We all know that when it comes to the business of babies (and let’s face it parenting in general), sometimes things don’t go according to plan.
From time to time, though, due to events in pregnancy or labor, some babies need a little extra help in making their way into the world, and ‘Plan B’ has to be initiated for labor and delivery.
According to research, approximately 1 in 4 women will have their labor induced; going past their due date (post dates) being the most common reason for induction.
Pitocin is one of the most common forms of intervention in childbirth.
What is Pitocin?
Pitocin is the synthetic version of the hormone oxytocin. It’s used in maternity practice, primarily to either induce labor, or to speed up a slow labor when adequate uterine activity fails.
Pitocin is a trade name, most commonly used in the United States. In other countries, it might be known as something else. In Australia and the UK, for example, it’s called Syntocinon. Regardless of the name, it does the same job: it’s used to induce labor.
It’s important to recognize that, although the names might differ, the medications are the same. They are artificial forms of oxytocin.
Administering pitocin is done intravenously (IV) through a digital infusion pump, so that the dosage can be carefully controlled.
Pitocin can be used in other ways, but ultimately, the goal is to make the uterus contract.
What is oxytocin?
Understanding the role of oxytocin makes it easier to understand the differences between it and Pitocin.
Most commonly, people know oxytocin as the ‘love hormone’, as it’s the hormone associated with empathy, trust, and relationship building.
It’s the hormone released during sexual activity, in the company of friends, and during laughter or hugging. Basically, that lovely warm feeling we get when we’re happy and relaxed is due to oxytocin.
When it comes to childbirth, oxytocin is essential in the process of normal labor, physiological birth, and breastfeeding.
Without oxytocin, there are no labor contractions. And without labor contractions, we have cannot have vaginal birth.
You can read more about what oxytocin does in 5 Things Oxytocin Does That Pitocin/Syntocinon Doesn’t.
Pitocin mimics our own natural oxytocin, but there are some major differences, which we’ll discuss later.
Here are 9 facts, to guide you through everything you need to know about Pitocin.
#1: What you need to know about Pitocin induction
For Pitocin to work effectively for induction, the body and the cervix need to be primed and ready for labor.
Cervical effacement means the cervix has softened or ‘thinned out’.
This might have already taken place, before you are induced. It will depend a lot on the gestation at which you’re induced, and whether or not your body has previously gone into labor.
Ideally, your body has done this naturally in the latter weeks of pregnancy, with the help of Braxton Hicks or ‘practice’ contractions. The more contractions you have, the more oxytocin will be released to prepare the cervix.
If this hasn’t happened, you might have received a prostaglandin pessary, or gel, which helps do the job of cervical ripening, to start the induction process.
Rupture of Membranes
The Pitocin drip also works better if your waters are no longer intact.
Spontaneous rupture of membranes, known in medical terminology as SROM might already have happened naturally.
If not, you might require an intervention known as an ARM (artificial rupture of membranes).
During this process, your midwife or doctor will use an instrument that looks a lot like a knitting needle with a tiny hook on the end.
This is carefully inserted into the vagina and through the cervix; it nicks the amniotic sac surrounding your baby, to release the amniotic fluid.
#2: Pitocin is not the same as oxytocin
Although chemically identical to oxytocin, Pitocin behaves differently in the body. Pitocin doesn’t cross the mother’s blood-brain barrier, so it cannot act on the maternal brain.
This means less natural oxytocin is released in the brain. As oxytocin is involved in falling in love, bonding and relationships, there is evidence to suggest that inductions could alter instinctive bonding behaviors between mothers and newborns.
Read our article Pitocin Linked to Postpartum Depression and Anxiety for more on this topic.
When the brain is no longer releasing oxytocin, and endorphin production is decreased, we not only lose our natural pain killers, but we also lose the sense of calm and content that oxytocin brings.
It’s easy to see why Pitocin inductions create a very different experience of labor for the pregnant mother.
#3: Pitocin creates stronger, more painful contractions
One of the challenges with induced labor, is that it seems to miss out the early labor stage. It can go from zero to a hundred very quickly.
