Pitocin after birth

[mija y mijo]

My first birth was an induction and they continued the pitocin after my daughter was born. Didn't think too much about it.

My second birth was completely natural in the hospital. After my son was born the nurse massaged my uterus (the doctor wasn't there) and they gave me pitocin to help things along. I was so exhausted and in awe of my son that I really didn't pay attention as to why... there was no alarmed sense that I was hemorrhaging. But the nurse did tell me to make sure the nurses on the postpartum floor continued to massaged my uterus, which they didn't. I do remember feeling very weak and exhausted after ds's birth, but I hadn't ate in over 18 hours or slept in over 36... I just assumed it was because of that I was so wiped out, but now I'm starting to wonder if blood loss had anything to do with it.

Is it just a common hospital procedure to give pitocin after birth to help the uterus contract, or does it sound like I was hemorrhaging and intervention was needed? I'd like to have a homebirth the next time around, but postpartum hemorrhaging is one of my concerns, especially after thinking back to ds's birth.

[GoBecGo]

My SIL had it after her induction, the staff told her an augmented labour more often leads to an exhausted "floppy" uterus and thus increases the risk of PPH, so they leave the pitocin on for a time after delivery.

If they give you pitocin after the baby but before the placenta then it's a "managed" 3rd stage, which is the norm in many hospitals. If it was after the placenta then its possible you were bleeding a little much (not necessarily a haemorhage though) and they decided to give it to help the uterus clamp down harder.

Uterine massage helps the uterus to clamp down, i did it myself whenever DD hadn't nursed for more than an hour during the first 5 or so days (until my uterus was so low it was hard to find). It probably made no difference to my (normal) bloodloss, but it made me feel better

[mija y mijo]

It was given after my placenta was out. So pitocin and massage are not "typical" for a natural birth, and it would seem I was bleeding too much? I wonder how common this is. I'm just curious if this puts me at a higher risk of hemorrhaging during a homebirth...

[nadia105]

I have had it all three times (all unmedicated births), but I have had a lot of bleeding after each baby. I was going to forgo it after the third, but I got some major clots and heavy bleeding, so I did have it again.

[GoBecGo]

I don't know, mine were both at home, i had syntometrine after DD1, because they were NHS hospital midwives and felt panicky after waiting 10minutes for my placenta (which makes me laugh now!), but i was all-natural with DD2 and my (independent) MW told me to massage my uterus if it felt soft after i asked her about PPH. Depending on where you are your midwife may have pitocin/some other contractant with her. It might not be legal though, i think that varies from state to state...? I'm in the UK, they all have oxygen, adrenalin, syntocinon, syntometrine or ergometrine with them. Most PPH's can be resolved at home with those drugs.

[bonamarq]

Okay - not a nurse here but was a doula for a while and hung out with HB midwives ALOT (served on the board of michigan midwives association for a number of years)

I recall that one of the mw "complaining" that the hospitals were starting to use pit on EVERYONE - that they just didn't even know what a normal natural birth looked like -

to OP if you were really hem. you would have seen them panic, is my guess -

Also - there is a very WIDE range of normal for bleeding post partum -

In essence - don't worry about it if you want a HB next time - yes, mention it to your MW - and if it makes you feel better make sure she carries pit -

but my guess is this is SOP in hospitals now a days - even with totally natural births...

[Mama Metis]

I know that at a hospital I used to work at, EVERYONE got Pitocin after a vaginal birth - this is a "managed" 3rd stage as a pp said. This is pretty common in US hospitals. From your description, I wouldn't think you necessarily had any excess bleeding.

Medical management of the 3rd stage is controversial. Clearly, it is an intervention. And because of hospital protocols, women get it even when everything is proceeeding normally. On the other hand, there is solid evidence that it reduces overall blood loss, so it is considered "evidence based" even though it's not natural.

[babyjelly]

As has been said, hospitals don't really know what normal bleeding looks like, so everyone gets pit. And I personally didn't let a history of pph (real
hemmorhage, too) disuade me frm having the homebirth I wanted. I hemmorhaged at home, too, and although it could have been handled better, I was fine without transfer.
Good luck in working it out for yourself
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[Adamsmama]

I had pit after each of my births ... one they gave pit from 5cm on (to augment labor) ... one was a complete induction so pit all the way through and the other was a natural labor/birth wit pit after.

