Is Pitocin The Bad Guy In Hospital Births?

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If you're pregnant or if you've recently given birth in a hospital, you might have heard about Pitocin. Pitocin often plays the role of the “bad guy” in many women's hospital birth stories because it's a labor intervention that can sometimes be overused, misused, or used without informed consent. Not to mention the fact that Pitocin can make for a harder, more intense, and more painful labor experience for unexpecting mamas who use it. But is it all bad? Is Pitocin really the problem? Is Pitocin the “bad guy” that it's made out to be? Let's talk it out.

Click here to scroll to the bottom of this post to see the quick-look podcast show notes for this episode.

What is Pitocin and Why is it Used in Labor?

 In order to fully understand Pitocin, I’m going to actually rewind a little bit and talk about your natural form of Oxytocin. Your body produces a hormone called Oxytocin and that is the hormone that is circulating during a spontaneous labor. Oxytocin (in the natural form that your body creates AND in the synthetic form) will cause your uterus to contract which is what needs to happen in order to go into labor and eventually have a vaginal birth.

So, understandably, Pitocin might be given to someone who needs to give birth sooner rather than later but her body isn’t producing adequate labor contractions on her own. Adequate, meaning enough to change her cervix so that she can give birth. 

This means that Pitocin is a drug given to pregnant women who are being induced or augmented in labor. The idea is to get contractions started or to keep them going once they've begun. It's also sometimes used in labor to make contractions more frequent, more regular, or stronger if spontaneous labor isn't measuring up to hospital standards.

Natural Oxytocin Versus Synthetic Pitocin

Your own natural oxytocin and synthetic Pitocin are actually identical in chemical structure, but there are differences in how they act in the body.

Your own oxytocin rises in both blood and brain fluid and inside your central nervous system in your brain, because of it’s access to your brain, it actually triggers other hormones called endorphins to be released at the same time. This is a genius design in our bodies because this cascade of hormone release can lower anxiety, decrease pain, and decrease stress.

On the other hand, Pitocin does not cross into the brain because of the blood brain barrier and therefore it’s kind of like your body doesn’t have the ability to respond with natural pain-relief  and regulate labor as it would if you were circulating your own Oxytocin. Therefore, when Pitocin is given IV, it can cause more frequent, longer and more painful contractions. 

Is Pitocin ever necessary?

Before labeling Pitocin as the enemy, it's important to hold space for the families that truly need it. It’s easy to look at stories of how Pitocin made things harder or more complicated in some people’s births. And that’s all very valid. But without Pitocin, there is a whole group of women who would not have been able to have a safe vaginal delivery and take healthy babies home at the end of the day. In cases like preeclampsia as just an example, mama is safer delivering her baby early to save her and her baby’s life…and if her body isn’t going into labor on it’s own, an induction would be necessary and in many (but of course, not all) inductions, Pitocin is needed to get contractions going, keep them going, or make them strong enough to actually dilate the cervix enough to give birth. 

Pitocin Use in Inductions

The use of Pitocin in inductions is extremely common but there are various methods that can initiate the induction process, including an amniotomy (breaking of the water), prostaglandins such as Cytotec or Cervidil, or a cervical dilation balloon. However, these approaches are somewhat limited. They can't be increased if the initial dose doesn't kickstart labor.

In contrast, Pitocin is the only induction drug that can be administered and adjusted throughout the entire labor process – from active labor, transition, and through the pushing stage.

But des every induction have to use pitocin? If you need to be induced, do you HAVE to have Pitocin?

No. But it is definitely the most common drug that gets used during inductions.

Is Pitocin Approved For Use In Labor Inductions?

Pitocin is approved to be used for medical inductions. That’s it’s whole purpose, really. There is, in fact, a medication that was created for something completely different and is being used for labor induction even though it wasn’t intended for that use originally… but that medication has nothing to do with Pitocin. It's name is Cytotec. But that's a story for another time.

The thing is, although Pitocin is absolutely approved and intended for labor induction, there isn’t enough data to suggest that Pitocin induction is safe for elective induction or augmentation without indication. So, again, this drug is indicated for the medical induction of labor; available data and information are inadequate to define the benefits to risks considerations for elective induction use.

The Role of Pitocin After Birth

After birth, Pitocin is often given either through the IV or as a shot into the muscle, so most likely in the thigh. The reason for this is to contract the uterus to slow bleeding after the birth of the placenta.

