Questions about pitocin after birth...

[mommyofatoz]

I am having trouble finding the answers I am looking for. I've googled and searched here, but still have questions about this...

First, I know that they do this to speed up the delivery of the placenta, and it reduces bleeding/hemorrhage, so I can see why it would be helpful it they noticed one was having bleeding issues, but...

--What would be the reasons to decline this routine procedure if everything is fine? Are there any?
--If I wanted to delay cord clamping, is there still risk to the baby if I am now having pitocin injected?
--What if I don't want an IV/heplock? I think I've read that intramuscular pit is more dangerous that pitocin given through and IV? Is this true? What are the differences between these two methods? How about given through a heplock?

Thanks!

[Kidzaplenty]

--What would be the reasons to decline this routine procedure if everything is fine? Are there any?
I can interfer with your natural hormonal response, and it can cause more painful contractions than normal for afterbirth.

--If I wanted to delay cord clamping, is there still risk to the baby if I am now having pitocin injected?
Not sure, but I have to asume that pit goes through the placenta and must have an effect on the baby, even though no one seems to know what or how. Also, it could cause too much blood to be forced into the cord by unnatural contractions, thus increasing the risk of jaundice.

--What if I don't want an IV/heplock? I think I've read that intramuscular pit is more dangerous that pitocin given through and IV? Is this true? What are the differences between these two methods? How about given through a heplock?
I don't really know the difference, but I would think intramuscular would be worse because it can not be stopped on a moments notice as the IV one could, so it would seem to have a higher dosage to ensure it works "right". This is just my theory, though, I don't have any research to back this up.

[MegBoz]

--What would be the reasons to decline this routine procedure if everything is fine? Are there any?
Hm, primary reasons I know of for declining pit is that it makes uterine cntrx more powerful & thus more painful & tougher on the baby. But obviously the latter isn't an issue after birth. And "After pains" are painful anyway...
But if my MW told me she really was concerned about bleeding & wanted to give me pit, I'd have to trust her on that call. (Well, presuming here you've found a HCP you have some level of trust for.)

Actually, that is exactly what happened to me. My MW massaged my uterus a bit & a bit of membrane from the BOW came out, she was concerned more was still there. She actually made a point of waiting to see if DS would BF, but he was totally not interested. LOL, I"m on camera saying to him, "C'mon! Help me out!" But he wasn't opening his mouth.

--If I wanted to delay cord clamping, is there still risk to the baby if I am now having pitocin injected?
I suppose you'd have to weigh the risks of pit vs. the benefit of the stem cells he gets from cord blood. Personally I'd still delay cord clamping. Pit is just a synthetic oxytocin - syntehtic version of a natural hormone anyway. Besides, I don't think cords pulsate for very long, it was barely a minute or 2 in my case before it stopped - so it had already been clamped & cut before my MW said I needed the pit anyway.

--What if I don't want an IV/heplock?
I had a heplock & it was somewhat irritating. I don't think it was necessary. The odds that I will, all of a sudden without warning, hemmorage so severely that my vascular system would collapse before they could open a vein are so small, it's not worth it a hep lock "just in case".

I think I've read that intramuscular pit is more dangerous that pitocin given through and IV?
Hm, news to me. My MW said, "Shot or IV?" since I'd already had the heplock. I had no idea which would be preferable, so I asked my doula & she said she'd chose the shot because otherwise I'd have to deal with the IV tube & it could get in the way & be a nuisance as I tried to BF. I thought that was a good point, so I went with the shot.

[cileag]

Just wanted to add 3 things:
1. Many times, I see midwives giving Pit after the placenta has come out, and so you could certainly ask for that if you're concerned about the baby. Although I agree with the MegBoz, and I wouldn't worry too much about it.

2. IM shot vs IV is really more during labor where the issue can come up. You don't typically want to give IM pitocin (the shot) to a laboring woman because you can't titrate it up and down. After delivery, I'd choose the shot because otherwise you're getting a full liter of fluid in very quickly (which can contribute to fluid overload if you've had IVs throughout delivery) and I've heard from several OBs and midwives that the shot is more effective.

3. Here's some more info from the World Health Organization if you need more help in making your decision. They're my go-to guide for routine procedures etc.
http://www.who.int/making_pregnancy_.../en/index.html

There's a section about 3rd stage management, which is what you're looking for.