[Ola_]

I was reading something just yesterday and the recommendation mentioned in it was to give pitocin as or just after the anterior shoulder is delivered.

[AnneCordelia]

Yes, the ACOG recommends oxytocin (pitocin) 10 IU intramuscularly (or by IV) upon delivery of the anterior shoulder as standard care. My midwife prefers to wait until both shoulders are delivered just incase there is an issue with the rest of the delivery.

I had a true hemmorhage at the birth of my first (lost 1200ccs, estimated) and I've had two lovely homebirths since. Hoping for a 3rd homebirth sometime soon.

[lunarlady]

My HBMW carried and used pictocin, although I still had to transfer due to third stage issues and blood loss. While my transfer wasn't ideal, I'd HB again.

[mija y mijo]

Seeing that it seems like pretty standard procedure, I'm not so worried about it now. I'll be sure to discuss my concerns with the midwife when the time comes. Plus, I would assume it would be noted in my medical records which I'll have transferred.

It's reassuring to hear that those who had PPH have not let it dissuade them from birthing at home in the future.

Thanks ladies!!

[GoBecGo]

Originally Posted by Mama Metis

I know that at a hospital I used to work at, EVERYONE got Pitocin after a vaginal birth - this is a "managed" 3rd stage as a pp said. This is pretty common in US hospitals. From your description, I wouldn't think you necessarily had any excess bleeding.

Medical management of the 3rd stage is controversial. Clearly, it is an intervention. And because of hospital protocols, women get it even when everything is proceeeding normally. On the other hand, there is solid evidence that it reduces overall blood loss, so it is considered "evidence based" even though it's not natural.

Can you point me to the evidence? I am really curious about this as i've had "both ways" as it were. With DD1 i lost less initially (250mls written in notes) but i had lochia for nearly 7 weeks, and it stayed bloody for most of that time. With DD2 i lost more initially (350mls in notes) but my lochia cruenta (the red blood) subsided completely within 3 days, so fast my MW was concerned i might have retained something, but nope, i was just done bleeding. Then i had a day or two of nothing much, then the normal serosa and alba periods. I definitely lost less blood after my natural labour, no question, even though i lost an extra 100mls or so initially.

[OkiMom]

DD1 I didn't have pitocin after birth, in fact they took off the IV (didn't take out the heplock though) before I even had a chance to nurse her. The nurse told me its easier to nurse if you don't have a ton of tubes attached to you. The heplock was taken out as soon as I got to the Postpartum ward. I had minor bleeding that stopped within a month of birth.
DD2 they gave me pitocin without asking (they injected it into the IV before I even got there). When I found out I flipped and told them to take the IV out I didn't want it. That birth I had bleeding for 6-8 weeks afterwards. One could argue that the pitocin didn't make a difference but my body seemed to deal better without it.

[L J]

DS1 was a UC, so no pit or anything there. My lochia lasted about 6-7 weeks, IIRC. It was a long time.

DS2 was born still in the parking lot of the hospital. In the confusion (among the staff) in the two hours after my arrival, they completely forgot that I hadn't delivered the placenta. Therefore, I was "allowed" to deliver the placenta naturally, and it detached on its own, before they started the pit.

After I delivered the placenta, they hooked me up to a huge bag of pit that they gave in via IV over the course of 10 hours. I didn't have the strength to fight them on it, and I just didn't really care at that point, but I did ask WHY I had to have it, because my uterus contracted back down to where it should have been really well, before they even hooked up the pit. A doctor commented on how efficient it (my uterus) was being.

I was told it was just "standard operating procedure" and every woman got pit afterward, natural birth or not. I'm sure I could have signed a waiver had I the energy to care, or fight, but, FWIW, my initial lochia only lasted about 7 days, and was light. I started bleeding bright red, fresh blood today, and I assume that is from the site where the placenta was attached unclotting and healing.

All that rambling out of the way, OP, it does not sound to me like you were hemorrhaging. But, I'm sure you can ask your OB the next time you see him, if it will ease your mind. Any sign of hemorrhage would have been noted on your chart, I would think. And yes, at some hospitals, it is just SOP to give pit to everyone, regardless of whether there are any indications that it is needed.

