oxytocin after birth?

[sanguine_speed]

What information do you have about this? It's done pretty routinely here to prevent PPH. I am on the fence because I have actually had a PPH before, so I'm considered higher risk. But, are there any drawbacks that I may not have considered? I did also have 2 births without PPH so this is of course by no means guaranteed to happen again. I just don't want to end up transfering or requiring another D&C and/or blood transfusion.

[womenswisdom]

My understanding is that it's thought that injecting pitocin causes your brain to "know" there is enough and stop signaling for more and theoretically can screw up the complicated hormonal interplay of the pp period. Whether that actually results in any measurable difference in anything, I don't know if that has been proven. My preference would be to take an expectant management approach, watch the bleeding closely and give pit if needed. Just my 2 cents.

[loveneverfails]

I've had 3 post partum bleeds and we are doing a shot of pit after the baby is born to facilitate the 3rd stage. It would take me a bit to find the citations, but the research does indicate that active management *does* decrease the likelihood of PPH by a good amount.

I'm taking the shot because I feel like I have a decent chance of needing it and the effects of PPH can be absolutely draining. And I never needed a D&C or had a transfusion (could probably have used one after one of my births.) I'd rather have the shot before the blood loss rather than after it, if that makes sense? The birth without PPH I had the pit IV and a 400cc blood loss. The births without pitocin to facilitate 3rd stage had blood loss over 3 times higher than that, and especially with one birth it hit me extremely hard.

To me, it is my way of guarding the post partum period by increasing the likelihood that I am not losing all that blood. My kids are all fairly young, and I'm going to need that energy when my husband goes back to work at 2 weeks post partum and I'm back at the helm of a family with a large number of small children. The risks of the pitocin injection are extremely minimal. I think it's basically "bruising at injection site."

Is it disruptive to get a shot while you're looking at your baby for the first time? Probably. But *for me* I feel like the shot of pit is absolutely the least obtrusive option I have compared to the couple of hours I've had in the last two births controlling bleeding and blood pressure afterwards.

[*MamaJen*]

For someone who is not at risk of PPH, I would strongly advocate against the Pitocin (remember, it's the synthetic form of oxytocin, not real oxytocin). Your natural brain chemicals play an important role in everything that comes after the birth. Oxytocin is pretty amazing stuff and is related to nursing and maternal bonding. Pitocin doesn't do that.
If I had multiple PPHs, I would probably go with the Pitocin. But if I had one bleed and two normal deliveries, I would go with watchful waiting. Also, but sure to nurse immediately, like in the first 10-15 minutes. That will stimulate your body to produce more Oxytocin. Do delayed cord cutting as well.

[*MamaJen*]

Here's an interesting link about optimal care in the hour after birth: http://www.midwiferytoday.com/articles/firsthour.asp

[kltroy]

There's a thread almost identical to this (same question) in the VBAC forum right now - check it out.

[MegBoz]

Originally Posted by loveneverfails

It would take me a bit to find the citations, but the research does indicate that active management *does* decrease the likelihood of PPH by a good amount.

Yeah, I think actually WHO recommends active management of PP time with prophylactic administration of pitocin!

However, aren't there certain other factors that increase risk of PPH such as:
-long labor
-extra strong contractions (as can be brought on by pitocin or cyctotec in labor)
-manual extraction of the placenta

Maybe since you've had PPH in the past and if you end up with an extra long labor, it might be worth doing it?

Otherwise, I'd personally stick with expectant management & nursing afterward. In my case, DS didn't want to BF! We tried, but he just looked at me - no interest! And, my MW was concerned that there were some pieces of the amniotic sac retained, so she wanted to give me pit. She asked my preference - shot or IV (it was a hospy birth so I had a hep-lock in place .) I chose the shot & it wasn't a problem. In that case, it was her judgment call that it was necessary & I trusted her (VERY GOOD MW!)

[mwherbs]

IV pit not a shot- to be clear and not recommend in low resource settings only in hospital settings.
there was a recent study done by some midwives in OZ and they came up with far better outcomes in low risk women when they did physiologic management and the active management group had more hemorrhages and greater amounts of blood loss-
Women Birth. 2010 Mar 10.
Holistic physiological care compared with active management of the third stage of labour for women at low risk of postpartum haemorrhage: A cohort study.
Fahy K, Hastie C, Bisits A, Marsh C, Smith L, Saxton A.
The School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, 2308, Australia.
>>>>>>>>>>>>>>>>>skipping to the end of the abstract>>>>>>>>>
"CONCLUSION: This study suggests that 'holistic psychophysiological care' in the third stage labour is safe for women at low risk of postpartum haemorrhage. 'Active management' was associated with a seven to eight fold increase in postpartum haemorrhage rates for this group of women. Further prospective observational evaluation would be helpful in testing this association."
much of this is about provider technique, it is not enough that a provider doesn't use pit they have to know how to wait and what to look for how to leave a baby on a mom, wait to cut the cord be altert but not intrusive-- and no drugs in labor

[at_the_hip]

I had 2 PPH with babies 2 and 3, quite serious...one in hospital and one at home. In hospital I had a hep lock but it was disturbed during labor/delivery so the pitocin wasn't administered into my bloodstream well, and I required methergine (which gave me long-term side effects PP).

With my second one at home we waited since I had a history of it happening only once, but even with baby on me, nursing immediately, Arnica, etc. I needed 2-3 shots. Even then it was a lot of bleeding, followed by a huge clot a few hours later.

