Pitocin after birth??

[EllisH]

I was just told by my ob this week that my hospital routinely gives a pitocin injection immediately after the birth, to avoid excessive bleeding and to make sure the placenta comes out properly (thereby avoiding the risk of greater intervention later on).  I was a bit surprised, as hospitals in the Netherlands (where I am) are traditionally low on intervention.  That being said, two of my best friends bled excessively after giving birth to the point where it was an emergency / threatening to become one (both gave birth at home, one had to be transferred to the hospital).  I was hoping that starting breastfeeding straightaway and massaging the uterus would suffice.  Anyone any views on pros / cons?

[greenmama66]

I don't know anything about hospital births but homebirth midwives I know will only use it if herbs are not working for a PPH and it's to be used ONLY after the placenta has come out. That's what I was told.

I nurse right away but still had 2 PPH- that were easily managed at home and did not require further treatment. Some say eating placenta will help too but it grosses me out raw (I have no issue eating it via capsules). Many midwives here use placenta and herbs first- will wait a few hours to see how mom is doing and as a last resort use pitocin. 

[Beverly]

In Sweden it's common practice to give a pitocin injection after the birth.  I'm not wild about it, but it's one of those battles I've decided not to pick.

[HappyMommy2]

I agree that I would only agree to it (1) if I was actually having PPH and not as a preventative measure, and (2) Only after the placenta has come out.  I want delayed cord clamping so the baby gets the rich placenta blood, and don't want pitocin getting passed to the baby.\

Good luck mama!

[DaisyMay]

Yeah I think it's standard practise here in the UK too, though it's one you can easily refuse if you'd rather not.  With my first I opted not to have the pitocin, but after about 45 mins of struggling to deliver the placenta I accepted it and delivered the placenta immediately.  I didn't bleed excessively but know that's another reason to have it.  The reason I preferred not to have it was that I was at home and had heard that there's a chance with the pitocin of everything clamping down and shutting up shop without releasing the placenta, and then I would have had to go into hospital and had all sorts of procedures to open up my cervix again etc and remove the placenta surgically.  This information was from my NCT ante-natal childbirth class - sorry I don't have any info/links on actual studies or exact figures - I have a feeling it was about 1/20 cases that this can happen in, though that seems a bit high.  As it was, if my placenta continued not to deliver I would have had to go into hospital anyway so I was happy at that point to take the risk.  I had been breastfeeding my son during the time my placenta didn't deliver, but as I recall he wasn't feeding too enthusiastically yet at this point.  With my 2nd I didn't have it (this was with a midwife in Texas who didn't use this method as standard) and I delivered the placenta naturally within 5 minutes or so of giving birth.  With this birth the midwife delayed cord-cutting and I believe this can help deliver the placenta more quickly (when the cord is cut immediately more blood stays in the placenta and this can make it boggy and more inclined to stay put - again I read this somewhere but don't have the exact info to pass on, sorry). 

[turnquia]

It is standard practice in most hospitals in the US.  The reasoning is study after study has shown prophylactic pitocin decreases blood loss and prevents PPH.  Its called active 3rd stage management.  Which usually involves immediate cord clamping, pit and quick placenta removal.  There is now questions being raised about immediate cord clamping in some studies and whether that is necessary, but pitocin use still showing great results in preventing PPH. 

I have some links... (ETA:  A link... not sure where my other ones went but you get the idea with this one) 

http://www.ncbi.nlm.nih.gov/pubmed/20614458

[mwherbs]

That study is why it is recommended but other studies one very recent showed that for women at low risk of hemorrhage were more likely to have a hemorrhage with active management . Active management is a combo of giving pitocin and delivering the placenta promptly.

[turnquia]

Originally Posted by mwherbs 

That study is why it is recommended but other studies one very recent showed that for women at low risk of hemorrhage were more likely to have a hemorrhage with active management . Active management is a combo of giving pitocin and delivering the placenta promptly.

Yes... I had more links saved and they have poofed from my favorites list.   True active management also involves cord traction, and we all know that can be bad.  The studies are showing that cord traction needs to be stopped and wait for signs of placental detachment after the pit has been given.  This was a lengthy discussion I had with my OB over how to manage delivery of placentas with twins.   So IF we have them at the hospital there will be a combination of active management and expectant management.   I will take the pit after delivery of 2nd baby, but no immediate cord clamping and traction as well as other methods, BFing, uterine massage, herbs and other medications if necessary. 

