potocin for brithing placenta question - Mothering Forums

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#1 of 21 Old 10-21-2005, 07:37 PM - Thread Starter
 
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I had my 38 wk exam today (doc said that I will probably not make it to my due date -hooray!!!! ) We discussed my birth plan and he stopped and asked about me not wanting pitocin to deliver the placenta. I told him that I wanted to keep everything as natural as possible and I heard that the contractions that pitocin causes are much more intense. He said that he normally recommends it to avoid hemorraging. He said that place such as France does not administers piotcin after delivery and they have 4 times as many pt to hemorrage. What do you ladies think about this? Is he being overly cuatious? Is it a being deal since the baby would already be out?
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#2 of 21 Old 10-21-2005, 08:13 PM
 
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It's totally unecessary unless you start to bleed heavily, which you probably won't if the baby is put to the breast soon after delivery and they don't fiddle around with trying to get the placenta out.

Sounds like it's a "just in case" thing with him. I'd also adamantly refuse to allow them to "massage" my uterus to get it to contract, again, unless I was bleeding heavily. They may want to check that it's firming up, but I wouldn't let them grind on my belly like I've heard they do in some places.

Good luck. Sorry he was giving you grief over this. I hate needles and generally don't have very many positive feelings for anyone who wants to stick me with one.

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#3 of 21 Old 10-21-2005, 08:17 PM
 
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i dont think its that common to bleed heavily after birth, but i think its okay to have pitocin as a back up just in case you do.. i dont think you should just do it thought, unless there IS a problem. with my son i did bleed quite heavily and my midwife recommended it after she massaged my belly and it didnt help. there are good herbs and homoepathy for PPH also, which ill have on hand this time, but it is good to know that there is pitocin just in case. i;d stick with what you really want or dont want. and dont do it just because your doctor says.. it isnt necessary to birth your placenta.. your body will do that naturally.

 

 

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#4 of 21 Old 10-21-2005, 08:27 PM
 
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What does he know about France's PPH statistics??? Really, I think he was pulling that out of his *you-know-what*.

Like everyone else is saying it's good to have available as a back up but not as a "prevention." My placenta took an hour and 15 minutes to birth after willem was born... in fact I couldn't birth it until I was completely alone in the shower.

You might also want to be sure they don't do anything that might make you bleed heavily and then need the placenta or methergin (like pull on cord).
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#5 of 21 Old 10-21-2005, 08:44 PM
 
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Normally I am strongly in favour of keeping everything totally natural but my midwives told me about 2 studies that they were very familiar with (down to methodology, sample sizes, etc.) that showed a more than 50% reduction in post-partum hemmorhaging with a one-time pitocin shot immediately after birth. Since I know of a couple people who've had lovely homebirths followed by difficulty delivering the placenta and hemorrhage that necessitated transport to hospital, I'm opting for the shot. It's not quite the same as receiving pitocin in labour - a one-time shot wears off pretty fast, you're high on endorphins and birthing the placenta is generally pretty painless, so even if there IS an increase in the intensity of the contractions that deliver the placenta, it's not something that's likely to make you all of a sudden want meds, and of course it won't affect the baby at all. That's the theory, anyway. If it turns out to not work well for me I will be displeased and not do it again, but I can't turn up any references to side-effects of pitocin provided post-partum.

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#6 of 21 Old 10-21-2005, 08:47 PM - Thread Starter
 
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Now I am scared again. He told me that the placenta is generally deliver 1-15 mintues afterbirth. I myself thought that it took a little longer but now I am afraid of hemorraging to death.

Thanks Spughy - I think that I will opt for it as well.
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#7 of 21 Old 10-21-2005, 09:47 PM
 
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Basically, the way to avoid hemmorhage PP is to keep the uterus "tonic" or firm.

You can avoid pitocin by putting the baby to your breast right away. The release of hormones caused uterine contractions when you breastfeed, which is why you have "afterpains" (some of which were stronger than my Pitocin induced contractions!) and to massage your uterus.

