is a complete sentence our job to find a medical reason for anything? We say yes or no when they provide the medical reason, the risks benefits.

That was the grand finale, a good one to end on. So those were some of your some of your responses.

Now that I'm all worked up...Well, so takeaways, yeah, where are we going with all this? Here's where we're going with it. I mean, these responses were really helpful because they allowed us to demonstrate like the whole spectrum of how Pitocin is being used appropriately, inappropriately with consent against consent intramuscularly IV hospital homebirth, right. I mean, it can come up anywhere. For any reason, I think the thing that stands out is whether there was the assent so you can feel confident in your decision and your statement that there is no evidence that the active management of labor, including Pitocin injection reduces the risk of blood loss greater than 1000 milliliters when focusing only on women considered to be at low risk of postpartum hemorrhage if you're at high risk of postpartum hemorrhage, or you are actively bleeding excessively. That's a different story.

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