New study associates Pitocin use with adverse effects.
I've been on a toot for years about the overuse of Pitocin (aka oxytocin) for unnecessary inductions and augmentation of labor. My concerns have focused on what it does to Mom's labor and our ridiculous c-section rate, but also on how it has led to an outrageous number of babies being born accidentally premature.
You think you're delivering a 38-weeker and whoopsy daisy, the dates were off and baby is only 36 weeks. I can't count the number of babies who've landed in the NICU because of that little mistake. Of course in these cases, the use of Pitocin is usually presented as a necessary tool (and lots of women just do what their doctors tell them to do – no questions asked). Most of the time however, if Pitocin hadn't been used and labor had been allowed to progress naturally, everyone would have been better off.
The American College of Obstetricians and Gynceologists (ACOG) published a press release earlier this year saying, "Induction and augmentation of labor with the hormone oxytocin may not be as safe for full-term newborns as previously believed, according to research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists." Researchers analyzed 3000 births that happened between 2009 and 2011 and found that the full-term babies (we're not even talking about the accidental premies here) of mothers whose labors were either induced (oxytocin was used to start their labor) or augmented (oxytocin was used to boost the intensity and/or speed of labor that started on its own) spent more time in the NICU with what they're calling "adverse effects." They don't indicate what those adverse effects are. A higher percentage also had lower than average Apgar scores (a 10-point rating scale that indicates how well baby is transitioning immediately after birth).
I'm not surprised. Pit's powerful stuff and when we use it, we're making labor more forceful and faster than Mother Nature intended. Maybe Mother Nature knows best just how much force and speed a baby can handle. It makes sense that some babies need a tortoise, not a hare approach to labor.
The press release also says, "The analysis suggests that oxytocin use may not be as safe as once thought and that proper indications for its use should be documented for further study." The primary investigator of this study, Michael S. Tsimis, MD says, "However, we don't want to discourage the use of Pitocin, but simply want a more systematic and conscientious approach to the indications for its use."
ACOG is essentially suggesting a Goldilocks approach – not too much, not too little...just right. But therein lies the problem. Pitocin is used like crazy in virtually every hospital in the U.S. It's used when it's 100% absolutely essential that a baby be born ASAP and when it's not. It's used for convenience, slow labors, long pushing stages and for all kinds of reasons other than what it's intended for: to start or boost a labor for clearly medical reasons where waiting on a "natural" labor is too risky.
It's not intended for when a mother or doctor is tired of waiting or for starting labor because grandma's in town. It's not intended to deliver a baby on his due date because otherwise, "he might go overdue" (I hear that a lot) or because "baby is getting bigger" (duh, they're supposed to). It's also not intended for doctors trying to keep their office and hospital schedules organized or to avoid after-hours deliveries.
Another report was released this spring that backs up the overuse of Pitocin. A survey commissioned by Childbirth Connection (a non-profit organization working to improve the quality and value of maternity care through consumer engagement and health system transformation), polled 2,400 women who gave birth in U.S. hospitals from mid-2011 to mid-2012.
A quarter of women surveyed experienced three or more of five major medical procedures such as labor induction, drugs to speed labor, and cesarean section. Only one in eight women had none of the major interventions. Most of the women couldn't identify the risk factors associated with induction or C-section and 1 in 4 said they felt pressured by their care provider to use these interventions.
What's particularly interesting to me is that even though most women don't need these interventions, don't know why they had them and don't know the risks involved, they also reported they completely trusted their providers. ACOG's press release indicates that, oops – maybe we shouldn't trust them quite so much. Blind trust is tricky that way.
Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to firstname.lastname@example.org.
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