Duke study links pitocin to post-partum hemmorage

[daisymommy]

Don't shoot the messenger...:duck:
http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937810010264.main-abr.pdf?jid=ymob

[MSWR0319]

I don't have time to read this right now, but can't wait to. I had the smallest dose of pitocin and hemorrhaged a week later with large clots. They didn't find any placenta and couldn't really figure out what happened. I have always wondered if it was the pitocin, as I always seem to be sensitive to drugs as far as strength of them go. Maybe I'm not totally nuts on my theory!

[SnuggleBuggles]

Back when I used to moderate a labor discussion board I had a whole write up on inductions (risks, benefits, options...) and I had found that connection back in like 2003. It makes sense when you think about it- pitocin causes different contractions (stronger, longer, closer together) than might naturally occur and those contractions might increase blood flow to the uterus. I honestly don't think risks like that are well presented when people are making decisions about inductions or, if they are, they are buried in among every other risk on the consent papers that just might not be carefully reviewed. I wasn't induced so I don't know what all they have you sign. I know they wanted to augment my labor with ds1 and there really wasn't any discussion on risks or benefits. Since it didn't actually get to that I don't know if right before it was administered they'd have brought all that up. Of course, bringing it up with a mom 18 hours into labor isn't really the best time to get informed consent. Wouldn't it be great if all expectant parents were given info on pain meds, c-sections, inductions like risks/ benefits/ options early on in the pregnancy? The 1st practice I went to with ds1 did give out a binder and in it was a sample consent form for an epidural and other documents like that. It'd just be nice to give the info when there is lots of time to digest and discuss it, kwim? Talking about risks/ benefits when mom is 38+w and ready to be done doesn't give the best chance of having it be as well researched as it would have been before mom was just ready to go.

Sorry for that ramble!
Beth

Beth

[meags]

Now I'm even more committed to natural birth than I was before (if that's possible)! Thanks for sharing!

[sewarsh]

i'll check this out later too, but have to say....i had pitocin with both my DC (water broke with no contractions for #1 and risk of infection was approaching and i was late with #2 & was 4cm dilated with no contractions and thought my vagina was going to explode).

no hemorraging or issues with either.

[daisymommy]

I'm glad everything turned out fine for you Sewarsh. For many people they are fine with pitocin. But obviously as this study points out--many people are not.

As we say around here, we shouldn't look to anecdotal evidence--but at what do the studies and science say.

[egoldber]

Interesting. I would be curious to read a more detailed discussion of the study, particularly how they selected and matched cases.

And on the anecdotal side, I had a prolonged (failed) pitocin induction for PROM with older DD. My uterus afterwards was quite slow to contract. I have often idly wondered if that contributed to my uterine rupture with my second labor.

[OKKiddo]

Back when I used to moderate a labor discussion board I had a whole write up on inductions (risks, benefits, options...) and I had found that connection back in like 2003. It makes sense when you think about it- pitocin causes different contractions (stronger, longer, closer together) than might naturally occur and those contractions might increase blood flow to the uterus. I honestly don't think risks like that are well presented when people are making decisions about inductions or, if they are, they are buried in among every other risk on the consent papers that just might not be carefully reviewed. I wasn't induced so I don't know what all they have you sign. I know they wanted to augment my labor with ds1 and there really wasn't any discussion on risks or benefits. Since it didn't actually get to that I don't know if right before it was administered they'd have brought all that up. Of course, bringing it up with a mom 18 hours into labor isn't really the best time to get informed consent. Wouldn't it be great if all expectant parents were given info on pain meds, c-sections, inductions like risks/ benefits/ options early on in the pregnancy? The 1st practice I went to with ds1 did give out a binder and in it was a sample consent form for an epidural and other documents like that. It'd just be nice to give the info when there is lots of time to digest and discuss it, kwim? Talking about risks/ benefits when mom is 38+w and ready to be done doesn't give the best chance of having it be as well researched as it would have been before mom was just ready to go.

Sorry for that ramble!
Beth

Beth

Interestingly enough, the military hospital I delivered my first two children at required you to attend a briefing once you got your positive pregnancy test to go over nutrition, approved over the counter medications during pregnancy, warning signs to come into the hospital or Dr's office for, and shaken baby syndrome, etc. Lots of great info especially for a first time parent. Sucked if it was your second in a short time though because they assigned you your first OB appt at the end of the briefing so you had to sit through it all to get that appt. lol.

Then at 25-30 weeks they had another class that you had to come in for that gave a tour of the facility, explained all the different possible procedures/interventions, pain medications, and a brief class on lamaze. Oh, and they had an empathy suit that the guys got to put on to see what all the added weight felt like.

I really miss that facility and especially my OB that delivered both of my sons--wish I could go back there.

