Role of pitocin after you give birth? - Mothering Forums

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#1 of 5 Old 09-28-2013, 08:59 AM - Thread Starter
 
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With DS#1 I had a hospital birth (spontaneous labour, no augmentation) but after DS1 was born and the placenta delivered I was put on a pitocin drip.  To be honest I was too tired and overwhelmed to question this and when I asked the nurse she said something about helped the uterus to contract.  But I thought immediate and frequent breastfeeding was the best way to contact the uterus and ward against the risk of post partum hemorraging.

 

I found having a drip line to my arm cumbersome, made breastfeeding, holding my baby and going to the bathroom, shower etc impossible.

 

Plus a few hours later, I noticed the needle had fallen out of my arm.  I mentioned this to the nurse who was checking my temperature, who screamed at me "I only have 2 hands"....and then no one came to reinsert it, so I didn't bother inquiring again....so obviously it wasn't life threatening to be without one.

 

I had a straightforward birth and delivery.

 

Is it standard hospital practise to administer pitocin post delivery?

Has anyone refused it, and if so, what was the outcome?


40 y/o married Mama, 3 y/o DS, Angel Baby lost in Sep 2013, Angel Baby lost March 2014.
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#2 of 5 Old 09-28-2013, 10:15 AM
 
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I had a pitocin-augmented labor with my first--after "stalling" at 8cm for 8 hours they gave me pit to get things moving again. I think I had 2 hours of pit and then pushed for 2.5 hours. All-told I was in labor 28 hours from the time my water broke til dd was born. They continued the pitocin drip until my placenta was delivered.

With my second I had a completely unmedicated watetbirth in the hospital and declined
an actively managed 3rd stage. My midwives were comfortable with my choice and since the baby latched right away and nursed like a champ, they didn't push pit. We did delayed cord clamping and I delivered the placenta maybe 30 minutes after baby. My labor nurse, however, was very nervous about natural labor and was a PITA throughout. She was especially uneasy about my lack of post-birth pit and kept roughly massaging my uterus, and she refused to remove the hep-lock because she was convinced that I could start to hemorrhage at any moment. I didn't.

From everything I've read, an actively managed 3rd stage is really only necessary after an actively managed labor. Laboring on pitocin is exhausting, so the uterus needs continued help to clamp down and shrink. This is also where cord traction comes from, if I recall correctly. My understanding is that If they administer post-birth pit and the placenta doesn't detach and expel right away, the pitocin-augmented uterus could clamp down and start shrinking with the placenta inside which would necessitate surgery. Also, by pulling on the cord they can actually cause more bleeding, and the pitiocin is needed to stop that. But when you have a natural birth, especially if it is not terribly long or complicated, your uterus is probably fully able to do its job in expelling the placenta post-birth and then clamping down with just nursing to stimulate the natural oxytocin. I think that a hep-lock is a good idea in case of spontaneous, unexpected hemorrhage, but my understanding is that most women won't experience that and the hep-lock will remain unused. That was my experience, at any rate.

Married 12/08 to Chilean DH and mama to DD 2/2/10. We're a bilingual home and we familybed1.gif and toddler.gif

 

Expecting #2 in late June!

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#3 of 5 Old 09-28-2013, 10:38 AM
 
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I had a shot of pitocin via drip line after delivery, as a treatment for post-partum hemorrhage that I was actually having.  I also had uterine massage, and they offered me the baby so I could get started breastfeeding, but I wasn't really safe to hold him.  I only had the IV for a little while - I think we were done with it before we moved to the post-partum floor - but I was in awful shape after delivery, and the time it took to, say, get me stitched up and feeling well enough to hold the baby was a definite delay in initiation of breastfeeding.  (That wasn't caused my pitocin though.  Baby was OP, I pushed for five and a half hours, and then I tore.  It sucked.)

 

Research has indicated that active management of the third stage of labor, including administration of pitocin, reduces the risk of post partum hemorrhage by 68%, compared to expectant management, which involves only nipple stimulation and waiting.  (http://www.aafp.org/afp/2007/0315/p875.html)  I know that breast feeding can help prevent post-partum hemorrhage, but I don't know that it's the best way, and it's certainly not the only way.

 

There are risk factors of PPH besides managed labor.  Prolonged labor is a risk factor, and so is precipitous labor - in both cases, muscle fatigue can lead to an atonic uterus, in which it's very difficult for the muscles to contract strongly enough to prevent hemorrhage.  The link above also notes that many cases of post-partum hemorrhage arise even when there are no risk factors, so professionals providing care at birth should be prepared to deal with a hemorrhage in all cases.

 

I have never heard of a case like Kitteh describes, where pitocin-induced contractions allow the uterus to contract without expelling the placenta.  Physically, there's only so small the uterus can get with a placenta still inside it.

 

The incident you describe with the nurse strikes me as a case of really bad nursing, and concerning for that hospital - A well-placed IV should not fall out, and her outburst strikes me as irrelevant to the situation.  Sometimes there are bad nurses, and sometimes good nurses have bad days, but just ignoring a dislodged IV is not okay, nor is yelling at a patient who brings something like that to your attention.

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#4 of 5 Old 09-28-2013, 11:02 AM
 
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I am a former labor and delivery nurse. We would typically administer 20 units of pitocin in one liter of iv fluid after delivery to help control bleeding. If a patient was bleeding heavily we would add another 10 or 20 units. If a patient didn't have an iv by choice or because of a fast delivery we could give 10 units of pitocin as a shot intramuscularly. The iv pitocin takes effect quicker.
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#5 of 5 Old 09-28-2013, 12:13 PM
 
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http://midwifethinking.com/2012/05/05/an-actively-managed-placental-birth-might-be-the-best-option-for-most-women/

 

http://www.thirdstageoflabour.org/thirdstagechoice.html

 

OK, I haven't been able to find the stuff that I was reading when I was making the decision of whether or not to have an actively managed 3rd stage, but I did come across these and thought they were interesting.


Married 12/08 to Chilean DH and mama to DD 2/2/10. We're a bilingual home and we familybed1.gif and toddler.gif

 

Expecting #2 in late June!

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