21 reasons to say NO to Pitocin.

Here's one that I've seen shared on many different sites over the past couple of years. Very proud to say that I was the original author of this one. :)

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Have you ever read the package insert for Pitocin? It’s a fascinating read. Did you know that the manufacturer of Pitocin, JHP Pharmaceuticals, actually wrote a really sensible list of recommendations and warnings for the use of this drug?

Given the current nationwide epidemic of Pitocin abuse, I started reading this document with my hackles up, expecting to be annoyed - but it wasn’t long before I became surprised by what I was reading. JHP Pharmaceuticals didn’t create this drug to hurry up the labor experience for normal, healthy women. In fact, the package insert warns against the use of Pitocin induction when it’s not medically indicated. The Indications and Usage section opens with a framed important notice that reads “Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefits-to-risks considerations, Pitocin is not indicated for elective induction of labor.”

There you have it, straight from the manufacturer. Pitocin isn’t even meant to be used for induction when there’s not a medical need for it. According to these instructions, there are specific situations which warrant the use of Pitocin. Maternal diabetes, Rh problems, preeclampsia at or near term, certain cases of uterine inertia (ineffective contractions during true labor), or situations where the water has already broken are listed as examples when Pitocin may be used appropriately.

Here’s another warning from the package insert that caught my eye. “When properly administered, oxytocin should stimulate uterine contractions comparable to those seen in normal labor.” That was really surprising to me. I thought it was an unavoidable fact, that Pitocin-induced contractions are simply longer and stronger than naturally occurring contractions. That’s been the common knowledge among women I’ve spoken to about this subject. A huge percentage of women who have given birth naturally and also with Pitocin say that their Pitocin births were more painful. As it turns out, artificially long or strong contractions are associated with overdose of this drug, not the recommended dosage.

Here are 21 more reasons why most women should say no to Pitocin, brought to you by - the manufacturers of Pitocin. Each of these warnings comes from the package insert.

21. Induction with Pitocin requires constant fetal monitoring, but external monitoring is inaccurate. The best way to monitor the baby’s heart rate is by using an internal monitor called a Fetal Scalp Electrode that is attached the top of the head, through the cervix. It’s very invasive and can be quite painful (for mother AND for baby) to have one of these inserted, and there have been reports of babies being cut, scraped, and even receiving eye injuries from the device. Either form of fetal monitoring limits the laboring woman's ability to move as needed.

20. Pitocin should not be used when there is a predisposition to uterine rupture, as is the case when a woman has had uterine surgery such as a prior c-section. The sad fact, though, is that there are many hospitals and OBs that will not “allow” a woman to attempt a VBAC unless she agrees to an induction and close monitoring.

19. Nausea and vomiting are some of the most minor symptoms on the manufacturer’s list of possible drug reactions.

18. Pitocin, just like any drug, can cause a severe allergic reaction called anaphylaxis, which causes hives, difficulty breathing and swallowing, heart palpitations, and can lead to death.

17. There is an increased risk of postpartum hemorrhage after Pitocin-augmented births.

16. Pitocin can disrupt the normal heartbeat of the mother, causing reactions such as cardiac arrhythmia or premature ventricular contractions.

15. Another risk of Pitocin is pelvic hematoma, a blood clot or even larger area of blood in the soft tissue of the pelvis.

14. Pitocin has an antidiuretic effect on the body, meaning it increases the absorption of water. This leads to the risk of water intoxication, especially when there are additional fluids such as saline in the IV or lots of water to drink. There have been cases of women suffering severe cases, including coma and even death, during labor.

13. Pitocin can cause a hypertensive episode in the mother. This basically means a sudden surge in blood pressure,and if the elevation is severe it can cause a heart attack or stroke.

12. Fatal afibrinogenemia is another listed side effect of Pitocin. In everyday language, this translates to slow, uncontrollable bleeding that results in death.

