Pitocin...in some countries named Syntocin...if you've heard modern stories of birth, you may have heard of this oft-used medication. In fact, it's become so commonly used that there are now lots of misconceptions about it and sometimes women or medical professionals even think it's a necessary part of birth, using it in every single one! However, Pitocin has only been used approximately the last 50 years within the medical system. When it comes to history, it's actually quite new and we still have much to learn about what can happen with its use, both to mother and baby. Many women are never told about the risks we do know and many are told that they need it or will get it without understanding the risks and true indications for it. While it can sometimes be a helpful tool at the service of women and babies when used judiciously, it is not without risk and can profoundly impact the birth for both mother and baby. It is the women themselves, of course, who deserve to know the information available and ultimately be the ones to decide if it is something they want to use in their bodies and births. This post is not at all meant to be exhaustive on the subject but a general overview of some of the things women are not told about this powerful medication.
Put simply, Pitocin is a medication meant to mimic the natural hormone oxytocin. Its primary mechanism is that it causes the uterus to contract. Very often it is used as part of an artificial induction of labor or to augment labor (i.e. to speed it up). It can also be used to treat or prevent postpartum hemorrhage. When used for induction it is done through an IV and when used after birth to prevent or control bleeding it can be administered via IV or an intramuscular injection. It can be a helpful medication in limited situations but we need to be very very clear that it is NOT the same as our body's natural oxytocin. Very often because they have one similar effect (i.e. causing the uterine muscles to contract), they are conflated. Medical professionals can make them sound synonymous or even straight up tell women that there is no difference.
Pitocin and oxytocin are absolutely not the same thing. It’s actually misleading that they label it like this. Synthetic oxytocin (a.k.a. Pitocin or Syntocin in other countries) does not function in the body the same way natural oxytocin does. While molecularly similar, Pitocin does NOT pass through the blood-brain barrier the way oxytocin does. Because of that it does not trigger the same biofeedback loop that natural oxytocin does.
Pitocin does not cause the same endorphin release we find natural oxytocin doing. It also does not self-regulate and protect the woman from oversaturating and exhausting her uterus which then increases her risk her for postpartum hemorrhage. Pitocin can overstimulate the uterus to where the unnatural and stronger contractions risk her for rupture or stress the baby and lead to fetal distress. These risks mean it is not even approved for elective induction.
Because there is no corresponding endorphin release or self-regulation, the contractions Pitocin stimulates are more painful and most women then desire an epidural or narcotic pain relief which bring their own list of risks. Studies have also shown significant increase in risk of postpartum depression and anxiety with Pitocin use.
Pitocin can have a place in some situations but it is not and never will be God-designed, brilliant, natural, fascinating, physiological, feel-good oxytocin.
Your body is magnificently designed to create oxytocin under the right conditions during labor, after birth, and while breastfeeding! Natural oxytocin feels good and creates chemical responses within our brains that emotionally bond us with our sexual partners and our babies. Oxytocin is the hormone responsible for orgasm. (No one's going to be doing that on Pitocin!) Oxytocin allows our uterus to contract and open for our babies. It releases endorphins that block pain and make us feel calmer and sleepier. It's responsible for that dream-like state we call laborland.
The comments from everything I wrote above on Pitocin when I posted it on social media made clear that many women are not being given full informed consent or refusal when it comes to this commonly used medication.
While there may be reasons to give it that a provider may mention, there are also a good deal of things that women are often not told that they should be in order to make a truly informed and safe decision. These following statements are taken from the FDA's guidance found here.
⚕️Because of the risks, Pitocin is not approved to use for elective induction.
⚕️It is advised against for mothers who have had more than 5 full term births (grand multiparas).
⚕️It is advised against for mothers with a previous cesarean or surgery on the cervix.
⚕️It can increase the risk of postpartum hemorrhage and uterine rupture.
⚕️It can be turned down or off. If you decide while receiving Pitocin that you no longer want it, you can have it turned down or off. This option is rarely presented to mothers.
⚕️In a full term mother, doses higher than 9-10 mU/min should be rare. However, we often see doses in the hospital going to 14, 18, 24, even 30 or more!
⚕️Intravenous Pitocin requires IV fluids. Prolonged IV fluids risk inflating birth weight and subsequent erroneous concern and intervention over baby's weight loss or gain.
⚕️Other FDA listed risks to the mother: cardiac arrhythmia, fatal afibrinogenemia, anaphylaxis, vomiting, nausea, pelvic hematoma, premature ventricular contractions, subarachnoid hemorrhage, hypertensive episodes, maternal death
⚕️Other FDA listed risks to the baby: bradycardia, premature ventricular contractions, other arrhythmias, permanent CNS or brain damage, neonatal seizures, low Apgar scores, neonatal retinal hemorrhage, neonatal jaundice, fetal death
⚕️Overdose Risks: "Hyperstimulation...can lead to tumultuous labor, uterine rupture, cervical and vaginal lacerations, postpartum hemorrhage, uteroplacental hypoperfusion, and variable deceleration of fetal heart, fetal hypoxia, hypercapnia, perinatal hepatic necrosis, or death."
Again, Pitocin is not inherently bad. This post is not meant to say that it is never necessary or useful. It can sometimes be a really helpful and even lifesaving tool when it is truly necessary for the health of mother and baby. However we can't lose sight of the fact that it is a very powerful medication. This post is not meant to exhaust every possible valid use nor every possible risk. If you are being offered Pitocin, I encourage you to take this information in but also do a lot of your own research, read the labels, and learn as much as you can about it. It should be used rarely and only when the benefits truly outweigh the risks of it. If you aren't aware and your doctor or midwife is not sharing the full risks with you before recommending it, especially to induce or augment labor, you aren't able to make a fully informed decision.
You and your baby are deserving of all the information in order to make the best possible choice you can in your circumstance. Ultimately, it is you and your baby who are the ones most affected by them.