As a rule, I am in favor of natural birth: a birth that among other things, starts on its own, includes non-pharmacological forms of pain relief, avoids medical augmentation, and allows a woman to be free to eat, drink, walk, and move during labor.
While I am in favor of natural birth, I also understand that sometimes interventions are necessary, can be helpful and do save lives AND… if you chose a provider, and a plan for birth that employs medical management of labor, what may, under different circumstances, be something I would advise against, all of a sudden can become something I am completely in favor of.
As an example… I am not in favor of randomly using Pitocin. I understand that in the wrong hands Pitocin can create a very difficult and even unsafe labor. I understand that Pitocin is over used and its dangers are often understated. In spite of that understanding, there are times when Pitocin can be the difference between a cesarean section and a vaginal delivery.
You enter the hospital in spontaneous labor. You opted for an epidural and your water bag was broken artificially. You progress at a slow normal rate getting vaginal exams/cervical checks every 1-3 hours. First you are 3-4cm. Two hours later you are 4-5cm. Six hours and a few vaginal exams later your cervix is “stuck” at 6-7 centimeters dilated. For some reason, Pitocin was never started or the nurse who was giving your Pitocin did not know how to titrate the drug.
You are told: “On average we expect you to dilate 1.2cm each hour and here you are 6 hours later and you have only dilated 2 centimeters. Looking at the monitor you seem to be having adequate contractions and I just don’t think this baby is going to fit. You have a fever and your baby’s heart rate is now higher than normal. At this point I recommend that you have a cesarean section,” and your cycle of primary to repeat c/section has begun. I have seen this scenario twice recently.
Pitocin had never been started on this mother and I tried to advocate for a trial of Pitocin. She was “stuck” at 7-8cm and I had learned in report that the MD had been saying all day… “I don’t think this baby is going to fit.” While her contraction pattern may have been “adequate” for a mother who was walking during labor and using other techniques i.e. nipple stimulation to increase contractions and to move her baby to optimal birthing position, she had opted for an epidural. She was having what we call a “coupling” pattern to her contractions. This pattern is often associated with a posterior presentation, a slower labor, and what we call a “dysfunctional pattern.” Anecdotally, Pitocin can help create a more “effective” contraction pattern in order to help dilate the cervix. This mother’s pelvis felt more than adequate to birth her 6 pound baby. The FHR was fine and my exams showed small but definite progress in the 2 hours that I was her labor nurse. I thought if only I could give her a little bit of Pitocin. Unfortunately, the MD disagreed and instead opted for a primary c/section. I later discovered the MD was going out of town in the morning and I believe based on previous dealings with this MD that under a different travel schedule he would have managed this patient differently. (He gives Pitocin to EVERYBODY!!)
This mother was also progressing at what would be considered a slow pace. She also had an epidural and her water bag was broken. She received Pitocin but the initial nurse increased the Pitocin minimally and the mother remained 6cm dilated. At shift change the new nurse was told the MD was considering a c/section. She immediately began to increase the Pitocin (SAFELY) keeping a watchful eye on her contraction pattern and baby’s heart rate. In less than 2 hours, she was completely dilated and birthing her baby vaginally.
Pitocin may have worked for mother #1 and definitely worked for mother #2. However, while Pitocin is not always poison, sharing this information was not meant to give you the impression that Pitocin is always the missing ingredient or that Pitocin will be the answer to your delivery question. What I do want you to know is when used appropriately and at the right time, Pitocin can be the difference between a vaginal birth and a cesarean section. Can Pitocin change your outcome?? YES Will Pitocin always be the answer? NO… it won’t be. Ask questions. Know your options and get informed BEFORE you go to the hospital in labor. By the time you sign your admission consents, it may be too late.
In Birth and Love
Nicole ~ On Twitter @SistaMidwife