11. Women have died from uncontrolled high blood pressure, bleeding on the brain, water intoxication, hemorrhage, and uterine rupture after the use of Pitocin during the first and second stages of labor.

10. There have been no studies to examine the carcinogenicity or mutagenicity of Pitocin. In layman’s terms, we have no idea if this drug causes cancer or causes cells to change in any way.

9. We have no idea what kind of effect Pitocin has on a woman’s future fertility, let alone the fertility of her newborn baby.

8. The deaths of babies, for a variety of reasons, have been associated with the use of Pitocin during labor.

7. Pitocin has been associated with heart problems in the newborn, such as bradycardia (slow heartbeat), premature ventricular contractions, and other arrhythmias.

6. Cases of permanent damage to the newborn’s brain or central nervous system have been documented as a result of Pitocin-induced births.

5. Pitocin during labor is associated with low scores on the five minute Apgar test, the newborn exam that looks at alertness, respiratory, and circulatory health.

4. Retinal hemorrhage, a common symptom of shaken baby syndrome, can be caused by the physical force of a Pitocin-induced birth.

3. Increased risk of newborn jaundice is associated with Pitocin.

2. Hypertonic (excessively strong) contractions, and tetanic (prolonged) contractions are some of the most common side effects of Pitocin overdose. If the contractions are coming so fast that there’s no resting time in between, the dose is too high. And this leads to my number 1 reason to say no to this drug, because it seems that far too often an inappropriately high dosage is given.

1. Overdose of Pitocin is characterized by an even more frightening list of symptoms, including cervical and vaginal lacerations, deceleration of the baby’s heart rate, postpartum hemorrhage, fetal hypoxia (oxygen deprivation), and even organ failure and death in the mother or baby. It’s chilling to me, to realize that the long list of complications before this paragraph are in regards to normal doses of Pitocin, and there is a separate section to discuss the problems with overdosing.

Pitocin, just like any of the pharmacological drugs we have available to us, is an important and sometimes lifesaving tool, but like any drug or medical procedure, it must be used with caution. The list of dangerous or even fatal complications is very long, and this list doesn’t even mention some possible lifelong implications of this drug, such as the suggested link between Pitocin and autism. There are always risks when we interfere with the natural process of pregnancy and birth, and these risks must be considered carefully when an option like Pitocin induction is on the table. It’s almost always possible to wait a while longer to let nature take its course, but once the induction is underway the options become more and more limited as the urgency of the situation grows.

Was Pitocin involved in any of your births? Do you feel you were well aware of the risks associated with it?

image credit: timsamoff/flickr.

My birth journey, part 3 - my second home birth

And here, in its raw original form just as I wrote it about 12 hours after her birth, the story of the birth of our Baby Girl. My birth story comes full circle, from an unplanned c-section to an unplanned "unassisted" birth. What a powerful experience, to birth a baby with only ourselves in attendance! The Man said that it was sort of funny to be there with me as I went back and forth between "midwife mode" and "mother mode" as I barked out random things like "Skin to skin now" and "don't touch the cord!" Many people jokingly asked if we got a refund from the midwife, but I'll tell you what, the way she and her student came in and did all of the after-care and my postpartum followup care was worth every penny!

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The changeover, from the prodromal labor I’d had for a couple of weeks to true early labor, started on Tuesday evening when I was 40 weeks 3 days. That was when I started having strong and sometimes-regular contractions, with increasing cramping and back pain. I started needing to use my meditations and did my breathing “techniques” through them when they got very strong. They usually weren’t regular, but they would become regular sometimes, and I only got them in the evening. I woke up a few times and walked through contractions during the night, but they weren’t incredibly strong and I was able to rest through most of them, and got a good stretch of sleep.

40 weeks 4 days, I had them much more strongly throughout the day, and I was getting excited thinking it might be that night. I had some signs that I was starting to dilate a little bit. I made it through the day though, and as the afternoon and evening went on I started to contract less and be more energetic and social. By the time The Man came home that night he could tell it wasn’t going to be the night, and I knew it too. I was thankful for a night of having the energy to hang out with my kids and read bedtime stories and just have a somewhat normal evening, though. I got super hungry and ate a LOT - fueling up for the marathon, I think. I slept well and didn’t wake up with any contractions during the night.

