Table of Contents
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.
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.
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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.
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.
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:
- Natural childbirth I: is homebirth more dangerous than hospital birth?
- Natural childbirth IIa: is ultrasound necessary and effective during pregnancy?
- Natural childbirth IIb: ultrasound not as safe as commonly thought
- Natural childbirth III: why undisturbed birth?
- Natural childbirth IV: the hormones of birth
- Natural childbirth V: epidural side effects and risks
- Natural childbirth VI: Pitocin side effects and risks
- Natural childbirth VII: Cesarean risks and complications
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- Buckley S. Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early parenting choices. Celestial Arts 2009. pp.110 ↩
Chris, you say:
“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.”
Are you familiar with any follow up studies that might link Pitocin use with later childhood hyperactivity and attention problems (ADHD type behaviours) due to some level of neurological damage?
Chris,
Did you have any input on the risk of aspiration pneumonia caused by mercomium in the amniotic fluid? As the baby’s gut has developed further in the 41st week and beyond, we were told this risk was much higher when we went beyond the due date (the unproven increased mortality risk speech wasn’t really working on us). From my reading, there always is a chance of this beyond week 37 but your take would be greatly appreciated.
Did your child have autism after that
My first child was induced in 1994 at 39 weeks. She has recently been diagnosed with Aspergers. My youngest born in 2014 also induced may have high functioning autism with both I was given pitosin. My second child is moderately impaired has autism. My 3rd child natural birth no pitosin, no autism. Any questions??!
my first labor was natural. my second went really long, and my daughter never dropped. we were administered pitocin before I felt it was necessary. I found out I was deathly allergic to pitocin and the counter drug. for 6 hours I was pumped with 10 additional drugs mostly adrenaline and things to counter the shaking to keep me alive. My heart rate crashed to less tan 35 beats a minute (obviously I was unconcious) The pitocin was started way too early, and other methods could have been used before the use of the “standard procedure”
Did your baby have autism then?
Not to insult the intelligence of someone who went through the rigors of medical school, but I believe underneath all the vitriol in her attack, Dr. Tutor was trying to say that presenting incomplete information may result in someone getting hurt because they decide to have their baby later than they should. I’m certainly interested in the argument she’s trying to make, if she’d just make it instead of spending all her time attacking people and beating around the bush. Oftentimes in arguments online someone refuses to give data or citations out of some sense of self-pride or stubbornness against the person they’re disagreeing with, but this isn’t very smart, because there are a lot of other people on here besides the person she’s addressing (Chris) reading her comments who would genuinely like to know and research further into what she has to say.
I find it ironic that she would choose the words that she did on the blog that she did, because the tome of every “Natural Childbirth” comments section is that doctors and other hospital staff are completely oblivious to the norms and concerns of everyday people, and that couples are at such a loss for what to do about it that they’re turning away from modern medicine entirely.
Her complete lack of ability to present (or rebuff) an argument makes me almost doubt she actually had anything to say, and her utter rudeness leads me to believe that if I actually had a legitimate concern under her professional hospices, I’d be totally ignored at best, if not insulted and seriously injured. I’ll certainly try to do the research she refused to do in her comments and learn why she made the point that she did. Still, I think she’s a perfect example of why people are turning away from traditional medicine and more towards natural childbirth in the first place, and other doctors like her might be wise to take note.
I’m a little late to the party here but my wife and I are going through this whole induction turmoil right now(this weekend in fact). I don’t believe that person identifying herself as a doctor has any hard evidence for her point of view. I have not been able to find it nor have the numerous health professionals I have gone round and round with been able to provide it to me. Perhaps it does not exist. There are some studies that show a correlation between carrying a baby for 41-43 weeks and a slightly elevated risk of infant mortality but the causation aspect is incredibly uncertain. The blank looks I have gotten when I asked if any of this applies to my wife who is in beastly good health(70 fasting glucose, low bp, athlete, paleo eater, no meds, no health issue ever etc) have told me everything I needed to know…they are completely unsure if this is actually the right course of action but they won’t admit it. I suspect that the gamble against liability falls down on the induction route so they all toe that party line.
