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Originally Posted by Erdbeer
 I vividly remember the IV drip being on 25 until just before my son was born, and the doc turned it up to 65. I am not a doctor and don't know what this means, but on my hospital release form it says the pitocin drip was 15 IE/500ml. ... Anyone know anything about this?
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Basically what the package insert says is that the Pitocin drip should be started at 0.5-2 microunits per minute, and slowly raised every 30-60 minutes until an adequate contraction pattern is achieved. The package insert further says that dosing at 6 microunits per minute mimics a "natural labor" and that levels higher than 9-10 microunits per minute are "rarely needed."
What you were seeing--the 25 and 65--is the milliliters of solution being delivered to you per hour. The "microunit per minute" dosing can be calculated based on that and your statement that your Pitocin solution was mixed at 15 IE/500ml (15 units per 500 milliters). Many OB's do raise the Pitocin immediately after the birth (running the remainder of the bag of fluid in) after pushing is complete to help prevent post partum hemmoraghe...but since only 5% of women will even have a hemmoraghe...it does seem like over-treatment to do it to ALL women.
Anyway...based on the numbers you gave, when your IV pump was reading 25, you were at a dose of 12.5 microunits per minute. Go back and read above...levels greater than 9-10 microunits per minutes are "rarely needed." Of course I've yet to have a doula client who was given Pitocin who *didn't* eventually get to 12...even when it was a CNM giving the Pitocin. And of course every one of them started having decels of the fetal heart rate at 12...including one really scary case where the nurses were instructed to go start getting the OR ready for a crash cesarean...which fortunately was avoided when the heart rate recovered after the Pitocin was turned off. Of course they turned it back on again and there were some mild decels again...2 separate episodes that led to turning off the Pit abruptly again. GGGGRRRRR.
Actually, in the case of the birth that led me to learn specifics of Pitocin dosing, the drip was started out at 4 microunits per minute, raised to 8 at 15 minutes, 12 at 30 minutes (at which point the midwife left the room, leaving the expectant dad and I alone with the mom who had finally started having contractions at 15 minutes--she'd been trying prostaglandins to no avail for nearly 24 hrs before Pitocin was started--her water had broken), 16 at 45 minutes. By 45 minutes she was absolutely out of her mind with the intensity of the contractions. That would be *before* the 16 really had time to kick in--she was reacting to the 12. I finally went and tracked down the midwife to tell her things were just too intense, and she told me "this is what labor is." I didn't want to argue with her, so just went back to my client. But a couple of minutes later the CNM came into the room, observed a few contractions, and then quietly turned the drip back down to 12. The mom went from 4 cm to complete in 1 hr 45 minutes--first time mom.
When your drip was raised just after the birth it was raised to 32.5 microunits per minute (which I've seen done post partum--even higher in one case, but the risks are much smaller at that point). I haven't read your birth story yet (I plan to!), but I believe that if you had the Pitocin for very long that you may have started to retain water (a common side effect of Pitocin), which may have caused swelling. This coupled with the extreme power of the contractions may have very well contributed to your severe tearing.
Jenn
Editted to add...
Okay, I just read your birth story. Yikes! The Pit was raised to 65 BEFORE you started pushing! HOLY COW! Yeah, your OB was going to make sure you birthed that baby before 10pm no matter what the consequences. Kind of similar to an aquaintance of mine who discussed episiotomy with her OB who told her "I only do them when medically necessary." "Medically necessary" became "I've got another client who needs to have a cesarean so you've got 10 minutes to push your first baby out...here, let me cut a nice episiotomy (without getting consent first of course) to help you out with that..." No wonder you tore stem to stern! As for the comment about your being a red head...its CRAP! I bought into that too..."you're a red head, so nursing will hurt..." blah, blah, blah. NOT! I tore with my first birth (2nd degree)--I was squatting and pushed my DD out in 20 minutes. But second birth I pushed my DD out in 10 minutes and had "skid marks." No stitches. 3rd birth (biggest baby) was born with his hand up next to his ear with about 5 minutes of pushing, and I had NOTHING. Same with 4th baby--no skid marks or anything. And as for nursing (just in case that was an issue for you), I finally learned before my 3rd was born that you REALLY need to watch that top lip to make sure it is flared out. My babies didn't tuck it in--they just just kept it straight--so I didn't think anything was wrong with their latch because it wasn't curled under. If I pulled it out with my pinky finger, I had no pain.
Hugs!