As soon as I stood up the next morning, on the day I was 40 weeks 5 days, I was hit with an intense and fairly long one. I had a couple more before I stood in the kitchen making breakfast and sobbing to The Man while he got ready for the day. I was a disaster, and for the rest of the day I had contractions and sobbing episodes pretty regularly. I tried my best to keep BooBoo entertained with busy work like drawing or play-doh, and he thankfully got busy with his toy kitchen and other toys in his room. He watched a couple of movies. I did what had to be done to get through the day. ;-) I did a bunch of chores around the house, washed all the sheets and blankets, swept all the floors, caught up on dishes. The contractions got more intense all day but it helped so much to walk around, so I kept busy. I can’t remember what made my husband decide to come home but he called to check on me a couple of times and I burst into tears each time, so I guess finally he decided it was time to head over. He got home and immediately took the kids out and I laid down and rested the best I was able to.

I wasn’t hungry for dinner that night, I ate lightly and was really starting to become irritated with things like noise and light. I remember getting annoyed because I kept turning off all the lights and it felt like everyone else was on a mission to walk behind me and turn them back on, every time I got “comfortable” some random light would turn on. Of course our house is very tiny so light would shine into my “space” no matter where in the house it was turned on. He got the kids bathed and put to bed and I kept walking and moving. It hurt to sit down so I stayed upright, and sometimes squatted while holding on to something like the counter or the couch arm. I was listening to music, and since I felt such a powerful need to stay upright and keep moving around, the music helped a lot as I would rock and sway to the tunes.

The contractions were much stronger than they’d been but I still didn’t believe that they were the real thing. My husband was quietly timing them while I did my thing, and he didn’t think I was in active labor either. They were coming irregularly the whole time. Around 11 they slowed down and then stopped. I sobbed for a while thinking of another day of stalled out labor. He made me a bowl of yogurt and strawberries when I realized I felt a little hungry, and I ate the whole bowl. He convinced me to try to sleep. I insisted that it felt better to stay upright, and he pointed out that I wouldn’t be able to use gravity to force labor to start if it wasn’t time. I washed up and laid down for bed, but couldn’t sleep and was moving around like crazy every time I had another contraction. The couch is right at the foot of our bed and I’d get up and lean over the back of it, which helped a lot with the pain.

The Man was lying in bed trying to sleep too, and every time I got up with another contraction I’d see him with the light from his phone. For some reason I thought he was texting with my midwife, but he was just timing them again. When I asked him about it the next day he said they still weren’t coming regularly. They’d be 3 minutes apart and then 8 - 10 minutes apart. I remember checking the clock in the kitchen every hour or so, and I distinctly remember looking at the clock around 1:30 in the morning and having another round of crying because it was so late and I was thinking how exhausted I’d be the next day after a night of laboring and no sleep. When I got back to bed I laid down one last time and tried to sleep.

With the next contraction I was back out of bed and honestly I can’t remember why my husband followed me that time. Until then he’d been trying to sleep in between all of my commotion, thinking that they’d peter out yet again and he’d have another day of work in the morning. Suddenly everything that had been taking days to get started, started happening VERY quickly. It wasn’t too long after that, that I started uncontrollably starting to bear down at the end of the contractions. I was definitely making a different range of sounds than I was earlier, and I was moving like crazy around the living room. I’d find one position for one contraction, but then would be totally uncomfortable and would find a different position for the next one. The Man had my midwife on the phone at this point and he was running around putting chux pads down, and I spread out a towel.  She told him to have me check myself to tell her how far up I could feel the baby’s head. She told me later that she could tell by my sounds over the phone that it was pretty close to baby time. The only thing I could answer was the classic transition in labor phrase, “I don’t know, I don’t know.” I was finally lost in labor-land and was focused only on breathing and moving through each moment of it.

