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#1 of 18 Old 07-31-2013, 06:02 PM - Thread Starter
 
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I'm 27 weeks pregnant and starting to gather needed supplies for my birth. My midwife does not carry pitocin, so I must go to a doctor to get a prescription for it. She said I just need to do the minimum checkup he will allow for him to be comfortable writing me a prescription. She is referring me to a "friendly" doctor, or ob, I don't really know what he is.

 

I will do this gladly, but I have a few concerns. One being that the doctor doesn't want to write me a prescription for it- we aren't positive they will feel comfortable doing this, two being that I am already being taken care of by my midwife and I have had all the prenatal care and testing I need done, three being that it will cost money to see the doctor and money for the pitocin prescription (no idea how much).

 

My midwife does not carry pitocin because she has never used it, or needed to. She carries shepard's purse, and angelica? (the one for placenta release). I am the one who wants there to be pitocin. However, I am keen to avoid it. I will try whatever natural remedies we can should I be hemorrhaging, and use pitocin if we must.

 

Here is where I am being silly. This is my first pregnancy, there is no need to assume I am going to bleed to death while giving birth. I am taking alfalfa, I was taking one twice a day (since 20 weeks or so), but we have now upped it to two twice a day. I also eat two eggs every day, and try to get dark greens daily. I should have adequate vitamin K in my diet, and we are going to be adding actual vitamin K supplements towards the end of my pregnancy. Vitamin K helping with blood clotting of course.

 

Some of my concern comes from my mother having severe postpartum hemorrhage. She had it with me, and worse with my sister, so both her births. This is also why my mother was concerned about me having a homebirth. However, we both admit that it's possible she wouldn't have dealt with that if she wasn't induced.

 

My midwife is not concerned and does not believe I need pitocin, but wants me to feel safe so she's helping me get it.

 

What experiences have you guys had? Do you think I'm being silly to go to extra trouble getting pitocin I probably don't need? Would you still feel safe if your midwife didn't have pitocin on hand?

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#2 of 18 Old 07-31-2013, 07:07 PM
 
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Just another perspective. I would not be comfortable being administered Pitocin, a drug that can have serious side effects, by someone who has never used it, and apparently can't legally prescribe it. I also wouldn't be comfortable with a doctor who was willing to prescribe a drug that you don't currently need, so that someone who can't prescribe it can decide when you need it, administer it, and monitor your reaction. I'm not sure that's even legal.

I've had Pitocin twice, both times in the hospital, and both times were horrible. My experience tells me to avoid it whenever possible.
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#3 of 18 Old 07-31-2013, 07:57 PM
 
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Having anti-hemorrhagic drugs available for me at home was a non-negotiable.  Postpartum hemorrhage is one of the most common complications, but I would much rather have a shot of pitocin, or be given cytotec or methergine and remain at home rather than have to go through the trouble of a transfer.  Hemorrhaging can also affect your milk supply, so there's that consideration too.  According to the Cochrane database (a great source for evidenced based care), active management of the third stage is recommended---this often includes giving a shot of pitocin.  However, it sounds like you and your midwife might have different expectations---it might be worth exploring.  If you like the safety net of western medicine and she isn't used to practicing like that, maybe she's not a great fit.

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#4 of 18 Old 07-31-2013, 08:13 PM - Thread Starter
 
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Originally Posted by michelleepotter View Post

Just another perspective. I would not be comfortable being administered Pitocin, a drug that can have serious side effects, by someone who has never used it, and apparently can't legally prescribe it. I also wouldn't be comfortable with a doctor who was willing to prescribe a drug that you don't currently need, so that someone who can't prescribe it can decide when you need it, administer it, and monitor your reaction. I'm not sure that's even legal.

I've had Pitocin twice, both times in the hospital, and both times were horrible. My experience tells me to avoid it whenever possible.

That is a consideration. If you don't mind, were you given pitocin for hemorrhage? I am planning to do all I can to prevent that, and I'm willing to try shepard's purse first.

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Having anti-hemorrhagic drugs available for me at home was a non-negotiable.  Postpartum hemorrhage is one of the most common complications, but I would much rather have a shot of pitocin, or be given cytotec or methergine and remain at home rather than have to go through the trouble of a transfer.  Hemorrhaging can also affect your milk supply, so there's that consideration too.  According to the Cochrane database (a great source for evidenced based care), active management of the third stage is recommended---this often includes giving a shot of pitocin.  However, it sounds like you and your midwife might have different expectations---it might be worth exploring.  If you like the safety net of western medicine and she isn't used to practicing like that, maybe she's not a great fit.