I’m not a doctor and don’t presume, to give medical advice, however I have witnessed 7 of my own children born in hospital over the past 22 years. I am right now sitting in the waiting room awaiting the birth of my first granddaughter. My Daughter in law has been given Pitocin since 4 am this morning. She is at 39 weeks gestation. Her cervix has remained at a constant dilation of one centimetre for the past 3 weeks. After over 12 hours of induced contractions and no change to the cervix, the Duckter announced that they would discontinue the Pitocin and start it back up in the morning when he returns for his shift. If no change to the cervix by mid afternoon tomorrow they will discuss other options. “C-section or go home for a few days and try again next week or so.” I am now remembering my first sons birth ,the shape of my wife’s pelvic bones, the fact that she was not induced until 43 week, the twenty some-odd hours of Labor and the emergency c-section that almost cost my wife her life! I shudder at the memory of the the deep purple colour of my sons face and head, as four nurses used all eight of their hands to open up the vertical incision the Doctor had just cut into my wife’s abdomen. No exaggeration, they pulled a rectangular shaped hole large enough for the doctor to reach in and under my son to lift him straight up out of her. The nurse then slipped the swollen and engorged purple umbilical cord, which was wrapped around his neck at least twice over his head. His colour returned and all was well with my wife and son. However after reading these posts, I realise how blessed we were. And that the diagnosis of Attention deficit disorder, his restlessness as a baby and child may lie somewhere between causation and correlation.
I am on a journey to get more research about pitocin and the potential relation to side effects. My son is now 6 yrs old and suffers from ADHD, Sensory Integration Disorder, Anxiety, Night Terrors, insanely controlling temperment, and has tantrums were he hits usually adults because they are trying to control him. Otherwise, he is insanely bright, very sweet, black and white with rules and happy. I have been in therapy, parenting classes, he takes Friendship classes because he has very poor social skills and his writing is horrendous (math skills exceptional)
I was induced with pitocin after being 42 weeks for about 20 hrs, received oxygen, ended up with a c-section and he ended up with an infection, weighing in at 9 lbs 11 ounces. I was trying to do the natural route but was told to get induced to progress labor. I couldn’t breast feed even with the silly plastic caps and ended up with untreated postpartum. (I also pumped for 4 months which was an insane task) I was married and with my husband for the first 3 yrs of his life (before divorce) and my poor baby was angry all the time. Between the CHADD conference that I went to (there was a study on pitocin and ADHD!) my parenting children with special needs groups, and forums I’m convinced his birthing experience had a crucial role in his current conditions. Just recently someone I know was induced and is having the same issues, including the infection after the c-section and 20+ hours of pitocin. If there is a correlation it needs to be found fast because its becoming more of a wide spread practice. I am compiling information to give my doctor as he mentioned he’s never heard of a correlation.
I definitely feel natural is how people were intended to give birth, but if like me (I believe I have some funky pelvis) the next option should be c-section were the baby has less of an impact.
You may want to consider Asperger’s. Considering the raging epidemic of autism and the correlation to oxytocin receptors, pitocin usage may turn out to be a mitigating factor. Don’t blame yourself, just work on interventions to improve life.
Hi Jeanie:
IRONICALLY, my delivery was very similar to yours despite me delivering vagina due to me believing my baby was going to be “smaller weight” and nicu team was advised in stand by. However I had an 9.5 lb HUGE baby, and he has all the same issues you are having with your son. He also has night tremors, anxiety, adhd which is sensory related usually, however he is very bright/intelligent/and has exception GROSS motor skills but not fine tor skills unless he can keep calm throughout the task….cognitively he is very in tune with things thankfully. I still want to know why and what exactly caused my son’s current issues, and how to help others prevent sensory diagnoses since so many new diagnosis are happening in just the last 10-15 years alone it makes you wonder what long term effects the synthetic chemicals can cause versus the chance of the traumatic birth being the root cause instead.
I noticed you said something about an “infection” in your post. May I ask for more detail, or name to the infection, cause, Treatment, etc for the infection?.
