Natural Childbirth VI: Pitocin Side Effects and Risks | Chris Kresser
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Natural Childbirth VI: Pitocin Side Effects and Risks

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In the last article of this series on natural childbirth, we examined the little-known side effects and risks of epidurals. In this article, we turn our attention to synthetic oxytocin.

There is absolutely no doubt that induction with synthetic 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.

The question I’d like to explore in this article is not whether induction with Pitocin is sometimes necessary – which I believe it is – 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.

There are two primary reasons that obstetricians use oxytocin: 1) to induce birth in pregnant women who are “post-term”, i.e. at 41 weeks gestation (known as “induction”), and 2) to speed up labor (known as “augmentation”). We’ll look at each of them in turn.

Is routine induction necessary at 41 weeks?

Conventionally pregnancy has been considered “post-term” at 42 weeks of gestation. At that point, if the cervix is not dilated, the current standard of practice in most industrialized countries is to induce labor.

This practice is based largely on clinical guidelines which suggested that women who reach 41 weeks undelivered are at higher risk of complications such as stillbirth.

But does the evidence really support this claim?

A meta-analysis in 2002 concluded that “routine induction of labor after 41 weeks reduces perinatal death”. According to the data, 7 deaths occurred in women allowed to go beyond 41 weeks compared to one death in women that were induced at 41 weeks.

However, of the 7 perinatal deaths that occurred, only 2 occurred from a cause possibly related to pregnancy duration. The other deaths were caused by factors unrelated to the duration of pregnancy, such as pneumonia in the newborn and diabetes in the mother. When these deaths are excluded, the difference in perinatal mortality between the group that was induced and the group that was not was not statistically (or clinically) significant.

It is difficult to argue, then, that routine induction at 41 weeks will reduce the number of stillbirths. However, it is arguable that such a practice could actually increase perinatal mortality and morbidity.

Studies in Canada suggest that the likelihood of cesarean section may be twice as high when labor is induced as compared with spontaneous labor. (We’ll discuss the risks of cesarean section in the next article.)

Furthermore, the justification that routine induction should be performed at 41 weeks to prevent possible deaths is unsound. Although the stillbirth rate at 37, 38 & 39 weeks is lower than at 41 weeks, the absolute number of fetuses who die is greater. Since more babies die at those gestations than at 41 weeks, by this reasoning we should be inducing at these earlier dates. Of course this doesn’t make sense.

As the authors of the 2002 article “Routine induction of labor at 41 weeks gestation: nonsensus consensus” conclude:

The ‘evidence’ on
which current practice and popularity of routine or as we
prefer to think of it, ritual induction at 41 weeks, is based is
seriously flawed and an abuse of biological norms. Such
interference has the potential to do more harm than good,
and its resource implications are staggering. It is time for
this nonsensus consensus to be withdrawn.

Is speeding up labor with synthetic oxytocin justified?

Official U.S. figures state a 22.3% induction rate in 2005, which is more than double the rate in 1990. In Australia rates were 25.6% in 2005, and close to 20% in England (2005) and Canada (2002). 1

The problem with augmentation is that it produces an abnormal labor. 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 laboring 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.

Pitocin-induced contractions will be longer, more forceful and much closer together than a woman’s natural contractions. This can cause significant stress to the baby, because there’s not enough time to recover from the reduced blood flow that happens when the placenta is compressed with each contraction. The net effect of this is to deprive the baby of necessary supplies of blood and oxygen, which can in turn lead to abnormal fetal heart rate patterns and fetal distress.

In fact, birth activist Doris Haire describes the effects of synthetic oxytocin on the baby as follows:

The situation is analogous to holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air, but not to breathe.

The U.S. Pitocin package insert is painfully clear about the risks of the drug, warning that it can cause:

  • fetal heart abnormalities (slow heart beat, PVCs and arrhythmias)
  • low APGAR scores
  • neonatal jaundice
  • neonatal retinal hemorrhage
  • permanent central nervous system or brain damage
  • fetal death

A Swedish study showed a nearly 3 times greater risk of asphyxia (oxygen deprivation) for babies born after augmentation with Pitocin. And a study in Nepal showed that induced babies were 5 times more likely to have signs of brain damage at birth.

Pitocin can also cause complications for birthing women. Evidence suggests that women who receive Pitocin have increased risk of postpartum hemorrhage, which is likely due to the prolonged exposure to non-pulsed oxytocin.

This makes the oxytocin receptors in her uterus insensitive to oxytocin (“oxytocin resistance”) and her own postpartum oxytocin release ineffective in preventing hemorrhage after birth.

