Postpartum Pit: The Shot in the Dark


You may have made many plans and gone to great lengths to avoid the use of Pitocin for inducing or augmenting your labor; but did you know that many providers have a standard practice of injecting mothers with Pitocin immediately after delivery? If you have, or had, an open IV line at delivery, you may not even be aware that you have received it.

Pitocin is the brand name of the artificial form of the hormone Oxytocin.  Oxytocin is a great hormone. It’s probably your favorite hormone.  It does important things like make the uterus contract, allow breast milk to come out, and perhaps most wonderfully, creates feelings of love and bonding that can range from fondness to ecstasy.

With all these great effects, why are we not all lining up for Pitocin shots?  Because the artificial form of the hormone makes the body respond like the natural hormone, but does not affect the brain.  We miss out on the best part of Oxytocin’s talents – those lovely feelings that make us feel love, reduce our perception of pain, and bond with our baby.  The Pitocin floods the neuro-receptors that usually accept the Oxytocin, so there is no room for any natural Oxytocin that may be produced to get through.

Not only does Pitocin not pack the emotional punch of Oxytocin, it prevents it!  This is one reason many women want to avoid using the drug.

In addition, studies have demonstrated an association between breastfeeding difficulties and Pitocin exposure; probably due to the disruption of the natural hormonal processes.*

It is important to remember that medications have their place. They can make life more pleasant and save lives. As the patient, it is your responsibility to have a conversation with your provider about what is important to you.  Many mom’s might want to avoid Pitocin for induction or augmentation, but not if the other option is Cesarean. In an emergency, safety always should come first, and Pitocin can be life saving in certain circumstances. You need to decide what is best for you and your baby, while balancing risk and safety.

You may have thought you had this Pitocin issue all worked out in your mind, but now I am going to throw you a curve ball.  Pitocin is used more often postpartum than during first stage labor.  What?!  Yes. You are more likely to be exposed to this drug AFTER you have pushed your baby out.

After your baby is delivered, the third stage of labor begins.  This is the separation and delivery of the placenta.  In order for the placenta to separate from the uterus, the natural oxytocin which is at extremely high levels at the time of delivery, causes the uterus to contract in effect eliminating the surface area that the placenta was attached to, and closing off the blood vessels in that area.[/vc_column_text][/vc_column][/vc_row]

Practitioners are usually in one of two camps on third stage of labor management; active or expectant. Expectant management of the third stage of labor involves allowing the placenta to deliver spontaneously or by using gravity or nipple stimulation. Active management involves administration of Pitocin to increase contractions and hasten delivery of the placenta, as well as controlled traction of the umbilical cord. Early cord clamping and cutting has traditionally been a part of active management, but most practitioners have moved away from that practice based on recent evidence suggesting delayed cord clamping is beneficial.  You might think that expectant management would be best – as we are always taught to respect our bodies and the natural process, but surprisingly, evidence suggests that active management has better outcomes including lower maternal mortality rates and lower rates of hemorrhage.

So; you are left here to find your own way – and what is right for you.  Ask your practitioner what their policy is on third stage management, and let them know your wishes or concerns.  In the event of a uterus that is not contracting after delivery, there is no question that postpartum Pitocin can be life saving. In a normal singleton, vaginal birth you should know and decide if you receive preventative Pitocin or not, and if you prefer active verses expectant management.

*Active Management of the Third Stage of Labor May Reduce Breastfeeding Duration Due to Pain and Physical Complications | Abstract

afp20070315p875-f4Postpartum hemorrhage is one of the leading causes of maternal death worldwide; it occurs in about 10% of births and accounts for over 130,000 maternal deaths annually.

Active management of the third stage of labor has been shown to be more effective than expectant management in preventing blood loss, prolonged third stage of labor, severe postpartum hemorrhage, and resulting maternal death.

Routine use of active management of the third stage of labor for all vaginal singleton births in health facilities is recommended by the International Federation of Gynecologists and Obstetricians (FIGO) and the International Confederation of Midwives (ICM), as well as by The World Health Organization (WHO).