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Pitocin & Hemorrhage

AN UNPLANNED STUDY

PITOCIN, INDUCTION AND EPIDURALS

Between 1998-2011, in my own Supported Birth classes, there were only 13 women who got through labor on Pitocin without an epidural. Eight of them had doulas. Five of them had super short labors. I’ve always told women who needed Pitocin not to deprive themselves of an epidural (you are already not having a “natural” birth) because of the way I have heard it described. It seemed strange to be applauding them for getting through it without any pain meds, yet heroic in some way that they avoided another intervention.

Then suddenly, between 2012 and mid 2013, there were FIVE women who had Pit-only labors. In my curiosity to see why the sudden increase, I came across the following extremely disturbing facts.

Here is what I found in my own inadvertent research:

Of the 18 Pit-only labors between 1998-2013, 11 of them were extremely short, intense, due to what can be called “hyperstimulation” of the uterus. The labors were 2, 3, or 4 hours long, with one at 5 hours. Some involved the mother’s membranes being ruptured as well.

Of these 11 short, Pit-induced and augmented labors, four had severe postpartum hemorrhages, one characterized as “the placenta came out in pieces” and one had severe tearing due to fetal distress requiring the mother to get the baby out fast.

This means, in my tiny study of my own students, about 2/3 of the women on Pit had these hyperstimulated labors, and about 1/2 of those hemorrhaged.

To see women having these kinds of unnecessary yet serious complications, is just too disturbing.

It is getting harder and harder for me to discuss Pitocin and induction “objectively” in my classes. My goal is to present information in such a way that women feel informed, take responsibility for their choices, and have an understanding in the aftermath of how and why things unfolded as they did - with the ultimate goal of a positive birth experience - one in which she feels she was treated well, made informed choices that influenced the course of events, and could feel as good as possible about her birth no matter the outcome (vaginal, natural, epidural, c-section). Knowing that many women will choose to be induced (whether under pressure or whether immediately agreeing), I’ve always wanted to lay the groundwork so that they might feel okay about things afterwards.

It’s getting harder and harder to do this. It’s harder not to tell women how much I hate Pitocin probably 90% of the time, not to tell them that nurses use terms like “pit-to-distress,” and not to plead the fact that the risks you are taking are greater than those you think you are avoiding. This is especially the case when the Pit is being used first, rather than as an antidote to a condition already occurring (e.g. a stalled second stage).

Women...if you are listening...here’s a small sample of what was written when a very famous midwife posted the question on Facebook to birth professionals (midwives, doulas, educators) asking them “What is your experience with induced labors?”

Get ready for the honest answers of people who are not trying to be “objective” and have no agenda to convince anyone of anything. They are writing within the professional circles.

L - I was induced with cytotec, and from talking to midwives about what I experienced, I believe I suffered a partial uterine rupture. When it hit me, how close my son and I came to death or long term consequences, was a hard moment. I then went on to become a doula and gave birth to my youngest son at home with a midwife, and he chose his own birthdate.

S - Unnecessary and miserable. Distressed baby.

L - The first hospital birth i witnessed, the mother was induced with pitocin b/c her water had broken and labor had not yet started on it's own (less than 6 hours had gone by at that time) she went on to have a 2 day labor with many many hours of pushing on her back....she had an epidural and ended up with an spinal headache...in the end the baby was born vaginally with the aid of forceps.

D - I have seen all types, some very successful overall but the ones where mama is induced early? Days of painful nonproductive labor and high incidence of cesarean section.

T - My personal experience with induction ended in a back labor with a persistent posterior baby, an early epidural because of that back labor,and a c-section for "failure to progress." Doula experiences have most often ended in epidurals for unnaturally strong contractions and the occasional c-section.

A - if it is not saving lives than for me induced labor is only violence against the body, birth, baby. I notice a trend among women I know. Inductions, and stress from constant appointments where the doctors tell women their babies will die if the don't do such and such. And repeated ultrasounds, seem to be common too.

R - Towards late pregnancy -- when I was consigned to OB care -- I'd usually find a reason to miss or skip the last appointments for exactly that reason -- "oh, I'm sick, oh, I have a meeting, oh, I forgot this or that, can we reschedule?!"
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Women are being induced based on guesstimated dates or guesstimated size of baby, rather than on actual placental decline or fetal non- well-being, and these inductions do NOT follow evidence-based medicine (Optimal Care in Childbirth: The Case for a Physiologic Approach. Henci Goer and Amy Romano).

Even the other reasons for induction do not hold up under research scrutiny. A few examples:

- ruptured membranes (poor research initially done on women getting constant vaginal exams during labor)
- low amniotic fluid (no difference in outcomes between those induced & those not)
- dating of pregnancy (2 week margin of error)
- size of baby from ultrasound (NOT accurate, plus induction has more risks than that of giving birth to a large baby, and   induction is probably WORSE for a large baby)
- risks risks risks of Pitocin, including those listed on its own labels

For all the research studies that characterize what we call evidence-based medicine, I recommend "Optimal Care in Childbirth: The Case for a Physiologic Approach" by Henci Goer and Amy Romano.

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