What Is Pitocin Induction?

Here's what you need to know about Pitocin—and how it could impact your labor.

Pregnant Woman Holding Belly
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Pregnancy can be an incredibly exciting time of change. It's also a time when, no matter how well you plan, things can sometimes take an unexpected turn away from what you'd hoped for or imagined.

For example, you might have had a picture-perfect pregnancy and made it all the way to the big day…and then nothing happened. In some situations—like going past your due date—your doctor may talk to you about having your labor induced, and that is when you're likely to hear about Pitocin for induction.

Keep reading to learn about what Piticoin is, including when it's used, how it works, its side effects and risks, and alternatives.

What Is Pitocin?

Pitocin is an FDA-approved synthetic hormone used to mimic the effects of oxytocin. Pitocin can be given through an IV or as an injection. It's used to initiate or enhance uterine contractions before or during labor. To understand Pitocin, it helps to understand what oxytocin does in the body.

Oxytocin is a naturally occurring hormone that helps promote bonding, which is why it's sometimes referred to as the "love drug" or "love hormone;" it is the hormone responsible for giving you that giddy, in-love feeling. Oxytocin's power to melt hearts plays a pivotal role in the bonding between parent and child immediately after delivery.

But before delivery happens, oxytocin helps to kickstart uterine contractions by elevating the production of prostaglandins. Prostaglandins are important hormones that drive the processes behind blood flow, clot formation, labor contractions, pain, and inflammation.

When Is Pitocin Used?

Pitocin is used to start or improve uterine contractions, which can initiate labor, help labor progress, and control postpartum bleeding after delivery.

The following are common circumstances when Pitocin might be used to induce labor:

  • Overdue: Once you reach 42 weeks (and sometimes before) without labor starting spontaneously, induction is likely to be recommended to avoid complications.
  • Low amniotic fluid: Since low amniotic fluid (oligohydramnios) increases the risk of fetal death, the ACOG recommends that labor be induced between weeks 36 and 37 in cases of low amniotic fluid.
  • Placental abruption: If the placenta becomes detached from the uterus, it can cause serious complications, such as blocking oxygen and nutrients to the baby necessitating induction.
  • Certain health conditions: Induction might also be recommended in cases where a health condition such as gestational hypertension, preeclampsia, uterine infection, kidney disease, and gestational diabetes increases the risk of complications during labor and delivery.

Pitocin can also be used during labor and after delivery. Pitocin might be recommended to augment labor and improve the strength and frequency of contractions when labor is slow or stalled (sometimes referred to as "failure to progress"). It is also sometimes used during the third stage of labor after the baby is born to aid the delivery of the placenta or to help control postpartum bleeding or hemorrhage by causing the uterus to contract down.

When Is Pitocin Not Used?

Pitocin is a powerful drug, and it is only used for labor induction or augmentation under specific conditions. There are times when induction is not a safe option, such as:

  • Placenta previa (placenta blocks the cervix)
  • Previous Cesaerean section
  • Previous surgery on the uterus
  • Breech or transverse baby position
  • Active infections such as genital herpes
  • Umbilical cord prolapse
  • Cervical cancer

People who have had previous C-sections or uterine surgery are at a higher risk of uterine rupture after using Pitocin. For this reason, your doctor will likely seek other methods of inducing labor if you've had a C-section or uterine surgery.

How Pitocin Induction Works

Before starting Pitocin to induce labor, your health care provider will determine how ready your cervix is for labor using a pelvic scoring system called the Bishop score. With a cervical exam, your health care provider will rate the consistency of the cervix, where the cervix is (position), how thin and open the cervix is (effacement and dilation), and how far the fetus has descended into the pelvis (known as fetal station). Together, these ratings make up the Bishop score.

Since Pitocin can't open a closed cervix, the cervix must be "ripe" before administering Pitocin. If the Bishop score isn't high enough (i.e., your cervix isn't ripe enough), your health care provider will use medication to ripen the cervix before starting Pitocin.

When your body is ready for Pitocin, the medication will be given through an IV in your arm or hand. The dose will gradually be increased until you are having regular contractions at which point your health care team will decide whether to keep you at that dose, adjust it, or stop the Pitocin altogether. You and your baby will receive continuous monitoring during this process.

Possible Side Effects and Risks of Pitocin Use

Like any drug, it is important to understand the potential side effects and risks of Pitocin. According to the Federal Drug Administration (FDA), Pitocin is a safe and effective treatment for starting and/or speeding up labor contractions. However, that doesn't mean Pitocin use doesn't carry risks.

For example, Pitocin can make contractions too strong, too fast, or too frequent, which can lead to issues like fetal distress and uterine rupture. Pitocin can also cause other adverse reactions such as:

  • Nausea and vomiting
  • Postpartum hemorrhaging
  • Anaphylaxis
  • Cardiac arrhythmia

Additionally, many birthing people who have experienced labor both with and without Pitocin report that labor with Pitocin feels more difficult and intense.

Alternatives to Pitocin for Labor Induction

Pitocin is not the only way to induce labor. In fact, it is often used in conjunction with other medications and tools that prepare the cervix. In situations when the cervix is not favorable to labor, there are a variety of options to begin induction. Here are a few examples.

Stripping membranes

If you imagine the uterus as a balloon, the amniotic sac (where your baby is growing) is the water-filled bag inside that balloon. Connecting the two is a thin membrane that your doctor can "strip" by inserting a gloved finger into the vagina and cervix to separate the membrane by moving their finger back and forth—this process is sometimes called "membrane sweeping" and has a success rate of 86.4%.

Prostaglandin induction

One way to induce labor is to help the cervix ripen with prostaglandins. To do this, your health care provider will give you either a gel to insert in the vagina or a pill to swallow. The active ingredient is prostaglandin, a synthetic hormone that can help induce labor contractions and is considered the preferred method for inducing labor by health care providers.

Foley bulb

A Foley bulb is a catheter made of a soft material like rubber or silicone inserted into the uterus through the cervix and then inflated with about 1 ounce of saline solution to create pressure on the cervix to help induce labor.

Amniotomy

Amniotomy is more commonly known as "breaking the waters." This is when a health care provider uses a special tool with a small hook on the end to rupture the amniotic sac. Once the sac is ruptured, the amniotic fluid is released, and labor may start almost immediately thanks to the release of hormones.

Key Takeaways

Pitocin is a synthetic hormone that mimics oxytocin to induce or speed up uterine contractions. It triggers strong contractions from the uterine muscles but cannot help the cervix fully efface. For that reason, Pitocin can only be used for induction if the cervix has already ripened. While Pitocin is an FDA-approved drug that is safe and effective, it is not for everyone. Talk to your doctor about questions and concerns, including the risk of side effects.

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Sources
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