pitocin to prevent excessive bleeding post-birth

[HumbleLuna]

Hello,

When my daughter was born 6 years ago I had some issues with post birth bleeding. A few hours post-pardum when I tried to use the bathroom for the first time I had two pretty large clots(about fist sized). Then the midwives called in an ob to manualy remove any other clots that may be in my uterus. Yeah after 16 hours of natural labor this was very unpleasant.
Anyway my midwife told me today that she would recommend that I get a shot of pitocin right after birth to contract the uterus and prevent excessive bleeding. She said that this may cause some pretty awful afterbirth pains..since this will be my second child. I am thinking that this isn't something I would want to do, but I am a bit traumatized from what happened during the birth of my first child.
Has anyone experienced anything like this? Does anyone have any experience with Pitocin after birth to reduce bleeding? Any advice or suggestions would be great.
TIA mamas,
-Heidi

[beansavi]

Exactly the same with me Daughter...six years ago....I had a homebirth with my son last year and my midwife just gve me the shot while I was first picking Finn up and looking into his eyes for the first time. I didn't even feel it! I agreed to it previous because it just took a load off/oneless thing to worry about. With dd I lost blood so much I felt crappy for a week afterwards. I didn't need that again, kwim?

[LemonPie]

I had it with my last baby (hospital NCB). Surprisingly, the nurses gave me a fair chance to get my baby latched first, but when she wouldn't latch they went ahead and gave me an IM shot. It stings going in--I remember complaining about it and joking that I couldn't believe I was complaining about THAT after natural childbirth

They said I was a "red-haired bleeder" and claimed women with fair skin/freckles/red hair bleed more? I don't know if that's true or not. In any case, I did have BAD afterbirth pains (enough so that I finally took some of the Norco they'd been offering me all day), but those are supposed to be bad with each successive baby anyway.

In any case, I'd rather have the pitocin AFTER than DURING the birth. And of course nobody wants to lose too much blood! I'd agree to it again, given the circumstances.

Jen

[bryonyvaughn]

Originally Posted by mamablueberry

...Has anyone experienced anything like this? Does anyone have any experience with Pitocin after birth to reduce bleeding? Any advice or suggestions would be great.
TIA mamas,
-Heidi

Pitocen doesn't address bleeding directly. It can induce contractions which will shrink the uterus down and mechanically squeeze the uterine blood vessels closed.

If you're not contracting and have an "exhausted uterus" (low blood sugar or rebound result of augmentation during labor perhaps?) all the pitocen in the world won't do jack for you. You'll just bleed out like they've done nothing to stop it. If you live through the experience you can have *severe* side effects from all that unused pitocen circulating in your system.

BV, who avoids pitocen wielding HCPs like Dracula avoids garlic

[onlyboys]

I was at a birth recently where this exact scenario played out--primip, who had an intense long labor, which started out fast and furious and continued that way. She had very long pauses between pushing contractions in second stage, and when her son was born, within 15 minutes, she was hemorrhaging.
The midwife gave her a shot of pit, and the bleeding stopped, or slowed to a manageable, normal flow.

This labor was not augmented in any way at all. No breaking of water, no herbs, certainly no pitocin at all.

I would say (as an observer and a novice student midwife) that the pit DID stop her bleeding by causing her exhausted uterus to contract. The herbs the midwife used did not slow the flow of blood, and eventually, after the shot, the client also got an IV to help with her BP. If a single shot after birth could have prevented this, I would say the client could certainly choose this next time.

Also, pitocin acts with a fairly short duration in the body, and while I'm not minimizing the effects of pitocin, the side effects of a PPH are very real as well, and quite icky.

Good for the OP for thinking of these things in advance!

[bryonyvaughn]

Originally Posted by onlyboys

...I would say (as an observer and a novice student midwife) that the pit DID stop her bleeding by causing her exhausted uterus to contract.

Well I'd say as her uterus had within it what it needed to contract, it wasn't an exhausted uterus. Some folks misleading call any non-contracting uterus (when they think it should be contracting) an exhausted uterus.

Originally Posted by onlyboys

...Also, pitocin acts with a fairly short duration in the body, and while I'm not minimizing the effects of pitocin, the side effects of a PPH are very real as well, and quite icky...

Yes. I just wanted to make the point if one has a truly exhausted uterus, pitocin will not cause contractions and will not prevent PPH. Mothers will die if pitocin is the only tool in MWs PPH toolboxes.