[DrSally]

I haven't read the article yet, but I had a prolonged pitocin induced later and a very severe post partum hemmhorage a week after DS was born. My uterus didn't contract back down on it's own.

[essnce629]

I didn't read the article yet, but this definately isn't new news. I was a doula for my mom's friend back in 2002 and she had a very very severe postpartum hemorrhage (uterus had to be packed with guaze in the OR, she almost needed a transfusion, and was severely anemic afterwards). They were going to perform a hysterectomy if they couldn't get the bleeding to stop. This occured after a really long labor that had be augmented with pitocin. I was standing right there after the birth and when the nurse pushed down on her abdomen blood was just gushing out and clots the size of baseballs. I went home that night after the birth and looked up postpartum hemorrhage in my OB nursing textbook and right there at the top of the list of risk factors for postpartum hemmorrhage was pitocin. And this was back in 2002.

[SnuggleBuggles]

Interestingly enough, the military hospital I delivered my first two children at required you to attend a briefing once you got your positive pregnancy test to go over nutrition, approved over the counter medications during pregnancy, warning signs to come into the hospital or Dr's office for, and shaken baby syndrome, etc. Lots of great info especially for a first time parent. Sucked if it was your second in a short time though because they assigned you your first OB appt at the end of the briefing so you had to sit through it all to get that appt. lol.

Then at 25-30 weeks they had another class that you had to come in for that gave a tour of the facility, explained all the different possible procedures/interventions, pain medications, and a brief class on lamaze. Oh, and they had an empathy suit that the guys got to put on to see what all the added weight felt like.

I really miss that facility and especially my OB that delivered both of my sons--wish I could go back there.

:applause: That's a really good model of care for 1st timers. :)

At the birth center with ds2 we would have one 45 minute appointment every trimester to cover some big topics. 1st trimester was nutrition and 3rd was birth but I can't remember the 2nd.

Beth

[OKKiddo]

:applause: That's a really good model of care for 1st timers. :)

At the birth center with ds2 we would have one 45 minute appointment every trimester to cover some big topics. 1st trimester was nutrition and 3rd was birth but I can't remember the 2nd.

Beth

Yeah, it was a really good facility when I was there...and out in the middle of the desert too, lol! And we made fun of the name of the hospital because it was located in California: Weed Army Community Hospital. I know there was a Navy Guy during WWII with a last name of Weed but still, ya gotta know you're going to get some laughs over that name in the state of California! :)

[sste]

I wonder if I am also someone who does not respond well to pitocin. I ruptured on a very low and controlled dose of it, although I was on it for some time - - about 15 or so hours.

On the other side though, I was a day shy of 42 weeks with no dilation/effacement/contractions etc. It was either pitocin or a repeat c-section which has its own risks with respect to uterine scarring. My OB and multiple other people there tried a physical (balloon) induction first and could not get it placed my cervix was so far from being in the right spot.

Anyway, this is all to say that I am no big fan of pitocin but if we were to stop using it or sharply limit it you would have more c-sections for post-date babies. Now, I know I have read on this board that there aren't increased risks up to 42 weeks but when I was 40 weeks and trying to decide DH and I pulled an article reviewing the literature and this does not appear to be the case. A small amount of risk is added each week starting at 39 weeks actually and the increment of risk does get a little bigger (but not huge) as you get to the 41/42 week points. That said, I was willing to take that risk but alot of people probably won't be and that is where I think you end up with the pitocin versus c-section seesaw.

[egoldber]

But the interesting thing to me is they were not just looking at pitocin vs. no pitocin, they were looking at the total amount over a period of time, what they called the "area under the curve". Part of what they are saying it isn't just that you get pitocin, it's at what dosage and for how long.

[sste]

This is a good point. I have to confess a post and run where I didn't look carefully at the link - - I was more responding to where I thought posters seemed to be going with this, which I read (perhaps read into) as let's think about not offering pitocin as an option so frequently.

I think there has previously been data about the benefits of low dosage at least for rupture - - I believe that is what my OB told me. Though I was apparently an outlier. :(

[egoldber]

I hear you. Sucks to be the outlier. :(

[karstmama]

i didn't go read the study, but this was definitely on l&d nurse radar in 1990!

[MSWR0319]

I read the article and while it doesn't pertain to my experience exactly, I still think it's on to something. I'm wondering if it isn't maybe a long labor in general plus piton that causes problems? I labored 30+ hours with a posterior baby and finally needed the lowest pitocin dose for only 20 minutes to get me the last .5 cm. A week later I hemorrhaged with large clots and then needed a transfusion because I was so week from being anemic, even though my levels were just above what they normally do for a transfusion.

