pit after the birth

[Aliy]

Talked with my midwife today and she mentioned that they like to administer a pit shot after the delivery to prevent excessive bleeding. Now I had a bit of an issue with my first and i don't think i did with my second but i don't know if they gave me pit or not with my other births. I had an IV in and i'm not sure if they admistered anything.

I told them i'd like to aviod it if nesscary. to try other methods first letting the baby nurse and I have some sort of tea thing I got from a herbologist from around here.

what are your thoughts about routine administered pit to prevent excessive bleeding. She said they do it to prevent having to transfer after birth.... they are totally open to what I want but I'm just not sure. Even said they can recheck after birth and I can question then and address the need for it

[Chloe'sMama]

I have never heard about it administered at a HB without need.  My MW said she brings it just in case, but has only had to use it a few times out of hundreds of births (mine was not one of them....)

I wouldn't let them, unless there was evidence of excess bleeding after birth.

[Meganlove]

I am against putting anything into my body just because. I don't think that is a good enough reason for anything. I would do some looking into it and decided from what you read if you want it. I have never had a problem with bleeding after birth and I think that too often thins are just done "because". good luck with what ever you decide to do. 

[Aliy]

well that where i'm leading. I'm totally good with it if i need it but I don't want it if i don't need it.

[Marissamom]

only way I'm having the midwives give me pit is if I'm already bleeding, or if my platlets drop at the end of pregnancy again (since I still don't know why that happened at the end of my first pregnancy). otherwise I plan on nursing baby right away (and if he won't I'll nurse my toddler, or maybe both at once).

[MegBoz]

I've heard this before and my knee-jerk reaction was, "HUH?! What? Prophalaytic administration of a drug, in 100% of cases, on a routine vs. as-needed basis. This is something HB MWs are doing?!??!"

But it actually is evidence-based care, and WHO recommends it. It does reduce risk of PPH.

HOWEVER - I don't personally feel it's necessary for me... AND I suspect the WHO recommends it because the rate of PPH is so high because:

1. In the US (& other places where birth is heavily medicalized), rates of PPH are raised by common practices of induction & augmentation with pit in labor. (both known to increase PPH rates.) I think the rate of induction + augmentation with pit was something insane like 60% in the US - although I may be remembering incorrectly. That's from the book "Born in the USA."

2. Rates of PPH are also increased by other American interventionist-practices such as manual placenta extraction or cord traction. (At least I'm fairly certain those 2 things increase PPH risks.)

Then, in other areas of the world where medical care isn't readily available, mothers may be at increased risk of PPH due to inadequate nutrition (low iron levels). Also, if PPH does occur, getting mama to a hospital in time for transfusion may be an impossibility, making routine prophalytic pit the best choice "just in case" in the developing world as well.

But none of this applies to me (or most of us HBers here.)

My iron levels were low when I had blood drawn at around 16W, but I started supplementing with Floradix & will retest. & obviously if my birth stays at home, it won't be augmented with pit & 3rd stage won't interfered with... therefore, I think my PPH risks, as a healthy HB mama, are low enough that "expectant management" is the best course of action for me. IOW - if my MW suspects bleeding is too heavy, I want her to give me a shot, but if it looks just fine, I don't see a need - "wait & see" = "expectant management." (I'm fairly certain that is her standard anyway - I have to double check.)

At least that's my own personal perspective on the issue & why I don't feel the need to follow the WHO recommendation here. Plus, philosophically, I just don't see the need to interfere in a natural physiological process 100% of the time without cause - as opposed to on an "as-needed" basis.

[RoseRedHoofbeats]

Also talk to them about alternative means of preventing/stopping bleeding, like putting a bit of the placenta between your gums, nursing the baby right awauy, uterine massage, herbal anti-hem tinctures. There are a lot of things they can do before pit.

~Rose

[TyrantOfTheWeek]

You can also supplement with alfalfa, nettles, and RRL toward the end of the pregnancy to prevent hemorrhage.

[IdentityCrisisMama]

I just came to post the same thing!   I'm considering a prophylactic shot after the birth after speaking to my MW today.  I had a PPH with my first and it was just such a bummer to have recovery take so much longer. I'm going to read the thread a bit better maybe post some more.  