This is because a labor induction with Pitocin doesn’t involve other hormones in the way spontaneous labor does.
In normal labor, the body produces increasingly strong contractions that gradually intensify over time.
As the uterine muscles begin to tighten and relax during contractions, the muscles release endorphins – similar to what happens when we exercise.
Endorphins are incredible. They help us feel good and are the body’s built-in natural pain relievers. In spontaneous labor, endorphins increase in line with oxytocin.
The more intense contractions we have, the more endorphins are released to help.
However, in induced labors, this doesn’t happen. Pitocin does not stimulate our body’s natural endorphins: they can’t ‘keep up’. This alters our ability to manage the intensity.
Pitocin contractions vs natural contractions
Women who have experienced induced labor often describe contractions that feel as though they come out of nowhere.
This is because of the way Pitocin is administered. Pitocin is released directly into the bloodstream through a drip. This means the flow is continuous, and precisely the same amount is released every minute.
Natural oxytocin in the body is released in waves or pulses – sometimes more, sometimes less. This creates some uterine contractions that are stronger, and some that are less so.
This method of release is also receptive to feedback from the mother’s body and the baby. This means the baby responds more favorably, and is less likely to experience fetal distress in labor.
The opposite is true with Pitocin. As the continuous flow is turned up and up, it results in increasingly stronger, longer, and more painful contractions, and allows baby less time to recover between contractions.
#4: Pitocin creates a greater need for pain relief
During an induction, many women find themselves requesting pain medication to help manage their contractions.
When strong contractions come on quickly, there is less time for the body to become used to what’s happening.
That is why Pitocin increases the need for pain relief, especially in women who have not had a baby previously.
Research suggests that women who have their labors induced are nearly 4 times more likely to have an epidural.
#5: Pitocin doesn’t have a timeframe
You might be wondering how long Pitocin takes to work, or how long it will be before you meet your little one after starting labor with Pitocin.
These are logical questions to ask; unfortunately, there aren’t any easy answers.
Inducing labor is complex, and there are many other factors that can influence the length of labor.
How fast does Pitocin make you dilate?
Some women make satisfactory progress with only a very small amount of Pitocin; others might need a lot.
Pitocin is diluted and run through an infusion pump, which travels into your system via a drip.
Each hospital has a specific protocol regarding the dose and rate it’s run at, and how frequently it’s increased.
Generally, the synthetic oxytocin infusion is increased slowly, every 30 minutes, until a certain contraction pattern is reached – usually about 4 contractions in 10 minutes. The infusion will continue until your baby is born and, normally, for some time afterwards.
As the drip is started at a very slow rate, it takes a while for uterine contractions to begin. However, most women will start to experience strong contractions within 2 hours.
#6: Pitocin can affect bonding and breastfeeding
We know that Pitocin can be very effective in inducing or augmenting (speeding up) labor. Some of the potential ‘side effects’ of Pitocin, however, are less well known and researched.
Women who receive an artificial oxytocin infusion in labor are three times less likely to initiate breastfeeding in the first four hours after birth. They are twice as likely to give formula to their baby in hospital, with reduced breastfeeding rates at two months.
Natural oxytocin is a key hormone for breastfeeding, so it’s possible that introducing Pitocin into the mix might interfere with normal oxytocin levels.
#7: Pitocin induction isn’t without risk
Elective induction comes with a range of possible side effects. This means those who are being induced need to be monitored more closely.