I've never had an injection of pitocin with any of my 5 births.
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#8 of 21 Old 10-21-2005, 09:51 PM
 
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Okay, this thread has my attention. I can't have Pitocin with my labor because I am going for VBAC and it is linked with increase in uterine rupture. But what about the one shot deal? I also had HELLP last time and even when I'm not pregnant my platlets aren't super high. So, I could have a bleeding problem where they would need to use the Pitocin. Hmmm... I will have to talk to my doctor about this. Any extra advice is appreciated. Do you think increasing my Alfalfa intake (vitamin K) might help?
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#9 of 21 Old 10-21-2005, 09:58 PM
 
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this thread got my atttention too... First of all, the reason most women will hemmorhage in the first place is because doctors tend to cut the cord and then pull the placenta off the uterus and thus cause rupture or trama to the uterus- thus heavy bleeding. This happened to me in a hospital birth (with my first) and I bleed A LOT, and I was given pit- but with my second the placenta detached within 3 min and I birth it out fine, it didnt hurt, and yes my MW said I was a "bleeder" but we put my baby on my breast and that was that- bleeding happends in birth, but most major trama is induced by humans trying to screw with nature....

I would say don't do it, and ask your doctor to let the cord stop pulsating and also let it detach naturaly- for some reason people think the human body has no idea what to do..

GL with your labor, birth and congrats on your new baby comin soon!

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#10 of 21 Old 10-22-2005, 03:55 AM
 
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Quote:
Originally Posted by tryingitnatural
Now I am scared again. He told me that the placenta is generally deliver 1-15 mintues afterbirth. I myself thought that it took a little longer but now I am afraid of hemorraging to death.
Erm- it does. The syntometrine (pitocin over here is called syntocinon: the one-shot injection after birth is a combination of two jabs) will cause the uterus to contract down within 7 minutes: so whilst the risk of PPH diminishes, the risk of a retained placenta requiring surgical removal increases accordingly.
I had a borderline PPH with Isaac, which we think was down to the fact that my contractions disappeared with my amniotic fluid. If you have ANY interventions- even something as "harmless" as coached pushing, I think it's worth having (and I'm not big on interventions in childbirth) if you have any other risk factors. Although the best results statistically come from giving the injection with the shoulder, you can delay either: until baby breathes, until the cord stops pulsating or until there are signs of separation. It will work within 7 minutes, regardless of when administered.
Having been reading up on physiological third stages, it looks like separation at 20 minutes or so is fairly normal, and most women will be ready to push their placenta out at the 30 minute mark.
Re: France. 99.9% hospital births, 99.8% managed deliveries. (check for yourself.) If he was quoting Norway, Sweden or somewhere like that I'd take him more seriously, but France has obstetricians. I know an independent midwife who's travelling over there to catch a baby for this reason.

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#11 of 21 Old 10-23-2005, 12:33 AM
 
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I had the pitocin shot after DS was born, because he had to go to the warmer and then to the NICU (meconium in water, cord wrapped around his neck, not breathing good - but was released within 3 hours and was perfectly healthy - yay!).

I will decline it this time IF the baby is placed directly on my stomach/chest and is able to nurse during the first few minutes. If those aren't possible, then I'll agree to the pitocin again.

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#12 of 21 Old 10-23-2005, 03:32 AM
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He's a doctor, he is of course going to go for medical interventions... don't let him buffalo you. My Dr. however does NOT do pit "routinely" - and FYI - he is a Professor at Canada's top ranking medical Uni.
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#13 of 21 Old 10-23-2005, 03:43 AM
 
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Quote:
Originally Posted by tryingitnatural
Now I am scared again. He told me that the placenta is generally deliver 1-15 mintues afterbirth. I myself thought that it took a little longer but now I am afraid of hemorraging to death.
From all the reading I've been doing, I've read frequently that it can take up to an hour, and that is considered "normal." I think it should be on hand in case there is a problem, and only used if there is actually a reason to, not just because it's "routine."

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First of all, the reason most women will hemmorhage in the first place is because doctors tend to cut the cord and then pull the placenta off the uterus
Why would they pull it??? That makes me cringe just thinking about it! :Puke

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#14 of 21 Old 10-23-2005, 08:17 AM
 
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Here are some links to info on management/mismanagement of the 3rd stage of labor.
A for PP hemorrhage in France - I don't know if that is true, but most births in France are certainly over-medicalized, over-managed and rife with unnecessary interventions, which could certainly lead to PP hem.-

http://www.midwiferytoday.com/enews/...=international

http://www.midwiferytoday.com/articl...?r=1&q=tritten

http://www.lotusbirth.com/doc/FEB2003Lotusbirth-314.htm

.
After the birth of my 2nd child, I was bleeding quite heavily, and my midwife said. "You need to stop bleeding. You don't need to bleed. Tell yourself to stop bleeding!" And I did.
At a birth that I attended as a midwife's apprentice, the mother was hemorrhaging. THe midwive started with Shepard's purse tincture, tried a homepathic remedy (sorry, I can't remember which one), and when all that failed she resorted to a shot of Pitocin in the leg. Worked.
I don't believe that all women routinely need Pitocin to avoid excessive postpartum bleeding.
In the words of my French childbirth course instructor "Your body - he KNOW what to do!"
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#15 of 21 Old 10-23-2005, 08:10 PM - Thread Starter
 