We talked about how Pitocin causes contractions of the uterus in order to dilate the cervix during labor. So it makes sense that Pitocin would also cause contractions after birth as well. The difference is that now there is no baby in the uterus so these contractions will help shrink the uterus instead of helping to cause dilation of the cervix.

These uterine contractions will feel similar to intense period cramps.

This administration of Pitocin after birth is usually a standard order that is ordered for every mother after giving birth in a hospital whether it was vaginally or by cesarean.

The Difference Between Pitocin In Labor and Pitocin After Birth

The postpartum Pitocin order is vastly different than the Pitocin order during labor. If you’re receiving Pitocin during your labor to induce or augment your labor, you’ll be receiving Pitocin slowly through the IV. Any dose between 2 mu/mm all the way to 20 mu/min is a “normal” dose. Some hospitals even go as high as 30 mu/min and they can get to this high dose pretty quickly. A nurse can increase the Pitocin dose every 20-30 minutes from 2 mu/min to the max dose. So it might seem like she’s in your room constantly increasing the medication and that’s allowed by how the order is written.

But postpartum Pitocin is different and can literally be dumped into the vein through the IV (This is called a bolus). You might notice that your nurse hung the Pitocin bag and the line was left wide open and the entire bag of Pitocin emptied into your body by the time you have a chance to look up and realize you were getting something. The speed of the Pitocin going in is actually normal even though it seems really quick.

The Risks and Benefits of Pitocin

Pitocin's role in childbirth is both crucial and complex. While it has undeniable benefits in some situations like medical inductions, it's essential to recognize that its usage should be dictated by individual circumstances and medical necessity rather than standard procedure.

The administration of Pitocin after birth may be necessary for women at high risk of hemorrhage. Factors increasing hemorrhage risk include abnormal uterine anatomy, a cervical or high vaginal tear, uterine rupture, or a retained placenta.

Pregnant women carrying multiples, those who have had ≥5 births, those with high blood pressure disorders, or an infection during labor are considered at moderate risk for hemorrhage.

However, it's worth noting that medical induction of labor itself increases the risk of excessive blood loss after birth.

There is a time and a place for Pitocin. Some women might require pitocin. But just because some women and some births require pitocin or would benefit from Pitcon, does not mean that every woman needs it or that it should be automatically ordered for laboring women “just because this is labor and delivery”. Pitocin is not without risk and every intervention should be explained to laboring women so that they can fully understand the risk and the benefit and understand if her benefit outweighs the risk of the medication.

Pitocin is not a risk-free intervention.

The risks of using Pitocin include: 

• Increased Pain of contractions
• Overstimulation of the uterus
• Infection
• Uterine Rupture
• lower heart rate, which can affect your baby's oxygen supply 
• Fetal distress
• Excess bleeding after delivery 
• Medical issues during labor due to Pitocin use may result in an emergency C-section, or in rare cases, may require a surgeon to remove your uterus. 
• An Induction failure may occur about 25 percent of the time. This would mean moving on to Cesarean delivery when they were unable to get you into active labor. 

Another unfortunate risk of Pitocin induction is that you will be strictly monitored and you may be asked to remain in bed so that you can be continuously monitored now that you’re on this high-alert medication. And for most Pitocin inductions, your diet will be restricted to Clear Liquids Only because of the risk of possible cesarean delivery when being induced with  Pitocin. 

Understanding the risks associated with Pitocin is key to making an informed decision about its use. This is especially crucial when the primary benefit might merely be to speed up labor and deliver your baby sooner without medical indication.

The Inappropriate Use of Pitocin

Although there are standard orders that are given to all laboring or birthing mothers, there is no standard laboring mother. Each one of us is unique and each of our situations and labor experiences are vastly different. Sometimes Pitocin is unneeded and unwanted and that should at the very least, be a conversation. 

Sadly, the use of Pitocin has often been normalized in labor and delivery scenarios without any clear rationale. This is particularly true in situations where women with no foreseeable complications are admitted, and Pitocin is administered without justification.

The female body is designed for childbirth, and the natural process should not be perceived as inadequate or incorrect. A slower labor progression or contractions occurring every ten minutes, instead of every two, do not necessarily signify that something is wrong.

You are More Incredible than Pitocin could ever be

Mama, our bodies are so much more incredible than anyone gives them credit for. We are not birthing wrong. We are not laboring incorrectly or inadequately. If you and your baby are healthy and low risk, but your contractions are coming every 10 minutes instead of every 2 minutes like the textbooks say they should, your body isn’t wrong.