~BV

[HumbleLuna]

Thank you for all your responses so far. I am still having a hard time deciding(I have another 20 weeks to think it over) I am trying to figure out what went wrong or if I did something wrong during labor to cause the large blood clots. The only intervention from my midwife was when she broke my bag of water at 7cm upon my request. I remember dialating fast after that and pushing before I should have. Could this have cause the bleeding?

[HumbleLuna]

Originally Posted by bryonyvaughn

Well I'd say as her uterus had within it what it needed to contract, it wasn't an exhausted uterus. Some folks misleading call any non-contracting uterus (when they think it should be contracting) an exhausted uterus.


Yes. I just wanted to make the point if one has a truly exhausted uterus, pitocin will not cause contractions and will not prevent PPH. Mothers will die if pitocin is the only tool in MWs PPH toolboxes.

~BV

You seem to have stong feelings towards this. I was just wondering if you have personal experience with PPH?

[bryonyvaughn]

Originally Posted by mamablueberry

You seem to have stong feelings towards this. I was just wondering if you have personal experience with PPH?

I tried to present indisputable facts. Pitocin can be very helpful in causing a uterus to contract and thereby indirectly stop PPH. If the uterus is incapable of contracting, pitocin is useless to stop PPH. If you have a history of PPH, I'd think it would be *one* useful item in a birthbag.

I had a MW who deceptively and repeatedly performed interventions without my knowledge or consent. The MW's interventions directly lead to my PPH that nearly killed me.

~BV

[onlyboys]

Hmmm. I wonder, though, how often the issue with a PPH is actually an exhausted uterus? Pitocin is a very common tool with which PPH is routinely stopped/prevented. Perhaps the uterus isn't "exhausted" per se, it's just really fatigued. A fatigued uterus would, I think, respond to a shot of pit.

I think this was the case with the client I mention... Her pushing contractions were 10+ minutes apart, and the midwife just patiently waited. She knew then, she told me later, that this might be a case where PPH was more likely to happen. After the baby was born, her uterus seemed higher than most first time moms I've felt, and sure enough, even after getting baby to the breast (and this kid latched HIMSELF on, amazing!) she still wasn't contracting enough to make her bleed normal. Pit seemed to normalize things for her.

[pinksprklybarefoot]

I had both pitocin and Cytotec for pph.

Honestly, I noticed nothing. But it was my first baby, and I know the afterpains thing can be way different with subsequent births.

[dynamicdoula]

Originally Posted by bryonyvaughn

If you live through the experience you can have *severe* side effects from all that unused pitocen circulating in your system.

Pitocin only has a 15 minute halflife... so what would the severe side effects be? When I hear 'severe' I think of like.. arms being lopped off.

[dynamicdoula]

Originally Posted by bryonyvaughn

Well I'd say as her uterus had within it what it needed to contract, it wasn't an exhausted uterus. Some folks misleading call any non-contracting uterus (when they think it should be contracting) an exhausted uterus.


Yes. I just wanted to make the point if one has a truly exhausted uterus, pitocin will not cause contractions and will not prevent PPH. Mothers will die if pitocin is the only tool in MWs PPH toolboxes.

~BV

BV, I think I understand what you're saying and I don't disagree.

There's a difference between uterine atony an uterine fatigue. Fatigue means there's something left for the uterus to use to contract, atony means... well.. uterus is just done.

Cytotec is another option and... methergine?? I think? Next to that is intervention in the OR, as far as I know.

[lyttlewon]

OP with my first birth I was given pitocin right away for PPH and I still had the blood clot you discribe. It did stop my bleeding.

[bryonyvaughn]

Originally Posted by dynamicdoula

Pitocin only has a 15 minute halflife

More often than not there are many interventions associated with Pitocin's use that can compromise a person's ability to break down Pitocin.

Originally Posted by dynamicdoula

... so what would the severe side effects be? When I hear 'severe' I think of like.. arms being lopped off.

Serious side effects of Pitocin

[g&a]

Personally, I am leary of any interventions done "just in case". You may not hemorage this time. This is a different birth. Pitocin seems to work quickly, so I would wait until you actually hemorage to use it.

This was a major sticking point with my ob with my last birth. She does it routinely and said she would not care for me if I didn't agree to it. We agreed to it reluctantly (being good patients), and then were relieved when she ended not being at the birth. Now I am smarter and would run quickly away from anyone who treated us like she did.

g.