Perhaps I also had that an infection (I can cross reference my medical records and recordings from hospital delivery and research more), and who knows maybe the mixture if pitocin too all impacted things? My son’s algar scores were all perfect though, and he seemed to be very alert and normal and healthy But always restless and overly active. He drank his bottle of 5oz immediatey from birth. He is now a picky eater and has many sensitivites on his skin, and also to some foods I beleive too (he was on special formula bc he broke out in rashes/baby acne the 3rd week home from so he drank hypoallergenic Similac Allimentum or Nutramigen formula until 10 month and switched successfully to a milk based product and he grew out if allergy… never had any ear infections and only took antibiotic ONCE since birth (that was at age 19 months and it was a mild dose too).
Jeanie:
My son’s writing is a major issues and his math and memory are off the charts!!! He cannot hold a pencil to save his life though, unless he is using an Therapy Weight device to assist him. His attention span exists when he isn’t over processing or dealing with what seem like side effects of the spd/adhd (constantly going and not able to fully relax even when sleeping at night). Lack of rest seems to catch up with him way quicker than a normal person, so he has to take a nap every evening for an hour to calm himself.
Ok, please let me know about the “infection” and also any helpful writing processes your son may have had successes with. I am also debating enrolling him in Montessori education/school versus traditional schooling bc I think it could help him focus in his talents and gifts, like memory/math/mechanically inclined/great gross motor and weak fine motor skills personality type.
Thanks again, and I look forward to your reply. Sorry for my spelling etc.. I am still learning English fully as new language.
“People are tired of the system–grouchy docs, impersonal hospitals, meds and interventions that give the most horrible side effects and quality of life, not to mention COST, and really very limited benefits. People are just sick of bandaid medicine and symptom management without end, until you have a med list 20 miles long. I think I’d rather stay home and take my own health into my own hands, and have peace and quality of life.” AMEN
Chris,
I sure do appreciate your website and all the information and insights that you give. Thanks for being willing to go against the grain. I think that is one thing about this generation–the ability to challenge all the strongholds of misinformation. Being an oncology nurse, I see hordes of misinformation. I’m sure it’s quite lucrative.
You have turned my knowlege of medicine upside-down and for that I am so thankful. You have given me so much to think about and consider. I am just grieved at the “education” I received in nursing now. Even with the mantra “evidence based practice” we still don’t seem to be getting things right. We, in the medical establishment, need people like you.
I’d like to share my journey a little. We have 6 children (so far) all vaginal births. First was in the hospital, with OB/GYN doc, SROM without progression, Pit., Nubain, puking, Compazine (for nausea, which snowed my wife between puking episodes), epidural (due to pain), vacuum extraction, big ole tear. All in all it was horrible, though I sure did like the doc. It’s no wonder why women don’t want babies today. Biggest problem is all that crap we thought we had to have left our baby lethargic and jaundiced and my wife’s milk supply basically nil. When we brought our baby back for admission under a bili-light we were instructed to forego nursing, because that was “contributing to the jaundice.” Before we regained our heads and put all this together my wife was basically unable to breast feed, though she was followed for months by a lactation consultant. We basically had to supplement with artificial milk.
Second, hospital birth, family practice doc, SROM without progression, Pit, skipped Nubain, epidural, severe hypotension, puking (again), no Compazine! Delivery went well. #2 was also severely jaundiced and we had to have a bili-light at home for several days which wasn’t covered under insurance, of course. Third birth, basically the same, though we put the baby under direct sunlight, no bili-light!
Fourth, hospital birth, nurse midwife and dulla. SROM without progression, No Pit, reruptured membranes, no pain meds, no epidural, better results! Some jaundice, but this was old hat so, we gave the baby sunlight. At this point we were uncomfortable with the medical establishment, but not enough to have home births.
Fifth, home birth, nurse midwife, membranes stripped, SROM with natural progression, nothing needed. Excellent experience. No complications. No turning back! Number 6, same! What a joy
I tell this story for one reason–people aren’t getting the results they want out of medicine in general. People are tired of the system–grouchy docs, impersonal hospitals, meds and interventions that give the most horrible side effects and quality of life, not to mention COST, and really very limited benefits. People are just sick of bandaid medicine and symptom management without end, until you have a med list 20 miles long. I think I’d rather stay home and take my own health into my own hands, and have peace and quality of life. Thanks again for sticking your neck out!
