The Lowdown on Using Pitocin During Labor
June 8, 2021
When it’s time to give birth, your body generally knows what to do: It’s programmed to release hormones that jump-start contractions and move your labor along. But childbirth doesn’t always go as planned. If your contractions stall or labor is slow to start (and baby really needs to come out), your doctor may recommend a Pitocin induction.
You may have heard some things about Pitocin—both positive and negative. The fact is, Pitocin can be incredibly useful to induce or augment labor, but, as with any drug, there are potential side effects and risks.
Because Pitocin is a drug commonly used during labor, it’s important for you to better understand how it works, and what it could mean for your overall labor and delivery experience. So what is Pitocin, and why might you need it? Moreover, why do so many women have such strong feelings about this medication—and is it something you can or should try to avoid? Read on to learn everything you need to know about Pitocin, including its benefits and drawbacks.
Pitocin, a brand name drug, is the synthetic version of oxytocin, a natural hormone that helps your uterus contract during labor. Oxytocin is secreted as your body readies for childbirth, but if you aren’t contracting quickly enough or aren’t in labor at all and need to deliver for health reasons, Pitocin can be administered as a medication to kick-start those contractions.
When the hormone was first identified and synthesized in 1955 by an American scientist named Vincent du Vigneaud, it was hailed as a groundbreaking medical discovery. In fact, Vigneaud received the Nobel Prize in chemistry for his work. “Up until the middle of the century, if a woman stalled during labor, there was no good way to increase the intensity of the contractions and help her deliver,” says Barak M. Rosenn, MD, director of maternal fetal medicine at Jersey City Medical Center. At the time, the only option was to go straight to the operating room. “But now, as an alternative to performing a c-section, we have the ability to give this medication to start or strengthen the contractions.”
There are two reasons a doctor may use Pitocin during labor: to induce labor, if the health of Mom or baby is at risk, or to augment labor when contractions have already begun but aren’t moving quickly enough, creating a potential for infection and other problems.
How does Pitocin induction work?
To induce labor, Pitocin is usually administered through an IV. The hormone binds to receptors in the uterus, which then activate the uterine muscles to encourage contractions. The contractions will gradually make the cervix dilate and then help to push baby through the birth canal.
While Pitocin induction triggers contractions, it works best “against a ripe cervix,” says Heather Bartos, MD, medical director at Be. Women’s Health and Wellness in Frisco, Texas. “A low Bishop score (which is a measure of cervical ripeness) generally won’t be changed by Pitocin.” This situation would typically call for the use of an oral or vaginal cervical ripening agent, such as Cytotec or Cervidil; these drugs work to thin and soften the cervix. Additionally or alternatively, your doctor may use a foley bulb to speed things along. During this procedure, a balloon filled with saline is positioned against your cervix to promote ripening and help with dilation.
As for the Pitocin dosage used, it depends on the hospital you’re in and its protocols, but across the board, best practice is to start slowly—typically with 2 milliunits, Rosenn says. Sometimes, that initial dose is all it takes to induce labor. Generally, doctors will wait to see how you react and go from there, increasing the Pitocin dosage every half hour or so until you’re experiencing contractions that are about two to three minutes apart.
How fast does Pitocin work?
“Usually a woman will feel mild contractions within the first hour, and then it varies from woman to woman in terms of when they become more intense,” says Geeta Sharma, MD, an ob-gyn and high-risk obstetrics specialist at Carnegie Hill ob-gyn practice in New York City. But another key factor in determining how successfully the Pitocin induction is working is how much the cervix is dilated—and how quickly dilation will occur after a dose of Pitocin varies from person to person. “It’s dependent on whether or not the mother has had previous deliveries and what her cervix is like—is it soft, has it begun to dilate? There’s a whole range of possibilities,” Rosenn says. “How long that takes depends entirely on the situation and on the woman.”
Pitocin is also sometimes used after delivery. “You want the uterus to contract as firmly as possible to stop postpartum bleeding, and a larger dose of [Pitocin] can help do that,” Rosenn says.
While post-delivery Pitocin isn’t necessary for every patient, it can be especially helpful for those who have developed an infection during labor; the uterus can become weak, and Pitocin puts pressure on exposed blood vessels to quell excessive bleeding.
As with most medications, Pitocin can be dangerous if not administered and monitored correctly. Pitocin brings on contractions, which are necessary for childbirth—but too many contractions in quick succession can actually harm baby.
“Every time you contract, it squeezes the blood vessels, thereby decreasing the blood supply to the placenta,” Rosenn says. "Baby’s oxygenation is dependent on a good flow of maternal blood to the placenta. So if you contract too often, the baby could get into trouble—which is why you don’t want the contractions to be too frequent or too long.” When baby’s oxygen supply is reduced, their heart rate may also begin to drop. This is why your medical team will watch you (and baby) closely during an induction. You will likely need to wear a fetal heart monitor throughout labor.
