Monday, September 30, 2013

What You Shouldn't Have to Expect When You're Expecting 1: Pit to Distress

chemical structure of oxytocin with labeled am...
chemical structure of oxytocin with labeled amino acids (Photo credit: Wikipedia)
So you're expecting a baby and for whatever reason your care provider has chosen to give you pitocin/synthetic oxytocin to start or speed up labor.

This medication goes through an IV so it can be carefully controlled. The goal is to have 3 moderately strong contractions during a 10 minute period of time. More than 5 contractions in 10 minutes or less than 1 minute of complete uterine relaxation between contractions constitutes a serious adverse reaction and should automatically result in pitocin being stopped. It may be okay to have it restarted at a lower dose if patient and care provider agree to do so.

Now for the very disturbing reality check:
Pit to Distress

An overstimulated uterus is very common with pitocin yet extremely uncommon with natural labor primarily because the body produces natural oxytocin in short bursts and synthetic oxytocin is run through a continuous IV. Just like any other medication, people react differently. Many people (my hand waving furiously) will experience contractions without relaxation and/or contractions that are way too hard and way too fast.

To be absolutely sure the uterus experiences the much needed relaxation phase during labor, simply place a hand on the abdomen and if it remains hard instead of going completely soft after contracting it is an abnormal and very dangerous situation. Equally concerning is if there are more 5 contractions in 10 minutes and/or less than 1 minute between contractions. If this situation goes unchecked, not only will mother be in distress from unimaginable pain not associated with normal childbirth, but the unborn child will be robbed of oxygen and can become quickly distressed. Continuous monitoring may not give an accurate picture of the contraction pattern and might even miss warnings of fetal distress.

Where is the doctor? Probably not even at the hospital. Doctors and even some nurse midwives are only trained in treating the birth of a child as a medical condition, not in how to wait for nature to do its job.
What about the nurses? Don't they have orders to stop the medication in case of adverse reaction? Not necessarily. They have likely not been trained in what to expect in normal childbirth. If they do know this is abnormal, they may still be ordered to continue the pitocin.

It is up to you to demand evidence based care prior to being given any medication, and if things go wrong be prepared to demand that the medication be discontinued if you react abnormally.

Need resources to make an informed decision?
Evidence Based Birth articles for induction and augmentation

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