 
I would like to avoid transfer, thanks for bringing that up. I also think if I am hemorrhaging, something needs to be done quickly. We only live 10 min from the hospital, but that's still too long. I feel like my midwife and I are on the same page, I want to try whatever she can offer first, and I don't want to be given pitocin unless I need it. 
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#5 of 18 Old 08-01-2013, 06:59 AM
 
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That is a consideration. If you don't mind, were you given pitocin for hemorrhage?

No, both times I was given Pitocin to speed up labor. :/ I question whether it was necessary either time, especially the first time, since I was told I wasn't progressing "fast enough" before I was even admitted to the hospital. (First baby.) Both of those ended up c-sections. I never had Pitocin for any reason during my other three births, which all ended with a vaginal birth. But I also never had any problem with postpartum hemorrhage.

I also kind of agree with PP that if you feel like it would be best to have the option of Pitocin in case of hemorrhage, you should consider another provider. Maybe there is another midwife in your area who is knowledgeable and experienced in the use of Pitocin. I just don't see how it could possibly be safe to have a serious drug administered by someone with no experience.
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#6 of 18 Old 08-01-2013, 02:52 PM
 
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 I was given pitocin for hemmorhage and slow release of placenta two times and it didn't cause horrible side effects/contractions or anything.  I think it's way different when it's used for augmentation of labor vs active management of the third stage.  

 

Anyhow, the first time, I was in the hospital, and had 2 intramuscular shots of pitocin administered fairly immediately, and my placenta came right out.  No problems, had a rather forceful uterine massage and nursed my baby and I stopped bleeding quickly. The second time, I had a precipitous birth at home with EMTs, two minutes away from the hospital I had planned to be at.  We were transferred to the better hospital with a NICU ten minutes away when my baby didn't breathe.  I bled rather copiously the whole way to the hospital and about ten minutes after arrival was given IV pitocin.  After the bag was done and my placenta still wasn't coming out, and I was still bleeding, I had to have a manual removal (very painful, even with morphine).  I think the stress of the transfer, my baby not breathing and wondering if she would be ok made things slow down, but I also wonder if the delay in administering the pitocin was a factor in needing my placenta to be manually removed.  The birth was otherwise normal on my end of things, much shorter than my first labor, and a very brief pushing stage, so it wasn't a case of my uterus being exhausted.  In contrast, my first birth the pushing stage was quite long - two to three hours, IIRC.

 

I would also be very cautious about having a medication administered by someone who's not experienced in using it.  And I would think that maybe another midwife might be a better fit for you, if you aren't in alignment about what would make you feel most comfortable and safe.  I'm a healthy 30 year old who has had two healthy pregnancies and no one would have seen this coming.  Bleeding out in an ambulance was not fun and wondering if I was going to die was very stressful.  That trauma was overshadowed by everything that came after, but if it hadn't been, it would have been a rough start regardless.  One thing that helped was looking back and feeling that I received the best care I could have in the situation as it existed; if I felt that something obvious had been lacking I might have been more traumatized.

 

edit - Oh, and I had no supply issues after either birth.  I was even able to pump and donate several hundred ounces of milk after my daughter died. 

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#7 of 18 Old 08-01-2013, 06:03 PM - Thread Starter
 
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No, both times I was given Pitocin to speed up labor. :/ I question whether it was necessary either time, especially the first time, since I was told I wasn't progressing "fast enough" before I was even admitted to the hospital. (First baby.) Both of those ended up c-sections. I never had Pitocin for any reason during my other three births, which all ended with a vaginal birth. But I also never had any problem with postpartum hemorrhage.

I also kind of agree with PP that if you feel like it would be best to have the option of Pitocin in case of hemorrhage, you should consider another provider. Maybe there is another midwife in your area who is knowledgeable and experienced in the use of Pitocin. I just don't see how it could possibly be safe to have a serious drug administered by someone with no experience.

Thanks for answering. I see the concern with her not using pitocin, however I don't think switching to another provider is an option. I'm 27 weeks along and have been seeing her since the beginning, she is the midwife I picked and I feel comfortable working with her. I knew early on that pitocin wasn't something she normally gave, but she offered to help me get it.

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 I was given pitocin for hemmorhage and slow release of placenta two times and it didn't cause horrible side effects/contractions or anything.  I think it's way different when it's used for augmentation of labor vs active management of the third stage.  

