The Lowdown on Using Pitocin During Labor
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. Read on to learn everything you need to know about Pitocin, including its benefits and potential side effects.
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 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. “If labor stalled, women would have c-sections. 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, meaning 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 administered usually 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 push baby through the birth canal.
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. Doctors will wait to see how the patient reacts and go from there, usually increasing the Pitocin dosage about every half hour or so as needed (by how much varies from hospital to hospital and from patient to patient).
Pitocin is also sometimes used after birth. “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.
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, assistant attending ob-gyn at New York-Presbyterian/Weill Cornell Medical Center 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.”
As with most medications, Pitocin can be potentially dangerous if not administered and monitored correctly. Pitocin triggers contractions, which are necessary for childbirth—but too many contractions in quick succession can actually harm the 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.”
Other Pitocin side effects include:
• Uterine rupture. While extremely rare, Pitocin can potentially lead to a rupture of the uterus or a tear in the uterine wall if the contractions are too intense. 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 with a previous c-section can still receive Pitocin—she just needs to recognize the risk and be in a hospital setting, so the doctor can react to any changes. But this shouldn’t be a concern for women who have “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.” But 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.”
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.
“At this time, there’s no good convincing data” that points to a correlation between Pitocin and autism, Rosenn says. “When considering Pitocin, it’s the last thing I would want women to worry about.”
Sharma agrees, saying the causes of autism need to be better explored and analyzed. “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,” she says. “It shows that we don’t know all the reasons behind causation and prevention of autism spectrum disorders.”
“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.”
Updated September 2017