- Over stimulation (hyperstimulation) of the uterus. Pitocin can overstimulate the uterus increasing the likelihood of your baby becoming distressed. Long contractions, with little gaps in between, reduce the oxygen flow to the baby. If not managed appropriately, hyperstimulation can lead to uterine rupture. Although rare, excessive contractions can cause the placenta to detach from the wall of the uterus early, putting mother and baby in extreme danger
- Fetal distress. Prolonged use of Pitocin also increases the chances of fetal distress
- Infection. Women who are induced are normally subjected to an increased number of routine vaginal exams to assess progress; this increases the chance of infection
- Fetal heart rate abnormalities. Some babies can tolerate Pitocin without problems, but some babies are more vulnerable to it. Small for gestational age babies or preterm babies are less robust, and therefore less likely to cope as well with the use of Pitocin
- Increased need for analgesia. As discussed above, stronger, longer frequent contractions affect the way we experience labor
- Malposition. In spontaneous labor, babies adjust themselves into the best position for birth. This happens in between contractions, while the uterus is relaxed. In induced labors, contractions are longer and closer together, which means the uterus has less time at rest. This increases the chance of unfavorable fetal positions, and makes vaginal delivery more difficult
- Increased risk of cesarean section. An Australian study examining birth outcomes for women having their first baby after an uncomplicated pregnancy, found that induction more than doubled the chance of an emergency cesarean section. The cesarean rate was 12.5% for women in spontaneous labor, compared with 26.5% for women who were induced
- Excessive bleeding/postpartum hemorrhage. Pitocin affects natural oxytocin release and, therefore, once the baby is born the uterus produces inadequate contractions to stop bleeding. That’s why it’s usually recommended that the Pitocin infusion continues throughout the Third Stage of Labour to reduce the risk of postpartum hemorrhage.
When is induction of labor offered?
There might be any number of reasons for your healthcare provider to suggest induction of labor using Pitocin.
An elective induction of labor is recommended if the benefits of prompt vaginal delivery outweigh the risks of waiting for labor to begin naturally, to avoid serious pregnancy complication.
This is known as the benefit to risk ratio.
Inducing labor can be beneficial if there are medical indications for the mother, the baby, or both.
A labor induction might be advised for any of the following maternal and fetal conditions:
- Going over your due date
- High blood pressure
- Abnormalities in amniotic fluid level
- Growth restricted babies.
#8: Pitocin doesn’t always work
It’s common for inductions to last anywhere between 12-48 hours from start to finish, and sometimes progress can feel a bit slow. But remember that any progress is progress.
An induction will generally take longer if your body isn’t really ready for labor yet.
If your body really isn’t ready for labor, Pitocin might not be effective. It might produce contractions, but they might not work to dilate the cervix sufficiently to let your baby through.
What happens if you don’t dilate after being induced?
If this is the case, you and your health provider have to make a decision about how to proceed with the labor and delivery.
You need to decide whether to continue with the induction process, or whether there is a medical necessity for surgical intervention – in other words, whether a cesarean section is required.
In some circumstances, this might be the safest option for you and your baby at this stage.
It’s a delicate balance between giving mothers the best chance of a vaginal birth, and protecting the safety of both mother and baby.
For further reading on this topic, check out the article ‘Why Do Inductions Fail?’
#9: Pitocin is not for everyone
There are some serious complications, or medical indications, where Pitocin induction would not be recommended, such as:
- Malposition, where your baby is lying across the uterus (transverse lie), rather than up and down
- Total placenta previa, where the placenta is fully or partially covering the cervix
- Previous cesarean section. The use of Pitocin when you’ve already had a cesarean scar increases the risk of uterine rupture
- Grand multips. Induction may not be recommended for women who have had more than 4 or 5 babies before
- Severely growth-restricted babies are unlikely to cope well with the stress of labor induction
- Fetal distress. Labor induction is not appropriate for babies who are already distressed.
Is induction of labor right for me?
Many people have mixed feelings about inducing labor. If you’re unsure about whether or not an induction is the right option for you and your baby, seek professional medical advice to learn more.
Everyone’s clinical picture is different, so there can never be a one-size-fits-all answer to this question. Obviously, this makes it harder to come to a decision about your own situation.
If you are unsure, speak to your doctor or midwife about the reasons why an induction is being recommended for you. Think about the risks involved in being induced, as opposed to the risks involved in not being induced, and look at the research behind that.
If you still aren’t sure, you’re also within your rights to ask for a second opinion.
To help inform your decision, speak to mothers who are in a similar position to yours, or who have been through the induction process.
Do your own research, too. Spend some time learning about the induction process and the different methods. Being informed will help you feel more prepared for what’s to come.