 

Anyhow, the first time, I was in the hospital, and had 2 intramuscular shots of pitocin administered fairly immediately, and my placenta came right out.  No problems, had a rather forceful uterine massage and nursed my baby and I stopped bleeding quickly. The second time, I had a precipitous birth at home with EMTs, two minutes away from the hospital I had planned to be at.  We were transferred to the better hospital with a NICU ten minutes away when my baby didn't breathe.  I bled rather copiously the whole way to the hospital and about ten minutes after arrival was given IV pitocin.  After the bag was done and my placenta still wasn't coming out, and I was still bleeding, I had to have a manual removal (very painful, even with morphine).  I think the stress of the transfer, my baby not breathing and wondering if she would be ok made things slow down, but I also wonder if the delay in administering the pitocin was a factor in needing my placenta to be manually removed.  The birth was otherwise normal on my end of things, much shorter than my first labor, and a very brief pushing stage, so it wasn't a case of my uterus being exhausted.  In contrast, my first birth the pushing stage was quite long - two to three hours, IIRC.

 

I would also be very cautious about having a medication administered by someone who's not experienced in using it.  And I would think that maybe another midwife might be a better fit for you, if you aren't in alignment about what would make you feel most comfortable and safe.  I'm a healthy 30 year old who has had two healthy pregnancies and no one would have seen this coming.  Bleeding out in an ambulance was not fun and wondering if I was going to die was very stressful.  That trauma was overshadowed by everything that came after, but if it hadn't been, it would have been a rough start regardless.  One thing that helped was looking back and feeling that I received the best care I could have in the situation as it existed; if I felt that something obvious had been lacking I might have been more traumatized.

 

edit - Oh, and I had no supply issues after either birth.  I was even able to pump and donate several hundred ounces of milk after my daughter died. 

 

Thank you for sharing your story. What a great way to honor your daughter by donating milk.

 

I think I will discuss this further with my husband and see what he's thinking. I really don't want to switch midwives this late in the game. I'm otherwise comfortable with her. 

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#8 of 18 Old 08-02-2013, 05:43 AM
 
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Yep, switching providers can be a real pain in the butt.  Is she a CNM and trained in how to give injections and use of pitocin?   In many states CNM have prescriptive authority....so I'm guessing no?  If she has never had the formal training and practice it's different than if she has had training and practice but hasn't used it in a couple years, and that is different from being up-to-date on the best practices.  So, anyhow, I hope you get things figured out and in a way you and your family feel comfortable with.

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#9 of 18 Old 08-02-2013, 01:24 PM
 
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Originally Posted by michelleepotter View Post

Just another perspective. I would not be comfortable being administered Pitocin, a drug that can have serious side effects, by someone who has never used it, and apparently can't legally prescribe it. I also wouldn't be comfortable with a doctor who was willing to prescribe a drug that you don't currently need, so that someone who can't prescribe it can decide when you need it, administer it, and monitor your reaction. I'm not sure that's even legal.
It is legal if the doctor prescribes it. The midwife can give it on his orders.

I've had Pitocin twice, both times in the hospital, and both times were horrible. My experience tells me to avoid it whenever possible.

 

Giving Pitocin postpartum is:

 

1) Not rocket science. It comes in an ampule with the right dose and you give it as an intramuscular injection, which is easy to do. 

 

2) Not dangerous postpartum the way it can be during labor. The big concern during labor is the uterus overcontracting, causing fetal distress. Immediately postpartum, we want that uterus to clamp down and if it's not doing it, Pitocin can help.

 

3) Not crazy painful for mom like Pitocin during labor. Yes, you'll have cramping, but it's not like labor with Pit.

 

 

Quote:
Is she a CNM and trained in how to give injections and use of pitocin?   

 

In many states, including Oregon :) CPMs are able to purchase and to give Pitocin.

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#10 of 18 Old 08-02-2013, 03:40 PM - Thread Starter
 
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Yep, switching providers can be a real pain in the butt.  Is she a CNM and trained in how to give injections and use of pitocin?   In many states CNM have prescriptive authority....so I'm guessing no?  If she has never had the formal training and practice it's different than if she has had training and practice but hasn't used it in a couple years, and that is different from being up-to-date on the best practices.  So, anyhow, I hope you get things figured out and in a way you and your family feel comfortable with.

She is a CPM. I don't know that she hasn't had training on such things. Thanks, husband and I are still discussing things.

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Giving Pitocin postpartum is:

 

1) Not rocket science. It comes in an ampule with the right dose and you give it as an intramuscular injection, which is easy to do. 

 

2) Not dangerous postpartum the way it can be during labor. The big concern during labor is the uterus overcontracting, causing fetal distress. Immediately postpartum, we want that uterus to clamp down and if it's not doing it, Pitocin can help.

