To Pit or Not to Pit
What's pitocin really like?
What do you do if you won't go into labor or your labor has stalled? What do you do if your baby has decided never to be born? What if your water has been broken for 24 hours and you still haven't had a contraction? How about if you've been 5 cm for 8 hours and your doctor is talking cesarean? What do you do? Sounds like it's time for some vitamin P. That's Pitocin—the synthetic version of oxytocin. Oxytocin is the hormone that runs around your body to make your uterus contract. Under ideal circumstances, you'll make enough to squirt that baby out on your own. Problem is, not every labor is ideal. That's why somebody invented pitocin—to give your natural oxytocin stores a boost. It's the drug of choice in most inductions and augmentations (when you're in labor on your own but need a little help). The question is: How bad is pitocin?
A lot of women swear that a pitocin labor is far more painful than a spontaneous labor. I won't argue with them. I've done two labors with and two without and can't say which was more difficult. I will say that pitocin is crazy effective in putting you into hard-rockin' labor. Hard rockin' labor is far more painful than soft-rockin' labor but most of the time—it's the hard stuff that gets the job done. The reason pitocin is considered so much harder than natural labor is that it gives you really strong contractions in a less gradual time frame than you might get on our own. Let's look at it this way: Think of an old fashioned record player. If early labor is when the needle's on the outside of the record and hard labor is the inside track closer to the label (the label is your baby); pitocin picks the needle up from the outside and puts it on the inside. Left on your own, you'd eventually get there yourself but it might take a really, really long time and your record might skip—essentially keeping you in a stuck position. Your needle has to play that last song on the record before your baby's born. That's just the way it is.
Here's how a pitocin induction works: You get an IV in your arm that runs some form of unmedicated fluid (usually a solution called Lactated Ringers—kind of a fortified drink of water). Your nurse will hang a second bag of IV solution with pitocin in it. It's highly diluted and runs through a computerized pump at teeny tiny doses to start. We bump up the amount of pitocin you receive through the pump about every 20 minutes until you're contracting every 2-3 minutes for a minute or more. It varies tremendously how long it takes to get a woman into labor. Sometimes all we need to do is bring the pitocin in the room and our patient starts contracting. Most of the time, it takes an hour or so to get things moving. Labor starts out as cramps and eventually ends up as big ol' contractions. Once we have an effective labor pattern (contractions come at regular intervals, are getting stronger and are causing cervical change), we quit bumping up the pitocin but continue infusing it at whatever dose is needed to do the job. Sometimes, you wind up having too many contractions so we decrease the dose through the pump. That's why we do almost continuous fetal heart and contraction monitoring with pitocin. We don't want to give you too many contractions and stress you and your baby out.
For women who are already in labor but have stalled and need a little boost—it's the same process: IV pitocin through a pump starting with a low dose and increasing until it's working. We rarely have to use as much pitocin with an augmentation as an induction.
What else can you do to get things moving if labor isn't progressing? If your water isn't broken and your doctor/midwife thinks the baby's head is low enough in the pelvis and well applied to the cervix—rupturing amniotic membranes usually gives labor a big kick in the pants. Changing positions and walking are good labor motivators too. And, surprisingly, getting an epidural is sometimes a really effective tool to help the pelvic muscles relax and speed labor to the finish line. If all these tricks fail and time is of the essence (infection, fatigue or fetal distress are setting in), you're likely to wind up with a cesarean section. Sometimes babies just can't make it out the front door (vagina) and you've got to take the roof off. It's nobody's favorite but it beats the alternative.
I think far too many women sign up for inductions for convenience-sake and then get caught with their pants down and a baby who's not ready for birth. Their cervix wasn't ready and it won't dilate no matter how much pitocin we give them. If they'd waited until their due date or for spontaneous labor they might have a better chance of a vaginal birth. When there's a medical necessity for an induction—thank God there's pitocin to do the job. When there's a darn good social reason for induction (like a recent patient who's husband was being deployed to Iraq and would miss the birth otherwise)—well alrighty then. Consider your options carefully and wait for good old-fashioned labor if possible. If that's just not happening, a little Vitamin P might be just what the doctor ordered to get the job done. It's a hard job no matter how you go about it. That's why they call it labor instead of picnic.
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