Dear Dr Amy,
You irritate me to no end. I am absolutely convinced that aggresive and unnecessary and botched intervention harmed both me and my child. Stay on your high horse. The art of medicine is a wonderful thing, but never forget your oath to do more good than harm. More is not necessarily better. Keep an open mind it will make you a better physician.
Chris,
This quote worries me the most: “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.”
Since you’re an acupuncturist, I imagine inducing using acupuncture is an alternative. Do you have any references or anecdotes about labor induced using acupuncture? I would hope the acupuncture-induced oxytocin release would come in pulses – oxytocin is released by the body, after all.
I just had my 6th (all were prior homebirths as well) and because I was a week overdue and was coming up against state mandated BS (most midwives cannot stand the state laws concerning women that go over 42 weeks) I decided to induce via acupuncture and homeopathy. I went to see my OMD for 3 days in a row. On July 22nd the morning of my 45th birthday I was 10 days late and decided to go for one more round of acupuncture. I had a nice relaxing session and walked out of her office at 11:30 AM.
At 1:00 PM I felt light surges, called my midwife and told her to head on over but I wasn’t sure I was really in labor as it was pretty mild. At 1:50 or so surges became more powerful and I headed upstairs to get in the tub as my husband had cleaned it once again and filled it. I told my oldest daughter to apply some counter-pressure to my lower back as I was in the tub and then said ok, much better now still not thinking baby would come until hours later. At 2:05 I felt and urge to bear down , my body had started the fetal ejection reflex and there was no mistaking what was happening, just then both midwives walked in- I stood up and birthed my son’s head in one swift push followed by his body. Birth time- 2:10 PM a beautiful 8.9 boy. What a lovely birthday present.
Thank you for posting this! I was induced with Picotin with my first child at 42 weeks. He displays many of the behavior issues described here (frustration, restless as a baby). Only now am I wondering if the Picotin caused it. I was in extreme agony for a while – and once the epidural was in I remember the panic in the room as my son was frequently “in distress”. I narrowly missed having a c-section as a senior doctor thankfully turned up and used a venteuse to get him out.
I am pregnant with my second now and fully expect to have another long pregnancy going over my due date. I have always had long cycles of over a month and the midwife has confirmed this often leads to longer gestational periods. I am going to do all I can to avoid another induction and will try doing what you did – I pray it will work!
Amy, it’s difficult to hear what you are saying with your condescending, angry tone and snarkiness. Would be helpful if you could just have a friendly discussion and debate sans all that and instead just present your facts and opinion in a friendly manner, as Chris has done. He responded politely to your assertions, it never came across as ‘lecturing’.
“Before you presume to lecture me on that, I wonder if you can provide me with links to RCTs (rather than observational studies) proving a causal relationship between induction at 41 weeks and improved perinatal mortality.”
Sure, right after you show me the RCTs that demonstrated that routine episiotomy is unnecessary and possibly harmful. There aren’t any, are there? That’s because for most obstetric procedures it is impossible to perform an RCT. Does that mean we should disregard the evidence that routine episiotomy increases the risk of tear simply because it wasn’t demonstrated in an RCT?
Wait. First you criticize me for using observational evidence, then turn around and say we should pay attention to observational evidence in the case of episiotomy because it’s impossible to perform RCTs for most obstetric procedures? Now you’re making my point for me. Should we ignore evidence suggesting that Pitocin has side effects and risks that most women may be unaware of because we don’t have RCTs that confirm that? Solid observational evidence plus plausible mechanisms are enough to warrant caution (both in the case of episiotomy and Pitocin), especially when vulnerable populations like pregnant women and babies are involved.
“First you criticize me for using observational evidence”
Where did I criticize you for using observational evidence? I criticized you for presenting misinformation.
Since you mentioned Hill’s criteria (the criteria used to tell the difference between correlation and causation), let’s use them.
1. Temporal relationship: Yes, pitocin was used before the bad outcome was observed.
2. Strength: This is measured by statistical tests, but can be thought of as similar to the closeness of the relationship. Are bad outcomes always caused by pitocin? No. Does pitocin always cause bad outcome. No.