In addition, Pitocin may have effects on the natural hormonal cascade which is so important to an undisturbed birth. In one study, women who received Pitocin to speed up labor did not experience an increase in beta-endorphin levels. I described the importance of beta-endorphin to the birth process in a previous article.

Hormonal disruption may also explain the reduced rate of breastfeeding following labor that was induced with Pitocin.

Summary

Again, I want to reiterate that induction with Pitocin can be a useful and even life-saving procedure, and should absolutely be used when necessary. But the evidence suggests that it is not without side effects and risks, and it should not be used in routine or otherwise uncomplicated birth.

Articles in this series:

  1. Buckley S. Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early parenting choices. Celestial Arts 2009. pp.110
  1. Do you have any information on the use of pitocin in the third stage of labor? I’m curious about what the evidence says as I can’t find too much about it, except that the WHO recommends it. But, if you have a natural birth won’t your own hormones also kick in (so long as you’re not deficient in Vit K or other clotting issues)?

  2. I was given petocin with 3 of my 4 children. Never was I told about the dangers of it. My 2nd child, with petocin, was a hard labor. She had wide shoulders. I was given petocin the whole time, as well as continued after to help the uterus contract. Her shoulders were stuck and she turned blue. She’s completely normal but struggles with spelling, hates writing, memorizing things like math facts are a struggle. I researched a little about things to help her with her spelling and ran across an article that talked about a condition called Dysgraphia. It matches a lot of her frustrations. One article said that they were doing a study on 53,000 people of different ages with Dysgraphia. They all had two things in common. 1. Traumatic birth in which there was a lack of oxygen for a short period of time, which effects primarily the left side of the brain because the right side starts to develop sooner than the left, making the left side more vulnerable during birth. 2. Mother was given petocin for longer than the 4 hour recommended time frame it is suppose to be used for. Just some things to research for parents trying to figure out what is going on with their kid. Hope it’s helpful.

    • Thanks for providing the article on dysgraphia. It’s not properly a scientific study but for this purpose it will do. I can’t say I’m familiar with that disability, though I can be sure I don’t have it (despite my lousy handwriting). There seems no reason to doubt the statement made there about ‘birthing issues’.

      I know something like that can be frustrating; the fact that the child is otherwise healthy and of normal intelligence could be said to actually make it worse. Just as frustrating (from my view anyway) is that society doesn’t see and account for that kind of disability – if it’s hard in the schools, it’s much harder in the world of work where quite generally
      anyone weird/different is unwelcome – but that’s a political digression. This fact explains how relatively few people understand it.

      It’s been a long time but I can’t check blogs often; that’s why I give my e-mail, as anything sent there will be read and responded to quickly.

      k_over_hbarc at yahoo dot com

  3. I have always wanted to ask this question of women that have had any form of drugs given to them during the birthing process. Your husband marries this sweet, caring, loving woman and this continues till a drug-induced birth is given. A couple of month’s later, your husband says you are not the person he married and your bonding or instinct to protect your baby from stranger danger is not intact? Anyone?

    Our strongest instinct to protect is damaged as handing over our babies to strangers to take care of them, becomes easy. Whereas it should be so difficult to do that you end up not doing it and taking care of your child yourself. in fact, it would never even be considered unless your are a Single mom and don’t have a choice and have to work. Many mom’s today don’t have to work, but choose to.

    I believe that PAIN plays a vital role in the bonding of mother and baby and HER instinct to protect would be powerfully strong with the pain of childbirth. We can see the relationship between a lot of mothers and baby/child out there as being more numb and paralyzed with very little bonding or protective care taken for the safekeeping of her baby/child. Lack of education for Mother’s Value is part of the problem as well as Self-esteem and her relationship with herself. I am a mother that had 26 hours of pain 3 minutes apart for most of it. I was given an Epidural 22 hours into the 26 which only worked on one side and I only dilated 3 fingers in all this time, they decided to give me a Cesarean. I would have died and so would my baby have died if these drug induced methods were not in place. Having said that, a lot of mom’s are not dying or even trying for natural birth, but given the option of Epidural or Cesarean before their waters even break. Something is very wrong and a toxic mother that has no pain or feeling to bond with her baby during birth and hasn’t even tried natural birth is very uneducated and so far from her natural instinct of knowing and mindfulness. We as Mother’s have the power to bring back a generation of children that are not so damaged by our ignorance and fear if we are given back the secrets that were taken from us a long time ago. I thank myself for going through 26 hours of pain as I truly believe if I hadn’t my bonding instinct would have been weakened had I felt no pain whatsoever. There is a time and place for these drugs but beware the invisible consequences if you must. You can do it, natural birth is just that, natural – if one has to have another form of birth with drugs, ensure that you monitor your moods and ask your partner, have I changed??

