Pitocin’s Use in Obstetrics
The recent trend towards “natural childbirth,” having babies with midwives at home and avoidance of medical intervention in labor, has fueled public perceptions that Pitocin, the synthetic hormone used in obstetrics, is the proverbial “bad boy” drug. Reports of dangerous complications and side effects about the use of Pitocin are found on web sites and blogs.
Despite its less than savory reputation, Pitocin, when used appropriately, is useful as an agent to induce labor when it is necessary, to improve the effectiveness of an existing pattern of labor, and to prevent and treat life-threatening post-delivery hemorrhages. It is not a drug of convenience, used merely to make labor “go faster.” It is a powerful drug to be used judiciously and with caution.
Pitocin is a man-made version of the naturally occurring pituitary hormone “oxytocin” (Greek: oxy=quick, tocin=birth), which functions to maintain uterine contractions in labor and assists in the milk let down response during breast feeding.
Pitocin is used to artificially start labor when medically necessary. Situations where “induction” of labor might be advised include: maternal hypertension, a fetus which is not growing well nor has a low volume of amniotic fluid, or occasionally for postdate pregnancies (failure to deliver after 42 weeks from a last menstrual period has been shown to have some risks to the fetus.)
Pitocin is also given in small amounts to “augment” labor. That is, to increase the strength, frequency, and duration of contractions in order to produce cervical dilation in labor patterns that are dysfunctional.
In the aforementioned situations, Pitocin is administered intravenously through a mechanical regulator designed to tightly control dosing. It is only used in a hospital labor and delivery setting with close monitoring of fetal heart rate and of uterine internal pressures generated by uterine contractions. Pitocin has a fairly short half-life, so if the contractions are too close together, the uterine pressure they generate is too high, or if non reassuring fetal heart rate patterns develop the Pitocin can be discontinued quickly until the problem is resolved.
Pitocin is also given after the baby is delivered, usually upon placental delivery. This helps the uterine muscle to contract and limits post-delivery blood loss.
Pitocin also has some risks associated with its use. Fortunately, these risks are not common with closely monitored, judicious dosing. Not all patients respond to Pitocin in quite the same way, and some patients are very sensitive to Pitocin. Strong prolonged contractions may occur, which may decrease blood flow to the fetus. Fetal heart rates may decelerate. Uterine rupture and electrolyte disturbances (which may be life threatening) are very unusual complications. Headaches and maternal increased heart rate are seen at times. Most of these side effects are reversible once the medication is discontinued.
Clearly, as with any medication, Pitocin is used when the potential benefits clearly outweigh the risks, and many patients will continue to benefit from its use.