 

3) Not crazy painful for mom like Pitocin during labor. Yes, you'll have cramping, but it's not like labor with Pit.

 

 

 

In many states, including Oregon :) CPMs are able to purchase and to give Pitocin.

 

This is what was going through my head. If she can take my blood I'd imagine she can handle giving me a shot of pitocin. And thank you for your input, it's a little tricky to research these things because of pitocin being used for different issues.

 

I don't suppose anyone has any input in how pitocin and shepard's purse compare? I'm having a really hard time researching that.

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#11 of 18 Old 08-03-2013, 11:53 AM
 
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I had a hemorrhage with my DD's birth, and we didn't see it coming. It was my first pregnancy, uncomplicated, fairly quick birth (8 hrs or so?) at home, and so I had asked my midwife to not do it unless there was a need. Well after the big gush of blood there certainly was a need, both midwives and the assistant performed uterine massage, and then I believe I got a second shot of it too. I lost 1L of blood in a short time and blacked out when I tried to sit up. The midwives actually left another filled syringe and told DH how to administer it (it's pretty simple) if I should have an unexpected gush in the 8 or so hours before their next visit. I did have milk supply problems but I think it's due to the hemorrhage, not the pitocin.

 

Based on this I would certainly want to have it available. I wouldn't administer it "just in case" or anything, but if things go wrong you will know it is there. And since it is something you are concerned about I think knowing that you have it will give you peace of mind while you are birthing. I am also planning baby #2 to be born at home with the same midwife group.

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#12 of 18 Old 08-04-2013, 04:36 AM
 
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I had a pretty significant tear with the birth of my daughter in June and lost a lot of blood. On top of that, my placenta just wasn't coming out on its own. Thank god we had pitocin with us because after an hour I finally delivered the placenta and bleeding was under control. Unfortunately I has lost a lot of blood and still had to transfer but it would have been a much uglier situation if we didn't have pitocin.
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#13 of 18 Old 08-04-2013, 06:56 AM
 
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It's a bit scary to me that there seems to be a lack of understanding on the OP's part that there are two separate things involved here and no one is clarifying that.

Postpartum hemorrhage has very little to do with clotting, unless there is a known bleeding disorder. Postpartum hemorrhage is related to uterine atony and birth trauma (tears and concealed bleeding) which will not be helped by clotting.

 

Your midwife should be educating you on these things if she hasn't already, and if she doesn't understand this then you should be educating yourself. Using Pitocin is not as simple as giving a shot. There can be side effects and all involved need to understand the limitations of the drug. There can be complications from giving an IM injection including accidentally injecting it directly into the blood stream instead of into the muscle. There can also be long term muscle damage, like necrosis, if the injection is not done correctly. The fact that your midwife doesn't use Pitocin tells me that she should not be the one to decide whether it gets used, and if she doesn't do injections, a crisis situation is not the time to learn. It is NOT the same as taking blood.

 

If you are concerned enough about significant bleeding after birth that you are trying to bring a hospital style birth into your home, then maybe you should consider a hospital birth with CNMs.
 


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#14 of 18 Old 08-04-2013, 07:08 AM
 
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And if there is a known bleeding disorder that causes problems with clotting, then that is too high risk for a home birth.

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#15 of 18 Old 08-04-2013, 01:43 PM
 
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Originally Posted by michelleepotter View Post

Just another perspective. I would not be comfortable being administered Pitocin, a drug that can have serious side effects, by someone who has never used it, and apparently can't legally prescribe it. I also wouldn't be comfortable with a doctor who was willing to prescribe a drug that you don't currently need, so that someone who can't prescribe it can decide when you need it, administer it, and monitor your reaction. I'm not sure that's even legal.

I've had Pitocin twice, both times in the hospital, and both times were horrible. My experience tells me to avoid it whenever possible.


Agreed.

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#16 of 18 Old 08-05-2013, 11:51 AM
 
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I guess I'd kind of wonder what else she isn't capable of doing, since I was pretty sure even most CPM's can administer pitocin.  It would definitely concern me.  My midwife (a CNM) doesn't use it to augment labor, but she is capable of using it for pph.

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#17 of 18 Old 08-05-2013, 03:39 PM
 
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Can she administer lidocaine to suture? Begging the question- can she suture?

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#18 of 18 Old 08-05-2013, 06:24 PM - Thread Starter
 
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Can she administer lidocaine to suture? Begging the question- can she suture?

Yeah she can suture. She said there was a shot of something I'd get for that, probably what you said.

 

I don't think she would have an issue administering pitocin, it's just not something she carries.

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