  4. Our first child was born with the help of an epidural only and is perfect in every way, athletic and top of her class. My second daughter was measured during the ultrasound and they found she was tiny – in the 5th percentile. Subsequent ultrasounds confirmed she was growing at a normal rate, but still tiny for her age. The doctor recommended inducing labor at a time close to the due date which made no sense to me. How would inducing labor help a small baby in any way? I objected and she backed down. She called my wife the next day and talked her into it. Baby was induced and her birth weight was perfectly normal so the induction was for nothing. No explanation was given for why the ultrasound measurements were all wrong. My wife went through months of guilt during the pregnancy, blaming herself for the baby’s ‘defect’. The baby was colic for many, many months. As a toddler she was extremely difficult to manage. Her outbursts made her very hard to be around. Our girl is now 7 and goes to the toilet in her clothes nearly every day and in still in diapers at night. We are having a lot of trouble teaching her to read. She is a wonderful child and very bright socially, but every day I wish I could go back the argue stronger for the natural birth. There’s really no way of ever knowing if these problems are linked to the induction which is frustrating. The drug companies are making a fortune with the drug and the link to problems with your child years later will never see the inside of a courtroom, so what do they care?

    • Although I can’t be an expert on your specific case, the baby was not ‘too small’ and that’s a common mistake made by doctors. There are better methods for assessing IUGR than just guessing the baby’s weight, but as the baby was ‘growing at a normal rate’ that should have been an indication against. You’re right that there’s no way of knowing if or when induction might be linked to problems later in life – which is why the safest choice, all else equal, is to decline. (This evidently applies to many of the comments here.)

      Counter-intuitively (by the way), the baby being too small actually can be a good reason for induction (or perhaps C-section), but the baby being too big almost never is. A too-small baby is often not getting enough nutrition in the womb (IUGR) and would be better off out, while a too-large baby has no especial problems and induction for that reason has not reliably been shown to reduce C-section or anything else.

      (By the way, while drug companies do corrupt medicine in many cases, I don’t think this is one of them.)

      k_over_hbarc at yahoo dot com

      • Concerning my child’s possible dysgraphia. She’s never had a vaccine. Pretty sure if I’m correct about her having it that it is directly related to her birth.

  5. My water broke with my daughter at 39 weeks, I was fully effaced and 4cm dilated and had been for 3 weeks. Since I had GBS I went to the hospital right away. I was given pitocin after five hours which in retrospect was probably not necessary. I was not mentally prepared for the pain and I asked for the epidural. I had an amazing birth experience.

    My daughter did have jaundice but we also have different blood types and she is half Latin American which I was told have higher chances of jaundice. In any event she was fine within 24 hours.

    I struggled to breastfeed but because I had flat nipples. However, breastfeeding was not an option and I made it work despite bleeding nipples and pain for 16 weeks. I breastfed until she was 15 months.

    I also did not suffer from post partum depression despite a history of severe depression in my youth. I overcame my severe depression through cognitive behavioural changes which to this day helps keep depression away and helped me handle the post partum hormonal changes.

    Everything has risks including waiting. But I find that people are quick to blame modern medicine (pitocin/vaccines) for autism or behavioural problems. I find there is a lack of scientific evidence for these beliefs. Perhaps those who are concerned about the link between autism etc and pitocin should try to fund unbiased research into this area.

    In my experience I was afraid that the pitocin and epidural would doom me from breastfeeding due to the natural movement. But from my very limited experience if you are determined to do something you will achieve it. Breastfeeding is not easy to some people and when I was told it shouldn’t hurt or it should be easy I was discouraged. But for some women it is going to be hard and it hurts but the pain goes away.

    There are so many things that come into play that I do not think that we can blame every difficulty that arises in motherhood or our children’s health to the birth of the child.

  6. I was admitted to hospital to be induced for my son’s birth in 2001 and went from no dilation to birth in 5 hours while on a Pitocin drip. The dosage was increased every time my OB/GYN came in the room and I experienced intense contractions with no breaks in between contractions. My son was born healthy, but has been identified as Gifted with a Learning Disability. I see so many children identified with Learning Disabilities and wonder about the link between Pitocin and brain function. I feel responsible for not being more informed about the potential risks of this drug although you feel quite powerless when in labour in the Hospital.