I guess the first questions are: 

1.  Is the mother at an increased risk for PPH?  How and why is that determined?  

2.  What are the advantages of giving Pit right away rather than waiting for evidence of PPH?  

3.  What are the side effects of the Pit?  

[Marissamom]

Originally Posted by IdentityCrisisMama 

I just came to post the same thing!   I'm considering a prophylactic shot after the birth after speaking to my MW today.  I had a PPH with my first and it was just such a bummer to have recovery take so much longer. I'm going to read the thread a bit better maybe post some more.  

I guess the first questions are: 

1.  Is the mother at an increased risk for PPH?  How and why is that determined?  

2.  What are the advantages of giving Pit right away rather than waiting for evidence of PPH?  

3.  What are the side effects of the Pit?  

#2, to my understanding, if pit is given right away, it decreases the chance of PPH happening in the first place

[Aliy]

i gues one of the concerns is my iron was low not low enough to be concerned but a point above concerned.....

I don't know I just don't want extra stuff. but at the same time I really don't want to transfer.... i guess we'll see when the baby comes what happens

[elisheva]

I've had it administered (with permission but without much research on my part) after both my homebirths. When I talked to my MW about it she said that even if bleeding looks fine at first, it could substantially increase after she has gone home (i.e. 3-4 hrs later) and the pit helps reduce those odds. 

Strangely, this is something that doesn't bother me at all (all respect for those who have differing opinions). I pretty much have had my way about everything involving my birth experiences so I guess this was my way of acquiescing instead of second guessing...plus, the idea of a transfer for pph vs one shot shortly after babe was born = no competition. I admit there may be risks I'm not aware of and I would fully encourage someone to do her own research.

[IdentityCrisisMama]

Aily, 

I have done some more reading and, as usual, I'm even more confused!!  

Here are the main things to know at this point: 

Is PIT shown to prevent PPH (I think the answer may be yes)?  Is PIT known to be effective (or as effective as prophylactic PIT) when used as a treatment for PPH?  In other words, does the "wait and see" approach to PIT significantly lessen it's effectiveness?  

What are the side effects?

Upon reading a bunch of other threads, it seems not entirely uncommon for HB MWs to carry and even encourage prophylactic PIT.  I do agree that for a mom with no history of PPH after 2 births it seems a bit strange to push that.  I, however, am seriously considering it though having had a PPH with my first birth.  Though my bleed was treatable with uterine massage, I had still lost enough blood by the time it was resolved that my recovery period was pretty crappy.  I'd rather avoid rather than treat at this point.  I do plan on avoiding by watching my iron, staying fit, supplimenting with herbs and vits and etc. but I feel like I'd like even more coverage because I did most of that stuff with my first birth (other than the herbs).   From what I've read (and this is mostly just on other threads on MDC - no studies or anything) I'm concerned that PIT may be more effective as a prevention than it is as a treatment.   If the side effects for one shot after birth are fairly minor or don't concern me I'm going to go for it.  

[IdentityCrisisMama]

Originally Posted by Marissamom 

Originally Posted by IdentityCrisisMama 

I just came to post the same thing!   I'm considering a prophylactic shot after the birth after speaking to my MW today.  I had a PPH with my first and it was just such a bummer to have recovery take so much longer. I'm going to read the thread a bit better maybe post some more.  

I guess the first questions are: 

1.  Is the mother at an increased risk for PPH?  How and why is that determined?  

2.  What are the advantages of giving Pit right away rather than waiting for evidence of PPH?  

3.  What are the side effects of the Pit?  

#2, to my understanding, if pit is given right away, it decreases the chance of PPH happening in the first place

Yea, I read that too.  I also read that it is more effective as a prevention than a treatment, which changes things for me.  

[IdentityCrisisMama]

Effects of PIT: 

http://www.midwiferytoday.com/articles/imicm.asp

"My immediate objection is that Pitocin disturbs the mother's own oxytocin at the time when it is highest. It is designed by God to help her get to know her baby."  

There's a little here that supports using PIT after other methods fail: 

http://www.midwiferytoday.com/enews/enews0135.asp

A good thread: 

http://community.midwiferytoday.com/forums/p/787/3921.aspx

Midwifery Today article on the Bristol Third-Stage Trial: 

http://www.midwiferytoday.com/articles/bristol.asp

Looks good (all scholarly) - I haven't read it yet: 

http://www.instituteofmidwifery.org/MSFinalProj.nsf/a9ee58d7a82396768525684f0056be8d/2f3a232c0f5bbb8f85256a0d0068204a?OpenDocument

I'd like to find Odent's  'Don't Manage the Third Stage of Labour'.  Anybody know where to get that?  