[kltroy]

Here's some good information about the evidence for managed 3rd stage. IMHO (as a professional research scientist), this type of analysis is THE BEST evidence that one can get. http://www.ncbi.nlm.nih.gov/pubmed/20614458

This would be the definitive RCT: active vs. expectant management.
http://www.ncbi.nlm.nih.gov/pubmed/9504513

Note the string of author comments on this trial - worth following up on.

[Mama Metis]

Can you point me to the evidence? I am really curious about this as i've had "both ways" as it were. With DD1 i lost less initially (250mls written in notes) but i had lochia for nearly 7 weeks, and it stayed bloody for most of that time. With DD2 i lost more initially (350mls in notes) but my lochia cruenta (the red blood) subsided completely within 3 days, so fast my MW was concerned i might have retained something, but nope, i was just done bleeding. Then i had a day or two of nothing much, then the normal serosa and alba periods. I definitely lost less blood after my natural labour, no question, even though i lost an extra 100mls or so initially.

Apologies for not checking back with this thread! GoBecGo gave some good links, but I personally like the Cochrane review on this issue because it does point out that although routine pitocin reduces blood loss, there could certainly be other adverse outcomes that aren't immediately clear. Always something to keep in mind with obstetric interventions, since birth is such a magically complex process!

Here's the link: http://www2.cochrane.org/reviews/en/subtopics/87.html I can't link directly, but click "Pregnancy and Childbirth" > "Normal Birth" > "Third Stage" > "Prophylactic oxytocin for the third stage of labour"

[rightkindofme]

I had postpartum hemorrhage so my homebirth midwife gave me a shot of pitocin. I was in the process of losing consciousness from blood loss so I feel very good about the fact that she 'managed' my third stage labor.

[MegBoz]

The WHO actually does recommend "active management" of 3rd stage with prophylactic pit to reduce chance of PPH. Active mgmt of 3rd stage is actually kinda evidence-based.
And, PPH is more likely after both a long labor & I believe one that's augmented. (I know I've read super-strong ctrx increase the risk, and augmenting/inducing labor with pit can cause that.)

DS was a hospital birth in a very NCB-friendly place with CNMs. My birth plan said no active mgmt of 3rd stage & they were fine with it. But my MW was concerned about some of the amniotic sac being retained (post-delivery of placenta, after she examined it). She said she wanted to see DS BF & if he did, she'd feel better about it. But if he did not, she wanted to give me pit.

The fact that she had that much respect for the role BFing plays in uterine ctrx post-birth & she WAITED and WATCHED to see if DS would cooperate made me that much more reassured that she wasn't just being medically-minded (i.e. "CYA/ reduce lawsuit liability").

Well, turns out he didn't - we tried, but he just wouldn't open his mouth. So she gave me the choice of pit IM (intramuscular = shot) or IV (I had a hep-lock.) No biggie & I'm glad she was on-the-ball like that.

Again, in my awesome hospital, 3rd-stage pit was not routine, but I would agree it seems very very common for US hospitals.

Of course, this shouldn't discourage you from HB since a HB MW would stop PPH they same way they would in hospital - with pit, maybe methergine, and perhaps even cytotec (rectally can help) if pit doesn't do the job. If the pit was sufficient to resolve the issue before, I would expect it would resolve it at home too.

Originally Posted by GoBecGo

Depending on where you are your midwife may have pitocin/some other contractant with her. It might not be legal though, i think that varies from state to state...?

Yes, true, some illegal HB MWs may not carry pitocin. I personally wouldn't feel comfortable in that case. IMO, the whole point of having a MW instead of a UC is to have a medical professional in case she's needed. How much good does it really do if that medical professional is not adequately equipped with medicines?

I guess if I had no choices but awful hospital or poorly-equipped MW, I may consider the latter, but thankfully I have options here. Ironically, CPMs (direct entry MWs) - are illegal in my state, but some practice anyway & they have pit & other meds. Mine is a CPM & therefore illegal, but is actually licensed in the neighboring state of Virginia. She has all kinds of meds. Illegality doesn't necessarily equal unequipped.