  7. I am 29 years old and was born with Petocin. My understanding is that the pit drip is to be turned off once labor has begun. Unfortunately for my mother, and potentially me, was that they did not turn it off. She reports that her labor was the most painful (I am the youngest of 5). I am researching the effects Petocin has on the baby and am wondering if there are any studies done on adults that were born with Petocin.
    From my research, the side effect that fits me would be a broken central nervous system.
    Just wondering if anyone knew of more research.

    • I had my labor indosed the pitocin drip wants they started it with in a few min latterthey had to stop it my son heart rate would drop I had to have a oxygen Mack on to bring my son heart up and then they tryed the drip agin same thing happens so the had to indose buy going in to brake my water my son is nine years old and has a slow learning disabilities I’m trying to figer out if pitocin could be the reson it was not used on my to oldest and they have no problem

  8. As a young woman of 25 years old in 1964, I opted for a home birth but as I went into very early Labour (nothing more than a few twinge) the midwife, without any discussion, drove me to the local hospital. As the day wore the pains remained pretty much at the same level. However, I overheard the nurses saying they wanted to get the labour over with so that they weren’t working through the night. As a result I was placed on a drip and induced. The pain was excruciating and without a break for hours and I just escaped being given a caesarian because the baby was born at quarter to eleven at night. I subsequently had a son delivered naturally at home without ANY medication and the difference was unbelievable. After my first child I suffered four years of post-natal depression making my life and that of my family a nightmare. After the second I was up and about and living life normally. I believe the artificially induced labour was such a shock to my system that it couldn’t easily recover.

  9. Just found this website after a friend told me of the link between pitocin and neurologicial issues. I have 5 children and the 2nd one was induced on the due date beginning with the overnight cream. The reason given was to prevent another c-section like my first. She was delivered via emergency c-section due to dropping heart rate from the umbilical cord around her neck. Doctor also commented that he was quite large. Long story short, the cream did not start contractions, so the pitocin drip was on and regularly increased all day long before any contractions began in the evening. Very painful… epidural given… only took on one side… had another epidural….went from 2 cm to 10 in less than an hour. I had no ability to push (although I tried) so 3 1/2 hours later plus forceps plus vacuum my beautiful son was born, 7 lbs 5 oz. He turned blue–either from the stress of labor (YES) or an infection. Just to be sure they put him in the NICU on antibiotics with an IV in his toe–and told me I needed to discharge within the 24 hour period allowed back in 1994. There is so much I would have done differently, but I was so happy to not have another c-section I did not think much about it. My son was definitely on the hyper side, but very smart and quite coordinated. His personality is different, but I attributed that to his “nerdiness.” I did not know the future then (and definitely wondered…), but he is 20 now with lots of friends and a year away from a degree in physics. I am fascinated by the links between childbirth and the autisim spectrum and other neurological disorders. I definitely believe that you need to be your own advocate and be somewhat wary of the medical profession in general. Their training is excellent in critical situations, but the adhering to protocal and avoiding malpractice is a necessary part of their game plan. What you don’t know can hurt you.

  10. “of the 7 perinatal deaths that occurred, only 2 occurred from a cause possibly related to pregnancy duration”.
    How do you possibly know this with such certainty? I’m no doctor (just a medical student) but right away I’m thinking about the increased risk of meconium-aspiration and pulmonary hypoplasia. And we know in general intrauterine infection rates are higher post-term. Maybe there are other things that could cause pneumonia that we don’t know about yet. Second you mention maternal diabetes….maternal diabetes exposes the kid to increasing amounts of glucose and subsequent risk for neonatal hypoglycemia among other complication neonatally and throughout development.
    Regarding the pitocin-hypoxia thing. Oxytocin (pitocin is natural). If we see non-reassuring fetal tones on the monitor from the hormone we give, we’re supposed to just cut back on it or stop it entirely and all is well!
    Postterm fetuses tend to be larger than term fetuses, with a higher incidence of macrosomia. Complications of macrosomia include prolonged labor, cephalopelvic disproportion, and shoulder dystocia, all of which increase the risk of birth injury.
    “Intrauterine infection, placental insufficiency and cord compression leading to fetal hypoxia, asphyxia, and meconium aspiration are thought to contribute to the excess perinatal deaths” – UpToDate
    I’m totally cool with alternative birthing methods and actually hope to take part in this in the future. However please don’t be misled without further research. My classmates and I are going to college/medical school/residency to suffocate babies.

