As mothers-to-be, we try to make the best birth decisions for the safety of ourselves and our babies.
We want to know that what we choose will help us to have a positive and safe birth experience – one that leaves us empowered and brings our baby safely earth side.
We hear about inductions often. One of the main reasons for this is induction rates are very high in some areas, with a third to half of all women receiving synthetic oxytocin (Syntocinon or Pitocin) to begin or augment (speed up) labour.
Would maternity care providers use synthetic oxytocin often if it was unsafe?
Inductions, like all interventions, have benefits and a place in obstetric care, otherwise we'd never see them used.
However, having benefits doesn't mean an induction is free of risks.
Birth is a normal physiological process — part of our normal, reproductive lifecycle — and anytime we interfere, we run the risk of complications.
Of course, there are situations in which the benefit of interventions outweigh potential risks, such as cases of the potentially fatal pre-eclampsia (high blood pressure). When medically necessary, an induction offers the opportunity for a vaginal birth, when waiting for spontaneous labour isn't a safe option.
However, when considering an elective induction – meaning there isn't a genuine medical benefit to mother or baby to induce versus continue the pregnancy – it's important to make a fully informed decision.
So, can Syntocinon or Pitocin affect your baby? We know the risks for a mother, but what about the baby?
If you're considering an elective induction, here are somethings you need to know, so you can weigh up the benefits and risks:
#1: Your Baby Could Be Born Before He/She Is Developmentally Ready
An estimated due date is just that – an estimate. Each baby develops at their own unique rate, and might not be ready to be born despite what the calendar says. See our interesting article on how labour starts.
Iatrogenic prematurity – meaning prematurity caused by a medical provider – is a risk of induction. In cases of pre-elampsia or when your baby is unwell in utero, the benefit of baby being outside the womb outweighs the risks associated with prematurity. However, in the case of an elective induction, the risk of being born prematurely is a serious one.
Being premature or even early term (37 weeks to 38 weeks and 6 days gestation) can increase the risk of breathing and feeding difficulties. If continuing your pregnancy is safe, these are risks you can avoid by waiting for labour to begin spontaneously.
#2: Synthetic Oxytocin Can Cause Fetal Distress
For most induction and augmentations of labour, synthetic oxytocin is used through an IV drip. The hormone oxytocin triggers uterine contractions. When your body releases this hormone naturally, you fall into a natural contraction pattern which allows you and baby to rest between contractions.
When you receive synthetic oxytocin, your uterus may contract more frequently and more intensely than with natural oxytocin. This can lead to baby not receiving enough oxygen, which means fetal distress.
Fetal distress can necessitate a c-section, exposing both you and baby to more risks.
Natural oxytocin also crosses the blood-brain barrier, and the synthetic version does not. Read more about how synthetic oxytocin is different to natural oxytocin here.
#3: Syntocinon/Pitocin Can Lead To A NICU Stay
Most pregnant mothers look forward to the amazing and beneficial skin-to-skin moments immediately following birth. Very little can prepare a mother for complications that interfere with those first precious moments, when it's something she's looked forward to for nine long months.
The American Congress of Obstetricians and Gynecologists (ACOG) published information from a study in 2013 that found artificial oxytocin might not be as harmless for full term babies as previously believed.
ACOG states, “Researchers found that induction and augmentation of labor with oxytocin was an independent risk factor for unexpected admission to the NICU lasting more than 24 hours for full-term infants. Augmentation also correlated with Apgar scores of fewer than seven at five minutes.”
Having an induction does not guarantee a NICU stay, but it does increase the odds of needing one.
For a healthy mother and baby, an elective induction might not be worth an unexpected NICU stay.
#4: There Are Several Documented Side Effects For Babies
When weighing up the benefits and risks of a procedure, it's important to be aware of all the risks, in order to be truly informed. While serious side effects aren't common, they can and do occur. If giving birth early is the safest solution for mother and baby, then the benefit of induction is likely to outweigh the possible risks.
If remaining pregnant poses no or minor risk, then these possible, reported side effects of synthetic oxytocin should be carefully considered:
- Neonatal jaundice
- Low fetal heart rate
- Neonatal retinal haemorrhage
- Neonatal seizures
- Brain damage due to oxygen deprivation
- Low apgar scores
- Premature Ventricular Contractions (a type of abnormal heart rhythm)
- Fetal death
It's very possible that you've met several mothers who have used synthetic oxytocin without any adverse effects, or perhaps you've used it yourself. Risks are not guarantees, they are simply things that can occur. This information isn't meant to deter or scare a mother needing a medically necessary induction. Information is key when making fully informed decisions, especially about elective procedures. Being informed is understanding both the benefits and the risks – and every human being deserves an opportunity to make decisions with their eyes wide open.
#5: Manufacturers Warn Against Elective Use
The manufacturers of Pitocin do not recommend it's use for elective inductions. They warn, “Since the available data are inadequate to evaluate the benefits-to-risks considerations, Pitocin is not indicated for elective induction of labor.”
What does this mean?
This means there isn't enough information to support using Pitocin to begin labour without a medical indication. It isn't without risks, and these possible risks do not outweigh the benefit of starting labour before it begins on its own.
Does This Mean Women Shouldn't Be Induced?
Simply put, no this information does not mean we need to avoid inductions at all costs. This information is simply to help parents weigh up the benefits and the risks of using Pitocin or Syntocinon, especially in elective situations.
If you are facing a medically necessary induction, then the benefits of birth outweigh the possible risks. You can go into your induction prepared with a proper support system in place, in case any side effects occur, such as feeding difficulties or a NICU stay.
For the majority of women the safest way to give birth is waiting for it to begin spontaneously and trusting the process will unfold at its own pace. If complications arise then we can make use of modern obstetrics to provide medical support. However, when we use modern obstetrical interventions without complications we can actually create complications.
This clip below from The Business of Being Born shows how the cascade of interventions work, including the use of Pitocin.