The Man said that he knew things “got real” when I asked him to help me take off my pajama pants. Within a couple of minutes I felt like I had to pee, and I started to head towards the bathroom but didn’t get far before another big contraction, during which my water broke in a big gush. The only reason I know this is because my midwife told my husband to get a strip of the test paper to see what the fluid was, and it turned black which meant it was amniotic fluid. She was already grabbing her stuff to head our way, after we'd woken her in the middle of the night to tell her to COME QUICKLY! I was still on my hands and knees when the next contraction started, and he was in the kitchen washing his hands. I somehow managed to yell to him “Come help me” and he came running in just as I had another huge urge to bear down. He looked behind me and he realized about a second before I did that the baby was about to arrive. I don’t even know whether I actually had breaks between the pushing urges or if I was just making myself slow down every so often. I reached behind me and felt the head starting to crown, and I consciously told myself to slow down and stop pushing for a second because I didn’t want to tear like I did with BooBoo. The head rested there for a moment, I sort of held it in place with my hand and put pressure on myself to relieve the intense pressure from inside, which helped a lot. Very quickly I was ready to push again, the biggest part of the head was out and I felt the rest of the body slide out into my husbands hands.

He wrapped the baby immediately into a receiving blanket and put her on my chest, and helped me take off my shirt so we could have skin to skin contact right away. I piled a couple of other blankets and towels on top of us. I felt under the blanket and was shocked that I didn’t feel “boy parts” on her, which I was fully expecting. Since I couldn’t look at that angle to actually see, because of the umbilical cord and the way the towels and blankets were positioned, I asked him to look. He lifted up the blankets and with tears in his eyes he said to me “A girl. A girl!!” I cried, of course, like I cried about everything else in this labor. I told him I didn’t believe him and told him to look again, and he confirmed it. He called my midwife back and said “It’s a girl!” She gave him some quick tips about what to do with the placenta, not to touch the cord, and so on. She was already on her way to us.

The placenta took longer to deliver than it did after BooBoo’s birth, I’m not sure of the exact time but it was probably about 30 minutes. I remember that with BooBoo it just seemed to slide out, but this time I had a few strong contractions and then had to actually push a couple of times to deliver it. Once I delivered the placenta we put it into a bowl, and The Man laid down some pads on the bed and helped me over to lie down on it, while I held the baby who was attached to the placenta in a mixing bowl. I laid down in bed and drank my Vitalyte and nursed our little girl for the first time, until my midwife and her apprentice arrived.

The only “complication” if you can even call it a complication, was that she basically flew out of the amniotic sac when my water broke, and left the sac behind, and it “suctioned” shut and got wedged up by my cervix. When my midwife examined me she found that the shriveled amniotic sac was stuck up there and needed some help to be delivered. Massage and gentle pushing from my end with gentle tugging from her end wasn’t enough to get it down, so I ended up getting a couple of doses of herbal tinctures to help with expelling any remaining pieces. The placenta itself was very healthy and intact but Heather was afraid of a piece of this sac being left behind and causing infection, so she wanted to be very careful to get all of it. She sat with me for quite a while, massaging my belly and helping me ease it out, and eventually the whole thing came down. I laid back fairly comfortably on the bed and snuggled the baby while she took care of me, and it didn’t feel like a scary complication at all.

Our baby, our beautiful daughter, was 8 pounds 4 ounces, and 21 inches long. Her head circumference was 13 inches. When I was pregnant with her, her hands were ALWAYS up by her face, and one concern we had was that she’d be born with her hand up there, with more of a risk of tearing me on her way out. Sure enough, she had a pretty good scratch under her chin and distinct red markings on her face, which line up perfectly with her little hand when it’s positioned there. I didn’t have any tears (yay!) but there was some bruising up by my cervix that my midwife said she’s seen when baby is coming out with a hand by the face, so she was definitely trying to get through my pelvis with the hand there. Fortunately she wasn’t actually born in that position but the positioning of the hand was enough to make labor pretty drawn out and painful, and I’m sure that’s why I needed to do so much moving around to help with positioning her and opening up my pelvis. My midwife’s theory was that as I started to push her out she pulled the hand down at kind of the last minute.