The design of the female body isn’t a mistake. It’s intentional. Sometimes our bodies slow down to give us a break. Sometimes our contractions spread out to allow us to take a breath. Our contractions can even space out to give baby a breather from intense labor contractions. MAYBE just MAYBE in a healthy body with a healthy baby, our 8 minute apart contractions that are manageable with some simple breathing techniques are actually just as effective an beneficial as contractions coming every two minutes and causing so much distress in mom that she is begging for pain relief when she was managing just fine before her labor was intervened on. 

Accepting Intervention & Help In Labor 

Sometimes things happen that require intervention and we can be grateful and thankful for modern interventions that we have available to us when we need them but we need to also be very aware that these interventions were invented to solve problems. Pregnancy is not a disease. Labor is not a complication. Not meeting the standards of a busy business trying to get you in and out to turn rooms is NOT a problem that needs to be in the forefront of your mind.

When making choices for yourself in labor and birth, consider two things…your health…and your baby’s health. Are you healthy? Is baby healthy? Are their complications happening right now? Are you at risk for complications right now? Will the next intervention solve a problem that I’m having? Or will it possibly just make something more convenient while also at the same time leave more opportunity for MORE problems to surface in your birth.

If Pitocin is offered to you in labor, the answer shouldn’t be “no. Pitocin is the enemy” and it shouldn’t be ‘yes. This is standard for all births” or even “yes, my body must be doing it wrong”.  You are unique and you get to make the informed choice for yourself and your baby. The problem isn’t Pitocin. The problem is the way that it’s used and overused. The American College of Obstetricians and Gynecologists (ACOG) recommends women and their doctors to evaluate the benefits and risks of Pitocin before using it in labor. Not to make it a standard for all labors and all births across the board. 

You CAN trust your body to do what it was built to do. And then we can be thankful for interventions for things that unfortunately can COMPLICATE labor. Labor itself is not a complication. And it doesn’t need to be fixed. But there are certainly things that can complicate things during the process. Like if your vital signs are abnormal or unstable like in the case of hypertension or preeclampsia. Like when your body isn’t processing sugar the way that it should and you have gestational diabetes, like if your placenta attached in unusual or atypical ways that make birth more complicated. Or if you develop an infection during the labor process, like if your labor stalls after your water is broken and doesn’t pick back up again after some time.

How Can I avoid a traumatic birth caused by pitocin?

Pitocin has done a lot of good for a lot of families. But it’s also caused a lot of harm and a lot of trauma too. So I’m not here to tell you what you should do in your birth but give you the gentle nudge to seek the truth and get information that is relevant to YOU and your birth and your experience. 

Ask questions like Why is Pitocin recommended for me right now? What is the benefit of my labor going faster at this point? Is this to speed things up or get things going? Why do we need things to go faster? What would be the harm in allowing my body to labor at it’s own pace? Is my body showing signs of distress? Is my baby showing signs of distress? How will pitocin affect those signs? Will Pitocin help? How? And the answers for you and your birth might be different from the answers that the woman laboring the next room will get. Because no two labors are exactly the same. And there is no shame in making the choice for yourself that feels the most right after getting answers to those questions.

And honestly, the same goes for after birth. You can put it on your birth plan and talk to your team prior to birth about declining Pitocin after birth unless things change and your risk for hemorrhage increases or in case you are showing signs of abnormal bleeding after birth and then request that you’re informed before it’s given. You can still ask questions. And trust me, you can still make sure that things aren’t done simply because “this is what we do here”.

That is never an appropriate rationale for receiving a medication or an intervention in labor and delivery.

There should be a unique, patient-specific reason as to why we are intervening on your birth. Because remember, being pregnant isn’t a reason to intervene. Being in labor isn’t a complication that we need to fix. These are normal life processes that can start and finish on their own without intervention and without being textbook or cookie cutter exactly the way we want it to look.

Conclusion: Be Informed, Not Fearful

It's essential to understand that your labor team is there to support you. They want you to have a positive birth experience and go home with a healthy baby. However, they might not see things the same way you do or value the birth experience as you do. This is why it's crucial to be well-informed, have a birth plan, communicate with your team, and advocate for your birth preferences.

While it may feel unfair to fight for the birth experience you desire, remember that a beautiful birth can and does happen in a hospital setting. Fear should not drive your birth experience – information should. Pitocin, when used judiciously and appropriately, can aid in the labor process. However, its overuse or misuse can lead to unnecessary complications. The key is to be informed, ask the right questions, and make the choices that best align with your personal circumstances and preferences.