Oxytocin Induction

Oxytocin is a powerful hormone. When we hug or kiss a loved one, oxytocin levels drive up. It also acts as a neurotransmitter in the brain. In fact, the hormone plays a huge role in pair bonding. This hormone is also greatly stimulated during sex, birth, breast feeding, and the list goes on.  In lactating mothers who are breastfeeding, oxytocin causes milk to be released in the breasts, so that the infant can feed at the mother's nipple. Oxytocin is also responsible for the dilation of the cervix during birth, and for contractions during labour. During labor, oxytocin stimulates the uterine muscle to contract.

Pitocin is the synthetic form of oxytocin. Oxytocin was discovered in 1909 when Sir Henry H. Dale found that an extract from the human posterior pituitary gland contracted the uterus of a pregnant cat. Dale named the unknown substance oxytocin, using the Greek words for "quick" and "birth." Pitocin was successfully synthesized in 1953, and two years later it was available to physicians for the inducing and augmenting of labor. In 1971 Peter Kopfler discovered that oxytocin was involved with mothering.  Kopfler called it a hormone of mother love.

By 1974 it was well known that Pitocin had a 40-50% induction failure rate and in 1978, largely due to the work of Doris Haire, Pitocin was investigated by the US Senate and the General Accounting Office. Between 1978 and 1981, Haire testified at three ongressional hearings on obstetric care, which included reports on the dangers to mothers and babies of the routine and elective induction of labour.

Pitocin is supposed to be used to induce labor or increase the strength or duration of contractions for the health of mother or baby. There is absolutely no doubt that induction oxytocin/pitocin can be a lifesaving intervention, and is necessary in some circumstances to protect the health and well-being of both mother and baby. Having said all that, it is the most abused drug in the world today.  In his classic book Husband-Coached childbirth, Robert Bradley, MD, compares the arrival of human babies by nature's schedule to fruit ripening on a tree. Some apples ripen early, some late, but most show up right in season. Bradley advocated relaxation, trusting nature, and allowing babies to show up when nature intended.

The question I’d like to explore is not whether induction with Pitocin is sometimes necessary– but whether the frequency of its use today in hospital birth is justified. As is the case with all medical interventions, it’s important to critically examine the balance between benefit and risk – especially when we’re talking about the use of powerful drugs with otherwise healthy pregnant mothers and their babies. The problem with augmentation is that it produces an abnormal labour. Synthetic oxytocin can interfere with the delicate orchestration of the mother’s natural hormones during birth, and according to some research, with the baby’s brain and hormones as well.

It’s crucial to understand that the effect of synthetic oxytocin is not the same as that of natural oxytocin produced by a labouring woman. The uterine contractions produced by synthetic oxytocin/pitocin are different than the contractions which are stimulated by natural oxytocin – probably because Pitocin is administered continuously via IV whereas natural oxytocin is released in pulses. We are just beginning to understand the long-term effects on the fetal brain of drugs such as Pitocin, and the exact long-term effects of inducing or augmenting labour are unknown. In practice it seems that pitocin is used much more frequently, even when its usefulness and safety are still questioned. About 80% of women who have had pitocin say that there is more pain with pitocin than without. Unlike natural contractions, you do not get the slow build up with pitocin induced contractions. Most women surveyed say stated that they would rather try alternatives to pitocin with their next labour.

 According to Williams Obstetrics, a pitocin induction and augmentation should only be performed when there is a clinical diagnosis of "hypotonic uterine dysfunction." This is a condition in which the contractions become ineffective at producing cervical dilation. This means that even when it comes to OB/GYNs, they should only use pitocin when indicated in abnormal labours. Moreover, contrary to popular belief, a truly "abnormal labour" is a very rare occurrence. However, even though doctors are warned of the dangers of using pitocin, it remains the most used labour and delivery drug and it is used routinely to "control" normal labours. It has become so common in maternity units that nurses and physicians dont even mention it when ask.

The medical system considers all labours as abnormal and therefore requiring "assistance. That is why Pitocin is such a controversial topic in childbearing today. We learn and know that oxytocin is a natural hormone produced by a woman's body.  Pregnant women owe it to themselves and their unborn babies to do everything they can to stay healthy and thereby minimize or prevent the need for medical induction. Babies born from natural, spontaneous labours have the best overall outcomes, and their mothers experience easier labours and quicker postpartum recoveries. This is because Pitocin is a strong anti-diuretic - meaning you can't pass urine. Even at very low doses, pitocin in combination with IV fluids administered to starving - fasting - labouring moms can result in water intoxication. Water intoxication heightens your risk of pulmonary edema.

I am very concerned about its widespread use, though. It is a powerful drug that should be approached with a lot of caution and respect. I also hope that we will continue to conduct research on the long-term effects of commonly used drugs at birth. Doesn't mean that their use will be eradicated, but it's important to know what implications Pit during labour may have down the road. Some women may be okay with accepting that set or risks; others may not be. As long as new mothers and healthcare professional know that pitocin is a drug. It is medical intervention and carry risks with it.