But I did have a study saved where they ONLY did pit and nothing else to help out third stage and the rates of PPH were very small.   But you have to take into account that how labor progresses makes a difference.  Induced labors and labors with complications, polyhydramnios, multiple babies, multigravida moms all are higher risk and do get thrown into those studies. 
 

[EllisH]

Thanks everyone, it's very useful to know how this fit into a bigger picture.  I'd already been wondering about the pros and mainly cons of early cord clamping as well, so I'll definitely ask that they wait with that.  I also feel more at ease with the injection (but will still address it with my obgyn).

[Comtessa]

A good friend of mine had a natural childbirth in a local, intervention-happy hospital.  She felt a bit bullied at being forced to have an IV, but otherwise the birth went well... until after the baby was born.  It wasn't until she felt an agonizing contraction that she realized that they had put Pitocin in her IV without telling her -- it was so matter-of-course at this hospital that they didn't even feel the need to inform her that they were pumping drugs into her bloodstream until she demanded to know what was going wrong.  According to my friend, the pit contractions -- even with the relatively small amount they give for 3rd stage -- were the most painful part of her whole labor.  Needless to say, she went to a different hospital for her next babies.  No IV's, and definitely no pitocin.

I think that Pit definitely has its uses to prevent/treat PPH -- my HB MW even carries some "just in case" -- but giving fake hormones prophylactically?  It just seems like a bad idea to me. 

During our HB transfer with DD#1, I was wheeled into your run-of-the-mill L&D room full of machines and needles, so many I couldn't keep track of everything around me (I was a little out of it after 3 days of labor, too).  God bless my wonderfully observant DH, who asked me, "Do you know there's a bag of Pitocin on your IV stand?"  I looked up, and sure enough, there it was, just waiting to be hooked up. 

So, I said to the nurse, "please take that out of here, I don't want it hooked up to my IV." 

She said to me with a horrified expression, "But, you're going to need it after the baby is born!" 

I retorted, "Let's assume I won't need it, and if I do, well, you can go and get it then, can't you?"

So, she harumphed and carried away the Pitocin bag.  A good thing, too; obviously my transfer hospital had the same general approach to active management of the 3rd stage as my friend's.*

The moral of the story is: if you have a natural childbirth, suddenly introducing Pit contractions might be a bad idea -- at least, that's my secondhand information.  AND, if you don't want Pitocin, make sure you get it out of their easy reach while you're there.  But, having it around is a good idea in case you start to hemorrhage, because it can certainly help (though there are lots of other things, as PP's have already said, that you can try first before going the drugs route). 

*(Incidentally, this is also the same hospital where, on my L&D tour, I asked about delayed cord clamping, and the charge nurse looked at me in true horror and said, "you have to clamp the cord right away, or it's very dangerous for the baby!  It will get jaundiced if it gets too much blood."  I'd never heard of such a thing, so I looked it up when I got home; sure enough, it's definitely not evidence-based practice.) 

[lunarlady]

With my first, I had some trouble delivering the placenta. They used several herbs, and expectant management (wait and watch). I delivered smoothly about an hour after the birth.

With my second, my MW used active management, including gentle cord traction, uterine massage, and pit. I had severe PPH and needed emergency transfer, more pit, and a transfusion. The forth stage of that labor was the most painful and traumatic experience of my life.

Most hospitals (and active management MW) want the placenta out in 20 minutes or less. Pit helps make that happen even if it wouldn't naturally for you. After my experience, I will not birth with anyone who doesn't do expectant management. However, pit is the reason my blood loss was limited to three liters, so I guess I can't totally bash a drug that saved my life.

[MegBoz]

Originally Posted by Comtessa 

A good friend of mine had a natural childbirth in a local, intervention-happy hospital.  She felt a bit bullied at being forced to have an IV, but otherwise the birth went well... until after the baby was born.  It wasn't until she felt an agonizing contraction that she realized that they had put Pitocin in her IV without telling her --

Yeah, I've heard pit ctrx are awful.

After my DS was born with no drugs in a hospital, I delivered the placenta with no problems. But my MW was inspecting it & said she was concerned about some of the amniotic sac being retained & concerned about that causing me bleeding. She was massaging my uterus & she said she wanted to see DS BF. She said if he did not BF, then she wanted to give me some pit to make sure. Well... LOL... he wasn't interested! Just wouldn't open his mouth. I'm on camera joking, "C'mon, help me out!" Nope.