  11. I would like to pose a question for thought. Pitocin is the synthetic version of oxytocin which also plays a role in social interactions, growth, and cortisol (stress) levels. I am wondering if this high influx of synthetic neurotransmitter could have an impact on other areas for mom postpartum as well as the the neurotransmitter receptors of the baby. I was given “the pit” for all of my children against my wishes. I had horrific contractions without breaks that caused fetal distress that disallowed me from getting out of bed kept me strapped down with monitors. I had horrible postpartum depression. My daughter has had symptoms of elevated cortisol throughout her life. She is smaller than average and underdeveloped. She struggles with anxiety and social issues–unable to retain friendships. She is hypersensitive to stimulus.

    • I can relate my son is 12 and is also smaller than average, he doesn’t retain information well, he forgets easily. Possibly ADHD, has social issues, he is also Germa-phobic. On top of that and more he has Respiratory issues. Also often cries because he is trying so hard to do well at home but mostly in school or society. He was born in 2004, I’m going to request my medical records for this labor and consult an Attorney. I’ve been con concerned for quite sometime and it kills me to see my son hurting. I believe he was not ready to be born and i had no labor issues. It was induced because she would possibly be on vacation if I went into Labor.

      Claudia

  12. I was given pitocin for my first child because my water broke and I didn’t have contractions for 9 hours after. This issue was I tested GBH positive and refused the penicillin. The time between birth and water breaking was critical as that would put the baby at risk so I took the pitocin. My son seems perfectly healthy and is now 2.5. I am due Sat with my daughter and due to the size of my son she is already talking about inducing if I go much past my due date. I hope I go naturally in the next 2 weeks. Last Thurs I was at 3cm 50% and on fri I lost my plug.

  13. I too am wondering about the long-term affects of this drug. My son is now 43..with psychological and physical problems..
    My first son was born naturally after 26 hours of labor..and he has no psychological or physical problems. I was in labor with my second son for 20 hours with pitocin…he suffers from migraine headaches among other things. I am almost positive that his problems stem from the use of pitocin during my labor.

  14. I would suggest that the recent paper by Mandruzatto ( http://www.pqcnc.org/documents/sivbdoc/sivbeb/16MgmtofposttermpregnancyguidelinesJournalofPerinatalMedicine2010.pdf ) be used as the citation to oppose routine induction, replacing older sources. It includes all the newest RCTs, is written by doctors, and makes the stronger conclusion, quote: ‘It is not possible to give a specific GA at which an otherwise uncomplicated pregnancy should be induced.’

    Combined with other things we know about induction – many of which have been mentioned in this article – this makes to me a good case against it.

    k_over_hbarc at yahoo dot com

  15. What about taking an Oxytocin supplements to boost your oxytocin levels on a daily or weekly basis? Does this pose the same risks and side effects as the synthetic IV?

  16. Why wait till 41 weeks to induce? At my nearest hospital, they routinely induce on your due date, if not before. For this, and other reasons, I am planning my second home birth. My first 2 children were born at a small hospital, delivered by midwives, where any kind of medical intervention was strongly discouraged. Sadly, that hospital was closed. To add insult to injury, madicaid is telling me that they will not pay for a home birth any longer.

  17. Dr. Kressler,
    To your knowledge, have there been any long term studies on the use of pitocin and the nervous system? My son (23) has long suffered with a variety of problems including abdominal pain radiating around to his back. He has been to many doctors and all intimate that his problems are in his head. He says he has the symptoms commonly listed for fibromyalgia. His daily pain profoundly impacts his quality of life and ability to function as a human being. My mother has long said that she believes pitocin had a long term negative impact on my brother and also a family friend. I’m wondering if there are any longitudinal studies. Thank you.

  18. My son was born 9 lbs 11 ounces, 42 weeks, with extended use of pitocin. He ended up needing oxygen at birth and with a mysterious infection that made him the heaviest baby in the ICU. He has PDD NOS, and combined type ADHD. With those two items he also has anxiety, anger/aggression issues, SPD, and the list goes on. I’m a member of CHADD, have taken parenting courses, and continuously work to try and help my son be a successful individual. There is an article/study that a psychologist created after 30 years of practice noticing a correlation with birthing experiences and neurological disruption. I definitely encourage pre-studying epidurals/pitocin or what is wanted for a birthing experience, especially for parents that are expecting heavier babies, that are boys 🙂 I believe pharmaceuticals create issues that only pharmaceuticals can solve, whether on purpose or accident who knows.