For me personally I could have been risked out by my mw due to my history but she knows I am very well committed to doing whatever it takes to be home! We decided with baby #4 to take a course of herbs for 5-6w before my due date, keep up with the Floradix, and I had an IV put in (close to when I was pushing) to administer oxitocin once the cord stopped pulsing/was clamped. I had no PPH, even less than normal bleeding...and my recovery was so much easier without all of the blood loss. I was even able to get up and take a shower right away which is a first ever!

I kind of expected to bleed more/longer PP because I didn't have the huge amount of bleeding but it was the complete opposite! Overall I bled much much less in the way of lochia and for a shorter duration to boot.

For me personally, due to my history of PPH, this was the best way to have my homebirth. I feel very comfortable with the same plan this time around. It was worth the effort!! FWIW, my uterus has always been rock hard and contracted well...no reason known for the PPH, although I have been told that redheads are more prone to bleeding (not sure if that is true, and I'm sort of a borderline redhead anyway!).

[AutumnAir]

I believe that with a routine injection of oxytocin immediately as baby's shoulders are delivered (which is how they do it here) there is a risk of retained placenta (where the cervix shuts down too quickly before allowing the placenta out) which is why it's almost always accompanied by cord traction (which can also lead to difficulties) and so you have the risk of needing a surgical extraction of the placenta.

I'm sure the risks are reasonably small - can't find my sources right now - so if you have a history of PPH then the benefits outweigh the risks most likely.

If, as a PP said, you've had one PPH and a couple of 'normal' births then, in your shoes I'd probably wait and see. The injection can be administered at any time, once excessive bleeding is noted, AFAIK.

[mwherbs]

if you have hemorrhaged you are at a higher risk for hemorrhage again- so something like active management could be one way to approach avoiding a repeat hemorrhage in addition increasing green veggies so that there is atleast 2 servings of cooked or raw greens a day , exercising and abdominal toning before pregnancy also consider some type of herbal uterine toner formula and possibly wearing a belly binder in pregnancy to avoid pendulous abdomen in pregnancy

[sanguine_speed]

Originally Posted by AutumnAir

I believe that with a routine injection of oxytocin immediately as baby's shoulders are delivered (which is how they do it here) there is a risk of retained placenta (where the cervix shuts down too quickly before allowing the placenta out) which is why it's almost always accompanied by cord traction (which can also lead to difficulties) and so you have the risk of needing a surgical extraction of the placenta.

I'm sure the risks are reasonably small - can't find my sources right now - so if you have a history of PPH then the benefits outweigh the risks most likely.

If, as a PP said, you've had one PPH and a couple of 'normal' births then, in your shoes I'd probably wait and see. The injection can be administered at any time, once excessive bleeding is noted, AFAIK.

Hmmm, and see I've also had a retained placenta that ended up in an intrauterine infection and IV antibiotics for a week in hospital .

[loveneverfails]

No, from when I looked this up last it's not the pitocin shot that carries the risk of retained placenta. It's if you use ergometrine/methargine while the placenta is in, which is why pit is the drug of choice for active management. Pit makes you contract straight down, whereas ergometrine/methargine make the lower segment of the uterus contract, which can close the cervix with a placenta still in. Please confirm that with your midwife, but I'm certain that the risk of retained placenta was not associated with pit but with the other anti-bleeding med commonly used for PPH.

I could be confusing you with someone else, but i think I remember that you had a premature infant? If so, was that the birth that had the retained placenta? With your previous PPH, was there anything out of the ordinary that might have contributed to your PPH, and do you know what your other estimated blood losses were with your other births?

[sanguine_speed]

Originally Posted by loveneverfails

No, from when I looked this up last it's not the pitocin shot that carries the risk of retained placenta. It's if you use ergometrine/methargine while the placenta is in, which is why pit is the drug of choice for active management. Pit makes you contract straight down, whereas ergometrine/methargine make the lower segment of the uterus contract, which can close the cervix with a placenta still in. Please confirm that with your midwife, but I'm certain that the risk of retained placenta was not associated with pit but with the other anti-bleeding med commonly used for PPH.

I could be confusing you with someone else, but i think I remember that you had a premature infant? If so, was that the birth that had the retained placenta? With your previous PPH, was there anything out of the ordinary that might have contributed to your PPH, and do you know what your other estimated blood losses were with your other births?

thanks for clarifying.
My PPH was with my only spontaneous full-term birth, my second baby. I did have a very long labor and large baby which I understand are risk factors. I should also mention that I did have a large initial bleed, but then had a lot more a few days later, probably due to the retained pieces of placenta--so it was primary and secondary. My hemoglobin was in the 60s. Not sure how much blood I lost with my others, but nothing was noteworthy about those.

My plan for now it to accept the oxytocin injection but not to clamp the umbilical cord until it has stopped pulsating (active mgmt usually includes cord clamping as i understand it).

[sienna]

Knowing nothing about this, I wonder aloud if the protocol to give the shot, in the absence of risks (like previous PPH), isn't a throw back from the time when everyone bottle fed. After all, the baby's frequent nursing itself stimulates oxytocin...but you'd have a shortage of that oxytocin stimulation if you weren't nursing.

And we all know that a huge amount of obstetrics is what it is b/c that is what they've always done.

[AutumnAir]

I found a couple of links which might interest you.

http://www.themidwifenextdoor.com/?p=640

http://emedicine.medscape.com/article/275304-overview

http://www.homebirth.org.uk/thirdstage.htm

It was the last one that I got my info from - turns out that in the UK they routinely use Syntometrine (a combination of Syntocinon/Pitocin and Ergometrine) - which probably accounts for the increased risk of retained placenta. So, it's worth checking with your HCP what exactly they would use for a managed 3rd stage.