The whole experience was absolutely wild and primal and beautiful. When I look back at the pictures from her first few minutes of life, I’m almost overcome with emotion from it! This time around I had very strong and classic feelings during the transition stage. “I’m never doing this again” and “I don’t think I can do this” and all kinds of other doubting kinds of statements, all in the 15 minutes or so before she arrived. It was a very painful labor and I had to work hard with my breathing and positioning to get through the contractions, but it was incredible the way I really felt like she and I were working together through it. In between contractions and even in between pushing I’d feel her moving and I’d rub her through my belly and talk to her as we got ready for the next one. We worked very hard and then it all happened so fast in the end. I felt so in tune with her and with my body. It was just the most incredible experience and I’m still so in awe of this little girl every time I look at her.

My birth journey, part 2 - HBAC

This is, as I wrote it about 12 hours after the fact, the home birth after c-section (HBAC) of my second child.

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On March 6 I woke up appearing to be leaking amniotic fluid. After a couple of hours we called my midwives to let them know. They had me start taking regular doses of Vitamin C to boost my immune system in case there was a small tear in the sack. I did labor throughout the day, with the contraction coming very regularly and sometimes very, very strong. Eventually everything slowed down though. My midwives stayed the night while I tried to get some sleep. I did get some sleep, but woke up with strong contractions throughout the night. The next morning they tested my vaginal secretions and found that there was no indication of amniotic fluid, so our thought was that there had been a small tear that ended up healing itself. They went home, and I tried to get some rest.

I labored slowly throughout the day on March 7. My mom, her partner, two of my sisters, and my sisters husband all helped us out, especially by taking care of Little Man. I napped in the afternoon, as well as I could between contractions, and had a pretty laid back rest of the day. Around 8 in the evening I was pretty tired and ready for bed. My husband lit some candles in our room and helped me get comfortable. I plugged myself in to my iPod and propped myself up on a huge pile of pillows, and tried to get some sleep. I was contracting pretty hard at that point, and I think that "sleep" was more equivalent to deep relaxation between contractions. I did well breathing myself through them, and being able to relax and listen to calming music was very helpful. I now realize that this calm, quiet time was when I was truly going through active labor and I'm thankful that I had the sense to rest and conserve my energy!

Eventually, towards midnight, my husband came upstairs and lay down with me. I had been resting and meditating this whole time, but I was so tired I just wanted to lie down and sleep. Lying down made the contractions come HARD. It wasn't too long before an incredibly intense one literally sent me springing out of bed, moaning and groaning at the top of my lungs. My husband leaped out of bed and instantly turned on the light. I can't imagine what he thought was happening! He was incredibly supportive for me from then on out, as he coached me through my deep, slow breathing - reminding me to "breathe up" and breathing deeply with me through the strong contractions. This must have been the time when I was hitting transition, the period of labor where the cervix finishes dilating the last couple of centimeters.

I became very "out of my head." The only response I could come up with when people asked me anything was "I don't know." My mom and husband were enormously supportive. My mom had learned a helpful technique that she used on me. During my strongest contractions she pressed her hands firmly against my forehead and the back of my head, while speaking softly to me about how my tissues were soft and flexible, my cervix was opening properly, and so on. My husband, as I said - he was amazing, and I couldn't have done it without him. He seemed to instinctively know what I needed to help me, and he was amazing at keeping my breathing calm and steady as I had practiced throughout my pregnancy. He and mom both kept me well hydrated between contractions, which I know was extremely helpful.