Looks like a good middle of the road article: 

http://www.pregnancytoday.com/articles/labor-delivery/pushing-pitocin-6162/2/

[sunanthem]

I didn't have the shot with my first baby, but my second midwife gave it to me after she gave me some herbal tincture thingy.. and she said the bleeding wasn't slowing up as much as she liked. I was scared of the shot b/c of the needle, but then after just having given birth, it really felt like nothing. I didn't want to put other stuff in my body, but since baby was already out, and nursing, and great, I was really didn't care as much if it was going to help. I think the midwife made the right decision, that's what I had her there for.

I would be kinda weary of them planning on it automatically though, that's strange to me.

[BroodyWoodsgal]

Synthetic oxytocin right at the very moment when my REAL oxytocin is doing some of it's most important work for no reason other than it's the MWs policy? *chuckle* *cough* HUH? - No thanks.

This would be a major red flag for me, if it were my midwife. I've never even heard of this, not ever! The idea behind homebirth is that it's safe because our bodies know what to do...birth doesn't stop when the baby is out, our body is still preforming an awesome process and it knows what to do. What the heck must her transfer rate have been like for her to start doing this!? <--- Actual question, did she talk about this? Is this some sort of "cover your butt" thing? Because that seems like a slippery slope to be hangin' over...isn't that mentality why hospital birth isn't so hot? Lots of unneeded intervention to satisfy insurance companies and hospital lawyers?
 

The bottom line is, if YOU are comfortable, go ahead. If you are NOT comfortable and they push the issue, get snarky, because that's weird. It's YOUR body so it's YOUR choice, you decided to have a HB so you could avoid policy coming before preference..you are allowed to hold on to that, even with a MW!!

[averlee]

I'd refuse (or find another midwife). I know I'm not a bleeder and would want pit only in a suspected hemorrhage. Also I do not like injections and have avoided hospitals partly for that reason.

[Caterina]

I had it (planned as a prevention) at my first birth because my platelet/hemoglobin count was extremely low at my blood test around 32 weeks. I supplemented with nettle and alfalfa and got several more blood tests before the birth. With each one the numbers crept up, but were still below the normal range. Like Sunanthem, I felt like the baby was already out, healthy, on my chest and I had a drug-free birth, so they could do what they thought best to me. We just talked about it at my appt this week - they aren't going to administer it right away like they did last time because my numbers are good, but will see how things go and make a quick decision after the birth. I'd of course rather not have it, but it wasn't a big deal to me last time and I was really really happy to just move from the living room floor into my own bed without even thinking about a transfer.

[Tumble Bumbles]

I totally agree with the below quote. True (organic) PPH that requires medical assistance is an extremely rare occurrence (though it does happen once in a while) provided the woman has access to good nutrition, no prior bleeding problems or existing disorders, her birth is not managed, and she is left for at least an hour with baby without any intervention whatsoever (no taking baby to weigh, no calling relatives telling them the news, no invasive management of placenta etc). The reason we see such high rates globally (and even in this country) relates to what MegBoz said, in addition to the invasive ways doctors (and even well-meaning midwives) manage the third stage of labor and disrupt the natural surge of oxytocin that would naturally prevent pph if allowed to do it's job.

This is a fascinating article by Michael Odent on the subject: Putting an End to a Women's Global Slaughter. For some reason it's being funny about letting me hyperlink, so here's the actual link: http://webcache.googleusercontent.com/search?q=cache%3AL2KudouwXwAJ%3Avidyafusion.com%2Fcrescentwomb%2Fmedia%2Fvol12no2.doc+putting+an+end+to+women%C2%B4s+global+slaughter%3ABleeding+to+death&cd=4&hl=sv&ct=clnk&gl=se

Originally Posted by AverysMomma 

Synthetic oxytocin right at the very moment when my REAL oxytocin is doing some of it's most important work for no reason other than it's the MWs policy? *chuckle* *cough* HUH? - No thanks.

This would be a major red flag for me, if it were my midwife.