Shot of Pitocin to deliver placenta?

[GuavaGirl]

My CNM gives a shot of pitocin after birth to help deliver the placenta, to decrease blood loss. She recommends it, but says it's definitely not required if I don't want it. It sounds like a good idea to me. Other than it not being necessarily natural, is there any reason not to get it?

[MammaB21]

Personally, I wouldn't get it unless excess bleeding actually occurs and it is indeed needed. I'd be simply concerned with getting any extra needles pokes, as I'm not crazy about needles. I think it would effect a very important part of the birth process. That moment right after baby is born before the placenta even comes out, I don't really want anyone messing with me. I'd also be concerned that it would make the after pains more painful when pain wasn't necessary at the time. Also, with pit, I'd always be concerned with things like allergic reaction. Pit can cause the uterus to overreact in a sense and contract too quickly causing rupture. There are plenty of other side effects. They are rare, and most would probably be more likely if it was given continuously in an iv, but personally, it wouldn't be something I would take as a 'just in case'.

[Plummeting]

I do prefer to take things as nature intended, whenever possible, BUT that I am not at all hesitant to take advantage of allopathic medicine when necessary. The qualifier there is "when necessary". If there were such a thing as a completely risk-free drug, then whatever, but there is no such thing. The risk of having a serious side effect from a shot of pitocin to prevent bleeding are very low, but they still exist, and what I'm wondering is if it's worth it to you to take a small risk for a problem that doesn't even exist? For me, it's not. It makes no sense, so I personally wouldn't do it.

I would have no problem at all using pitocin if I had excessive bleeding or retained placenta, and I'm glad I'm in a state where homebirth midwives are allowed to carry it, but no way is someone using it on me for no reason. I'm glad my homebirth CNM will have it with her and ready to go, but I'm not okay with taking a small risk to prevent a problem I don't have. If I develop a problem, then I'll take that risk and more - just not before.

http://www.rxlist.com/pitocin-drug.htm

The following adverse reactions have been reported in the mother:

Anaphylactic reaction
Postpartum hemorrhage
Cardiac arrhythmia
Fatal afibrinogenemia
Hypertensive episodes
Nausea
Vomiting
Premature ventricular contractions
Pelvic hematoma
Subarachnoid hemorrhage
Hypertensive episodes
Rupture of the uterus

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.

The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.

[rootzdawta]

Moved from I'm Pregnant to Birth and Beyond.

[gardenmommy]

I would skip it. I had it with my first, and it was miserable. After a drug-free labor, it wasn't pleasant to deal with pitocin after it was all done. It was given against my wishes, btw. I've had homebirths and no pit. with my other babies (3, soon to be 4), and birthed the placenta within 30-40 minutes of birthing the baby with no problem. I think the key is to 1) wait for your body to do its job, 2) put the baby to breast immediately, and 3) wait for your body to do its job. I would only consent to a pitocin shot if I was hemmoraging. Trust your body, it is made perfectly to birth your baby and your placenta.

[mauinokaoi]

seems unneccesary
my placenta fell out with no pain moments after delivery when I stood up

[JorgieGirl]

Unnecessary for some. Necessary for others. Any midwife (and Dr) should take it on a case by case basis. If you are bleeding a fair bit, it might be better to go with the shot to avoid a hemorrhage. If not, then wait it out and see.

No one person has the right answer until you're holding a brand new baby in your arms and more can be established at that point.

It makes no sense to either request it now, or rule it out now. Your mw should be able to guide you when the time comes.

[at_the_hip]

I take it but only because I have had serious history of PP hemorrhage. If I wait, then the bleeding will easily be over 1000ml, and I still end up needing it anyway. So it makes sense *for me* to get it preventively in an IV as soon as the cord stops pulsing and is clamped. The difference in recovery whether bleeding too much or not is huge.

That being said, if I didn't need it, I wouldn't. I probably also would UC, but that is another story!! If you have no reason to do it, then wait-and-see might be a better approach.

[loveneverfails]

At_the_hip, that is *exactly* where I'm at right now. This is my 5th birth as well, and I'm going back to active management, including the shot of pit after the baby is out. My last two births have had blood loss at 1250-1300 cc, and I don't want to wait and see that I'm losing too much blood. My births that involved a shot of pit with birth of the baby had blood loss of 650 and 400 cc.

In the absence of a known tendency to bleeding, I wouldn't do pit right off the bat. Pit will decrease blood loss. The studies on this topic are very clear on that. But it's a risk/reward scenario that needs to be figured out on a case by case basis.

[Materfamilias]

I'm against routine adminstration. The nurse tried to do it to me in spite of my birth plan I think it should be a case-by-case basis. My placenta came out no problem and nursing really got those contractions going.

[snoopy5386]

I had a lot of bleeding after DD's birth with the pit shot. Looking at pictures from those first days I looked like a ghost, I was so pale. I also was so exhausted from the loss of blood, I nearly passed out in the bathroom a few hours after the birth and didn't leave the hospital room for the couple of days we were there. Walking up the stairs to our house when we got home felt like a marathon. I had to be on iron supplements for 6 months after the birth and it took me nearly a month before I felt anywhere near normal in my daily activities - ie walking up and down stairs, walking around the house, etc.
Blood loss is my biggest fear for this upcoming birth center birth - that I'll need a transfusion and end up having to transfer to the hospital or worse. I'll be doing the pit shot again.

[Amatullah0]

can it also intensify/mes with afterpains? i got a shot of pit hours after placenta came out, for hemmorage or retained placenta or something(i was about to faint when standing up). i got afterpains no sooner than 3 DAYS later, to the point where i couldnt move.