At some point he went to call the midwives. I loudly insisted that nobody was allowed into the room and nobody was allowed to "tell me how to do things." This was my obstinate point during labor I guess! He went and called them and when he came back upstairs, he told me that he had spoken to them but that they weren't going to come until I decided that I needed them there. I was laboring really hard at this point and this barely registered to me. I realized later that he had actually called and told them to come out because things were moving along pretty quickly!

I had lost all track of time by now and I have absolutely no idea how long everything took at this point. I know that eventually I felt the overwhelming need to kneel on the floor by the end of our bed, and then my body pretty quickly started pushing. When you hear that your body will push all by itself, that is completely true, and I can't even describe the feeling of it. I felt primal while this was happening. I was still listening to music, and my husband still coached my breathing, although when he realized I was pushing he would remind me to breathe down, to start breathing the baby down the birth canal.

After a little while of pushing, I had this feeling that I should reach down and check. I felt something emerging from me, and it was all I could do to moan "I feel his head, somebody catch him!" Everyone in the room sprang into action. Somebody ushered in the midwives, who had barely just arrived. It turned out that what I felt coming out was the sack that had contained him in the womb! It was so strange and neat. There was no gush of waters breaking during my labor because all the fluid was still contained in the sack.

It felt like I pushed forever at that point. At one point I lamented "When will the sack end and my baby come out??" Everyone just kept encouraging me to keep going, as the sack kept coming out more and more. I know that a few times I stopped and wailed, between contractions, that it hurt too much and I couldn't keep doing it. My husband pointed out to me that I WAS doing it and I was almost done. 

Suddenly the sack that had been coming out so slowly just fell out of me. One of my midwives told me when this happened. His head was literally right behind it, and they had me reach down and touch his head. It was the strangest feeling. It didn't feel like a human head at all, it just felt soft and slimy. It was really, really hard work to make his head come down. Later on his head measured at 37 centimeters around, so he had a good sized head that took a fair amount of molding to fit through the birth canal. My pushing urges became enormous and very primal. I feel like I groaned and screamed like a wild animal, but my husband later told me it wasn't that bad at all. Finally after what seemed like forever, his head started actually coming through. I could feel myself stretching around him like I had never even imagined I could stretch before.

The big moment came as his head made its final push through. I had one fierce, long contraction that pushed his head all the way out, and then continued to push him out. He literally came sliding out of me with the force of only one, strong contraction! My midwives later said "Head to toes in just one contraction!" It was absolutely amazing. I realized during that last contraction that all of him was coming out at once, but I obviously couldn't find the words to let anyone else know. I was kneeling over a pile of towels at that point, and he basically flew out of me and landed on them. Instantly he started crying, but it wasn't an upset cry at all. It almost seemed like it was just reflexive. He did this soft, repetitive cry enough to clear out his lungs and his airways, and then he quieted down. We had an absolutely amazing period of eye contact and bonding while I sat on the floor holding him. I was the first person to hold him, which was also amazing!

Once he stopped crying after he was born, he spent several minutes staring intensely into my eyes and talking to me, in that wonderful language that only newborn babies can talk in. My mom was particularly amazed by this. It was like he was telling me a very important story, complete with hand gestures and hilarious facial expressions.

My placenta came very quickly and easily afterwards, and it was in perfect condition. It was amazing to look at it, and my sister took some pictures of it.

Our labor was long and sometimes really hard. I'm very glad that I read, re-read, and read again "Hypnobirthing" while I was pregnant, because those techniques really got me through it. It was totally and 100% worth every moment of every discomfort during my pregnancy and labor though, because at the end I got this perfect experience of bonding with my baby while we were both clear-headed and not under the influence of any drugs, in contrast to Little Man's c-section birth. Boo Boo started nursing perfectly within an hour after he was born, and he's really good at it. He's been nursing often, and he even gifted us with a soaking wet diaper just a little while ago.

The details are, he was born at 3:50 am on March 8. He was 8 pounds 6 ounces, and 21 inches long.