Other Pitocin side effects and risks include:
• Uterine rupture. While extremely rare, Pitocin can lead to a rupture of the uterus or a tear in the uterine wall if the contractions are too intense. This can be dangerous for mom and baby. For women who have had a previous c-section and are now trying to deliver vaginally, the risk of rupture is about 0.5 percent—but the use of Pitocin increases that risk to about 1.5 percent, Rosenn says.
A woman who has had a previous c-section can still receive Pitocin—she just needs to recognize the risk and be in a hospital setting, so a doctor can watch her and react to any changes. First-time moms and women who have had previous vaginal births need not worry: “The risk of rupture in women who never had a c-section is extremely low, even with use of Pitocin,” Rosenn says.
• Retention of fluid. “Another potential side effect is water intoxication,” Sharma says. “Pitocin is similar in its structure to ADH, an antidiuretic hormone, and in excess, Pitocin can cause water intoxication or retention of fluid.” Fortunately, this can be managed in a hospital setting.
• More painful contractions. While it’s difficult to assess objectively, many women do report more painful contractions with Pitocin. “It’s a common theme among women as a drawback,” Rosenn says. “For women who wanted to go into labor without regional anesthesia (or an epidural), Pitocin can make that more difficult.”
• Increased chance of needing a c-section. According to the Mayo Clinic, approximately 25 percent of women who are induced—whether via Pitocin or another method—end up requiring a c-section. On the other hand, a 2014 study found that c-section rate was actually lower among women who had full- or post-term inductions than those who were monitored by doctors and went into labor spontaneously at term or after their due dates. The reality is that a c-section may be necessary regardless of whether labor starts on your own or with an induction.
Over the years, Pitocin has developed a bit of a bad rap. “It’s one of the most feared medications among many women, because they often hear a lot of bad things about it—how it can increase the pain of contractions, how it can lead to c-sections, how it can be dangerous, etc.,” Rosenn says. “But what we have to remember is that it’s a naturally occurring hormone that has a role in labor itself—because, without this hormone, women wouldn’t be in labor or progress with their labor.”
There have been several contradictory studies on whether a link exists between Pitocin and autism. According to research findings outlined in a 2016 report, “mothers who received Pitocin during the birthing process were 2.32 times more likely to have a child diagnosed with autism later in life. [However], the fact that not all children exposed to [Pitocin] later developed an autism phenotype suggests interaction with other factors, which current research is attempting to elucidate.” The study also acknowledged that other recent publications have refuted such findings, and that, ultimately, more research is needed.
The causes of autism need to be better explored and analyzed on a broader level. “Advanced maternal and paternal ages are associated with autism. Advanced maternal age is also associated with an increased risk for c-section and conditions that may require the induction of labor—and c-sections are associated with an increase in autism spectrum disorders,” Sharma says. “It shows that we don’t know all the reasons behind causation and prevention of autism spectrum disorders.”
Rosenn echoes this sentiment: “At this time, there’s no good convincing data” that points to a correlation between Pitocin and autism. “When considering Pitocin, it’s the last thing I would want women to worry about.”
Pitocin induction might not sound ideal. But the truth is that the best laid labor plans—well, they might go awry. “Waiting for spontaneous labor may often be the best choice,” Sharma adds, “but individualized, careful consideration and discussion with your obstetrician is always strongly recommended.” In other words, you have to be willing to go with the flow. If baby is overdue, if you have a medical condition or if labor has come to a standstill, Pitocin might just be the catalyst your body needs to kick things into high gear.
The good news is that Pitocin is widely regarded as a safe and effective drug, and countless women receive it in the delivery room every day—even if some do lament its effects. If you have questions or concerns, speak with your doctor. Pitocin isn’t the only way to medically induce labor, so you can always discuss other induction methods and weigh the options together. And if you and your medical team determine that a Pitocin induction is necessary? You can feel empowered by your knowledge. There is no one way to labor—and, with or without an induction, the end prize is a baby in your arms. You’ve got this.
About the Experts:
Heather Bartos, MD, is an ob-gyn and the medical director of Be. Women’s Health and Wellness in Frisco, Texas. A navy veteran, she spent 12 years serving the women and spouses of the armed forces, and was an associate professor at the Uniformed Services University of Health Sciences in Bethesda, Maryland. She completed her residency at Baylor College of Medicine, and earned her medical degree at The University of Texas.
Barak M. Rosenn, MD, is the director of maternal-fetal medicine at the Jersey City Medical Center, a part of RWJBarnabas Health. Previously, Rosenn served as the director of obstetrics and maternal-fetal medicine at Mount Sinai West in New York City and a professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai. He received his medical degree from Hebrew University Hadassah School of Medicine.
Geeta Sharma, MD, is a board-certified ob-gyn and high-risk obstetrics specialist at Carnegie Hill ob-gyn practice in New York City. Previously, she was an assistant attending ob-gyn at New York Presbyterian/Weill Cornell Medical Center in New York City. She also completed her residency and fellowship there. Sharma earned her medical degree from Weill Cornell Medical College.
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