So she gave me the choice of pit IV or IM (intra muscular = shot). I had a hep-lock in place, but nothing hooked up to it. I chose the shot & didn't notice any increase in pain at all. It wasn't any big deal. So maybe the shot is better than the IV?
 

In any case, I don't think anyone yet mentioned it, but pit in 3rd stage is actually recommended by WHO.

I know a longer labor & I think a labor that was already augmented with pit can both increase the risk of PPH, so I might be relatively more accepting of prophlaytic pit in that case, but I agree, on the whole, I wouldn't want it without some cause.

Having low iron can also increase the risk of bleeding, so that's another thing to look out for. I had my blood test around 16w or so & was low, so I'm taking Floradix supplement & I think my MW wants me tested again later.

[loveneverfails]

I love active management 3rd stage for my births, and it really saved my rear end my last birth, because it kept my blood loss as minimal as possible, which was really really important when I was up from 2:30am when labor started until about 11 at night when I went to bed at home alone because my baby was in NICU and I had been with her all day without rest. 

I will choose active management for all future births.  I wish I had chosen it for the births where I wound up bleeding and needing it after I had bled a lot.  Pit will keep you from bleeding further, but it won't get that blood back into you, if that makes any sense? 

[nia82]

It wasn't hard to refuse it in CA, the midwife in  the hospital knew I only wanted it in case of PPH, which did occur after my placenta had delivered spontaneously. I bled pretty good and about 10 minutes after the placenta was out I had a pit shot in my thigh. It hurt like hell, but I didn't feel contractions from it at all. I had no pitocin throughout labor.... maybe I had a really small dose?

Anyways, this time around same game, only pit to stop a PPH.

[elus0814]

I was given a pit injection after my fourth birth in the hospital for no reason other than standard procedure. It was injected into my arm without my consent and caused horrible contractions after a fairly easy natural birth. They claimed it was dangerous to not give it with a fourth baby. I was in pain for days. I had my fifth baby at home and was not given it although the midwife had it right next to me because I was losing a good amount of blood. The pain after the birth wasn't nearly as bad as with the fourth. I routine injection is something I would FIGHT not to get.

[WifeofAnt]

I was given it through my hep lock.  I didn't really care at the time since the baby was already out.  I was expecting to feel some pretty bad contractions but I didn't really feel anything.  My after-pains two days later hurt a heck of a lot more.  I don't remember if it was given before or after my placenta was out though.  I'm pretty sure it was after (although I don't remember feeling it come out) since they showed me the placenta pretty quickly after he was born.

I was kind of glad I had it.  Even with the pitocin I looked and felt like I had lost a good amount of blood.  Sitting I'd feel fine but standing made me really dizzy and I looked very zombie-ish and pale.

We didn't do delayed clamping though because he passed meconium.   I knew he didn't inhale any because my water only a half hour earlier was completely clear.  Its a little disappointing but I wasn't going to argue about it.  I guess it makes me feel a little better that they apologized for it.

[mwherbs]

The amount of pit given for post partum is actuallly a very high dose 10-20 units or more. To put this into perspective when giving it for induction they take those 20 units and mix it in 500 to 1000 cc fluid bag and then hook that to another bag for fluids and it is dripped out in a drops peer minute solution .... If you already have ttnis drip going they open it up full and run it in as fast as possible. The idea is to give you a very strong contraction .

[lunarlady]

I had two shot of 10 units each at home, and an IV of thirty units at the hospital. The hospital said 30 units is standard, 60 in cases of PPH.

[mwherbs]

Wow! I had heard they used higher doses post section but I have never heard 30/60 as standard. Wow. I know if pit doesn't work there are some other things to go to, like methergin or cytotec

[ASusan]

I received pit for 3rd stage management. It was a surprise ending to an otherwise intervention-free birth. I bled out a lot, but I'm not sure it was dx as PPH. I bled for 20 minutes while the OB stitched me up from a tear. DH watched it all, and I'll likely never give birth at home.

C. Sue Carter (oxytocin neuroscience researcher) calls the use of pitocin "the largest experiment in childbirth." (although I think she was including use of pit to augment contractions there).