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thanks plaid leopard - great info on those sites especially the Lotus site
I am now rethinking the shot
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#16 of 21 Old 10-24-2005, 12:50 AM
 
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Midwives don't typically give pitocin routinely. Let the baby be born, give the baby to the mom, have the baby either latch on or even just be near the breast. Leave the cord alone--don't cut it, touch it, or yank on it or do rough uterine massage. If mom bleeds a little more than I am happy with and the baby is not nursing, I have her or the dad do some nipple stimulation--this causes the body to produce its own oxytocin, of which pitocin is a synthetic version. If the placenta isn't delivering and then the mom is bleeding too much, you can always give pitocin then!! It doesn't need to be given as a preventative measure. Postpartum hemmorhage is often CAUSED by measures such as aggressive uterine massage, inappropriate cord traction, etc. So when people are doing those types of interventions, it makes sense that they think everyone is going to bleed to death every time--it's an iatrogenic problem!! Usually the placenta delivers, by itself and with the mom's efforts, just fine. A little cord traction during a contraction while guarding the uterus AFTER the placenta has separated can help bring it along out of the uterus and vagina--but so can having the mom get up and squat so it can fall out! It's not such a big problem.
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#17 of 21 Old 10-24-2005, 02:05 PM
 
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Quote:
Originally Posted by Plaid Leopard
I don't believe that all women routinely need Pitocin to avoid excessive postpartum bleeding.
I don't think midwives (who DO routinely administer the shot here) or OBs do it because they think all women need it, they administer it routinely because it drastically reduces the number of women who do have excessive post-partum hemorrhaging. No non-hemorrhaging woman in a group receiving routine post-partum pitocin would ever actually know if she would have hemorrhaged without it. This is what is annoying about studies like this - you have a problem, a treatment, proven efficacy of the treatment, but no isolation of factors leading to the problem in the first place that would allow more targeted treatement. But because of the lack of side-effects of the treatment, blanket routine administration of the pitocin appears to be the better route, and nobody's put any real controlled-study-type effort into ways to really identify risk factors.

And yes, post-partum bleeding can be stopped once it starts, but by then significant blood loss has already occurred and I can't see how that's ok.

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#18 of 21 Old 10-26-2005, 11:35 PM
 
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A certain amount of bleeding post-partum is normal. I'm not talking about delaying administration of pitocin until a mom has had a massive hemmhorage and has lost too much blood. But pitocin can be administered immediately in the case where normal bleeding is starting to turn into too much bleeding. Yes, in places where "active management" is common and midwives are practicing in institutions as part of the health care system it's a protocol to automatically give everybody Pitocin. (I think this is the case in France, Ireland, etc.) Then again, in such systems induction and augmentation to lengthen labor are also a part of active management--the point is that with this type of management, everybody is treated the same with the idea that since some percentage of women might benefit from the treatment, everybody will be given that same treatment. As a homebirth midwife, I subscribe not to the theory of active management, but the theory of watchful waiting. I don't know any homebirth midwives who routinely give pitocin without a specific indication, and homebirthers here are not dropping dead or having major complications from postpartum hemmhorages left and right. Why trust the body to give birth to the baby but not the placenta? It just doesn't make sense. There is a difference between "bleeding" and "hemmhoraging", and a normal woman will bleed a small amount before and after the placenta, but this is natural and normal and will stop on its own particularly if you haven't confused her entire hormonal system with pitocin already during the labor and if you are allowing her natural oxytocin to function through nursing/contact with the baby. And if it seems that she is in fact bleeding a little more than ideal and pitocin will be helpful, an IM injection of pitocin will work just fine at that point. Why treat every woman like they're a disaster waiting to happen? I just can't believe that in a natural birth setting in the developed world with basically well-nourished mothers, that a high percentage of women will have a postpartum hemmhorage that will be a problem.
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#19 of 21 Old 10-27-2005, 03:13 AM
 
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Can I ask, Kavita, how do you define a PPH?? Do you use an estimated blood volume lost, or do you go more off how the mother is, and if she's showing any signs of shock etc?
Spughy- if I understand correctly, one of the reasons that our blood volume increases in pregnancy is because we're going to lose a fair amount of it when the placenta comes away at the end of it: the body already has a management strategy in place, if that makes any sense?