That being said, I was at the point of either using pitocin or having a c-section because DS was not coming out at all otherwise. So I don't feel like pitocin should never be used. I think maybe I was just one of the minority that it caused a problem for.

[MSWR0319]

I hear you. Sucks to be the outlier. :(

:yeahthat:

When they told me I was an outlier, I thought "gee thanks!"

[daisymommy]

And I agree with you that there are times modern medicine can be our hero. I don't at all think we should do away with pitocin, c-sections, inductions, etc. All of these modern technologies can save lives.

BUT--and a huge but at that--we have taken technology/medicine and run like crazy with it and ignored the possible risks. Women are not informed, and these interventions are handed out like candy. Every-other-woman in a maternal line-up who has delivered in a hospital setting has most likely experienced pitocin with one of their babies (I did with #1). I have a hard time believing that every single time it was truly medically warranted. Many times it's because you are on the time clock, and not progressing nearly as fast as the staff wants you too. That's my gripe.

But yeah, Sste, if I were in your shoes, I would have have gone the exact same route you did. No judgment here! I still remember your birth story, and am so glad you're still with us :)

[KLD313]

I didn't read the study but I was given a tiny bit of pitocin ordered by my midwife after my water broke but wasn't having any contractions and she never once mentioned this as a risk. I didn't really ask because at that point I felt like my birth plan was shot to hell and I was miserable but still, I wish she would've told me that.

[Katigre]

And I agree with you that there are times modern medicine can be our hero. I don't at all think we should do away with pitocin, c-sections, inductions, etc. All of these modern technologies can save lives....

I have a hard time believing that every single time it was truly medically warranted. Many times it's because you are on the time clock, and not progressing nearly as fast as the staff wants you too. That's my gripe.

Absolutely. There were some interventions needed in my birth with DS#1 that I (as a natural-birther) am happy I had (including a low dose of pitocin - I was on hour 48 of labor and hadn't moved past 6-7 cm for hours due to malpositioning of the baby).

However, there is something wrong when my friend, who had an 8 hour labor total, was automatically given pitocin 'just because she wasn't going fast enough' (even though she was going over 1cm/hour on her own!).

[daisymommy]

However, there is something wrong when my friend, who had an 8 hour labor total, was automatically given pitocin 'just because she wasn't going fast enough' (even though she was going over 1cm/hour on her own!).

:yeahthat:. And this is why, when I say that our horribly high maternal & infant death rates in this country are due in part to needless interventions and people ask "how can you say that? why do you think that?"--this is why I say that. Maternal hemorrhage is the second leading cause of maternal death (and the most common). If pitocin carries the risk of hemorrhage, and we are giving it to women left and right, willy-nilly, then yes, our needless interventions in this country are contributing to our high death rates.

Our modern science should be here to save lives.

[scriptkitten]

i was induced with cervadil (at 34 weeks for pre-eclampsia which was diagnosed at 29w).

i was also given mag sulfate, which made me loopy and totally messed up my ability to advocate for myself.

they started pitocin but stopped it because the cervadil was doing its job and the pitocin was working too well.

my delivery was a disaster.

despite my birthplan, i was convinced to get the epidural because "labor would be very long and it would help me sleep". ha ha. i was too druggy on the mag sulfate to say no and my DH was useless by this point.

the epidural worked too well and no one believed me when i said i had a pain in my lower groin that was not a contraction.

well, i guess that was my daughter in the birth canal because without warning i was fully dilated and her HB was crashing.

i pushed her out in 3 pushes and never felt a thing despite 4th degree tearing.

then my son went into distress (HB of 20!!!!) and i turned into a blood fountain right there in front of my husband who was like "oh that can't be normal"

they put me out immediately for an emergency section.

i was in surgery for 6 hours. the bleeding wouldn't stop. i had 4 blood transfusions, they had to put a balloon into an artery in my groin…after it was all said and done no one could believe i was still alive. and this is at a TOP hospital, with the best high risk team in the city.

my son turned out okay as you can see in my sig file.

anyway… i never wanted a medicated delivery. pre-e totally messed things up for me and the resulting interventions almost killed us all.

i know that if i had been able to deliver without all of the stress placed on my body by all of the drugs things might not have been so terrifying. between the epidural taking my senses away and the induction putting my body into hyperdrive, is it any wonder my body freaked out?

of course, pre-e is so mysterious that it may have played a role in messing up my body's ability to clot, but we'll never really know.

[daisymommy]

Scriptkitten~ :hug: I am so sorry! Thankful you're okay and still here with us and your children are okay too.

[scriptkitten]

^^ thank you.

[karstmama]

of course, pre-e is so mysterious that it may have played a role in messing up my body's ability to clot, but we'll never really know.

oh, it absolutely *did*. that's one of the main features of pre-eclampsia, very low platelets, and platelets are what starts clotting.