[Geerbabe]

As I understand it, active management of the third stage of labour usually includes traction on the umbilical cord in addition to a shot of pitocin (or oxytocin). You should discuss with your care provider when they feel it is necessary to use active management. Certain things such as a very fast labour can increase your risk of bleeding and make active management more advisable. However, without having those risk factors present, I am in the wait and see camp.

[mizm]

From what I know, many care providers routinely recommend the pit shot because according to a study, the risk of pp hemorrhaging was 1 in 10 women. They considered that pretty significant and basically said if one shot is going to save 1 woman...
personally, i think it should be case by case and women get it way too often that it should.. People can be screened for risk factors such as prolonged pushing, etc.
There are herbal alternatives as well - any herb that helps contract the uterus and we shall not forget - immediate skin to skin with baby and BREASTFEEDING will contract the uterus!

[RoadBuddy]

I would be open to it if there were any signs of trouble but not take it routinely. Unless your having a homebirth and the midwife is leaving soon after the birth and you're worried about knowing if there is a problem? I had a natural, hospital birth and was fine to decline the pitocin - I had no signs of hemmorage, the placenta came out easily, and I was in the hospital in case I did have excessive blood loss. I also had an almost pain-free recovery, which may or may not be related.

[Belle]

The doctor during my first birth seemed to think that by giving my the post-partum pit she was free to yank on my placenta to her hearts content because the pit would "prevent bleeding". She put her whole body weight into pulling on the cord. I thought she was going to pull my uterus out. According to her notes I lost 1000ccs of blood. It only took 10 minutes to birth the placenta so its not like it was in there for a long time or anything. She didn't even let me try to breastfeed to get it to come out. I was in agony from the pit-induced after birth contractions. I begged for drugs when I never did during the birth.

At my homebirth three years later, no body touched the cord and I got no pit. The placenta birthed on its own after 11 minutes. My midwives estimated my blood loss at 250ccs. My after birth contractions hurt but were managable with a heating pad and crampbark tincture.

[kltroy]

I went back and forth on this one. Here is the list of pros/cons I came up with:
PRO pitocin:
1. If you have a heplock, they can just deliver it through that, so no needlestick involved
2. Evidence shows that a "managed" third stage of labor results in less blood loss
3. If you start to hemmorhage, you will need a shot quickly, and it will definitely be an intramuscular injection (stick in your thigh).

AGAINST pitocin:
1. As you said, technically not "natural" - theoretically, your baby nursing should stimulate oxytocin production for you, though babies don't always want to nurse right away
2. There may be some conflict with delayed cord clamping and pitocin administration. Ask your MW about this. Once you've had the pitocin, can you still leave the cord unclamped? I don't know why not, but I seem to remember that.

For my VBAC birth I chose not to have the pitocin, and it was fine. The nurse did have a syringe with pitocin at hand in case I hemorrhaged, but we didn't end up using it. I did lose quite a lot of blood - I was dizzy when I stood up for about 12 hours after the birth - and I have no idea whether that would have been any different if I'd had the pitocin. I'm not sure I particularly care whether I have it or not, if I have another baby.

[at_the_hip]

Originally Posted by Amatullah0

can it also intensify/mes with afterpains? i got a shot of pit hours after placenta came out, for hemmorage or retained placenta or something(i was about to faint when standing up). i got afterpains no sooner than 3 DAYS later, to the point where i couldnt move.

IME the afterpains with pit were much less severe than the ones I got with methergine, which was required when it wasn't managed actively. I suspect that would also be the same with cytotec. For those of us with PPH history, it makes sense to take the pit to prevent the need of more risky/stronger drugs to control the bleeding (it also makes sense for those with a PPH hx to take an IV if you are dehydrated near the birth - I had this at the same time at HOME while pushing). But again, this is for women that have this known issue...I wouldn't assume that others would do this automatically because 90% of women won't have an issue without the pit.

The weird part was that I also had a much shorter run of lochia than my other births. I suppose I expected that if I had PPH, I'd have less bleeding to do in the long run, but the opposite was true for me!

[MiaMama]

Here are some thoughts.

Pitocin to control PPH can be lifesaving, no doubt. So I would not automatically refuse a shot before hand.

However, I could not find any good info about the rate of PPH in otherwise un-interfered-with birth. I have been researching Pit for other reasons, and I have found a few things that may be relevant to the discussion.

Pitocin augmentation during labor is increased with a higher risk of PPH. It makes sense to me that hormonal supplements can interfere a bit with your body releasing more of those hormones. So, Pit augmentation in labor would make me more likely to accept propholac Pit postpartum. I have read on some nursing boards that pit augmentation rates in their hospital are +90%, and in some, it is standard (everyone gets it). This also makes me question PPH rates, thinking that they may be increased based on 1st stage (labor) management. I have yet to find a study that factors 1st stage pit administration in rates of PPH. It definitley happens even when Pit is not used for labor augmentation, but augmentation may increase the occurance.

Also, the studies I did look at for pit management of PPH, it was stipulated that ALL women recieved cord traction. From personal experience, I learned that just because a midwife is attending, that does not mean that they will not pull the cord. If Pit administration is routine with this provider, then I would definitely ask about traction, regardless of what you decide about the Pit.

Personally, I am very wary of any kind of hormonal supplementation. I would consider it for good reasons, but not do it just because its routine.

[k9sarchik]

For myself and my next delivery I will be taking the Pit shot for the placenta. My placenta took 2 hours to deliver. I bled a lot! My midwife, IMO, took too long to give me the pit and I ended up transferring to the hospital. By the time I transferred to the hospital the placenta was out of my uterus but the OB did a whole freakin' procedure that utterly sucked! If I had gotten the Pit sooner it could have all been avoided.