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#20 of 21 Old 10-27-2005, 05:00 AM
 
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Originally Posted by flapjack
Can I ask, Kavita, how do you define a PPH?? Do you use an estimated blood volume lost, or do you go more off how the mother is, and if she's showing any signs of shock etc?
Spughy- if I understand correctly, one of the reasons that our blood volume increases in pregnancy is because we're going to lose a fair amount of it when the placenta comes away at the end of it: the body already has a management strategy in place, if that makes any sense?
I will quote here from my well-worn (both frequently read, and partly chewed by my dog when she was a puppy!) copy of Varney's "Nurse-Midwifery, second edition" textbook:

"Hemorrhage, by definition, is an abnormal loss of blood. In obstetrics this is considered to be a loss of 500 milliliters or more." (Note from me: 500 ml. is 2 cups. This is quite a bit of blood, and I rarely have seen people lose more than about 100-250 ml., about half a cup to a cup, throughout the entire third stage process. But I digress!) "One does not, however, wait until there has been a loss of 500 milliliters of blood before deciding that the woman may be hemorrhaging and taking action. In fact early action in the presence of excessive bleeding may prevent actual hemorrhage and certainly the life-threatening sequelae of hemorrhage that are first manifested by the signs and symptoms of shock."

The point here is that there is a pretty big place in between NORMAL postpartum bleeding and postpartum hemorrhage, called, "Hmm, she is bleeding a bit more than I'd like, and I need to take some action and get her uterus contracted now to prevent a hemorrhage from occurring." The first step of this if the bleeding is not too severe/fast would be to try nursing, or nipple stimulation, or uterine massage to contract the uterus, and the next step is to adminster pitocin through intramuscular injection. In my experience, it is not very common that this situation actually develops into an actual hemorrhage when managed correctly. You can also identify certain factors which put a woman at risk for hemorrhage, and be more alert to the possibility and act earlier in those cases. There's some consideration of the woman's condition that I put into the decision (for example, what her overall condition is before she started bleeding a bit too much) but mostly it's just evaluating what is going on in terms of the rate/type of bleeding (trickle? gush? steady stream? getting faster or slowing down?) combined with the total amount of blood being lost.

Of course, the book also notes that we can in fact identify in labor women who are more at risk of/predisposed to the possibility of postpartum hemorrhage. Some of these risk factors are just natural, like uterine overdistention due to a really big baby or multiple gestations, or grand multiparity. However, one OTHER major factor is that the use of oxytocin induction or augmentation of labor predisposes a woman to immediate postpartum hemorrhage due to uterine atony! In most hospital settings it is not at all uncommon that women are given pitocin to start labor or speed it up. In fact, this is a cornerstone of the philosophy they call "active management" which basically stresses that labor should be over and done with within certain specified time frames and pit should be used to speed things up if the body is not conforming to this pattern--which is especially the case even among hospital midwives in places like Ireland and Australia and I believe parts of Europe. It makes sense that there would be a higher rate of postpartum hemorrhage amongst these women, and that studies done on this population with a large percentage of at-risk people would indicate that use of pitocin after birth does in fact lower rates of postpartum hemorrhage. Never mind that it is the management of birth in the first place that is CAUSING at least some increase in the rate of postpartum hemorrhages, that they are then trying to prevent by giving pitocin postpartum to everybody! It's like by giving someone pitocin in labor, you sort of cause the uterus to kind of get confused and stop listening to the body's own hormonal signals, and it just poops out after the birth and stops contracting, and therefore bleeds more. Also, any uterine massage or pulling on the cord during the first part of third stage tends to cause more bleeding. Since I never give pitocin to induce or augment labor and don't cut the cord or massage the uterus before the placenta is out, I just don't see this problem very often in homebirth.
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#21 of 21 Old 10-27-2005, 02:14 PM
 
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Originally Posted by flapjack
Spughy- if I understand correctly, one of the reasons that our blood volume increases in pregnancy is because we're going to lose a fair amount of it when the placenta comes away at the end of it: the body already has a management strategy in place, if that makes any sense?
That's an excellent point, Helen, and one that frankly I hadn't thought of (slaps forehead). And thank you Kavita for all the additional info - I am rethinking my position on this. I think I need to do more research... I am going to ask my midwives for a copy of (or reference for) the studies they used. Or I might be able to use DH's university library access to find the study online. I am starting to suspect that the results they reported were from actively managed labours, not the natural labours that my midwives generally attend.

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