3. Dose-response: Is there a linear relationship between the dose of pitocin and the bad outcome? You’ve presented no evidence of that.
4. Consistency: Does the evidence of a relationship between pitocin and a specific bad outcome come from multiple studies that demonstrate that bad outcome. Or are there only one or two studies that show a correlation and others that do not. You’ve not presented enough evidence for us to conclude that pitocin is consistently associated with specific bad outcomes.
5. Plausibility: Yes, it is entirely plausible that pitocin could cause bad outcomes.
6. Consideration of alternative explanations: You haven’t considered a single alternative explanation for any of the correlations that you reported.
7. Experiment: Are there any studies that experiment with pitocin protocols to determine what outcomes occur using each type of protocol? You haven’t presented any.
8. Specificity: Is pitocin the only thing that leads to specific bad outcomes? This is the least important of the criterion. If it is present, it is a very powerful indicator of causation. But it is not present here.
9. Coherence: The explanation of action must comport with the known laws of science, and your theories of how pitocin might cause bad outcomes (if it did cause bad outcomes) does comport with known laws of science.
How did you do?
Not too well. You only managed to satisfy three of the nine criteria and that means that you have not shown that pitocin causes bad outcomes.
My intention was not to “prove” that Pitocin causes bad outcomes. It was merely to highlight potential risks and side effects, which as I said, are printed right on the insert. The decision about whether to take a drug always comes down to weighing potential risks versus potential benefits. As I said in both the introduction and the conclusion of the article, sometimes the benefits of Pitocin will outweigh the risks, but in other cases (when the woman and baby are healthy and the pregnancy is uncomplicated) the risks may very well outweigh any potential benefit. Informed consent involves educating patients about the potential risks (whether they are “proven” or not) of a drug they will be given, and all too often that is simply not done in conventional obstetrics settings. How do I know? From my patients and the many readers that have left comments throughout the series.
I am often fascinated by the fact that self-styled skeptics are so often only skeptical of anything that lies outside the dominant paradigm. What if the burden of proof was on the manufacturer of Pitocin to show, beyond a shadow of a doubt, that induction at 41 weeks reduces perinatal mortality and routine augmentation during uncomplicated labor improves outcomes? That as not been proven with RCTs, as you conceded. So, you are willing to trust observational evidence when it comes to the use of a drug that that could potentially cause harm to mothers and babies. But when the safety of that drug is challenged, suddenly the scientific rigor and “correlation isn’t causation” argument emerges. That is not consistent.
You made a very patronizing remark:
Most people would interpret that as criticism for using observational evidence to support a claim. I think it’s disingenuous of you to suggest otherwise.
Patronizing and condescension seem to be who she is, judging from her website which is dripping with both. One would think that if a person was so sure of their position, they would have no need to be so arrogant and self-important. Chris, you’re doing a great job here. You discuss aspects of health that need attention and ask questions that too many orthodox medical professionals should be asking, but are so caught up in their rigid paradigms and dogma that they can’t see anything past their ‘in the box’ thinking. Thank God there have always been those who risk ridicule from the keepers of the paradigm within any profession, otherwise there would be no progress.
“Most people would interpret that as criticism for using observational evidence to support a claim. I think it’s disingenuous of you to suggest otherwise.”
They would? Why? It has nothing to do with observational evidence. It is a shorthand way of saying that you never even bothered to ask whether these correlations satisfied Hill’s criteria. That’s what science REQUIRES.
Chris,
I’m wondering if you’d like to take legal responsibility for the this collection of misinformation. For example, would you like to accept responsibility if a baby dies of postdates between 41-42 weeks because you cited one out of date study on the subject and ignored many more recent studies that show that induction between 41 and 42 weeks does save lives.
People may die because of your misinformation. Shouldn’t you step up to the plate and acknowledge your responsibility?
Oh, and Chris, just a tip from Science 101: correlation is not causation.
All those studies you cited that pitocin “causes” this or that bad outcome. That’s not what they show. They show that there is a correlation between pitocin and the outcome. You could do a study as show that over the past 50 years as the legal abortion rate has risen, the rate of marijuana use has also rise, but that wouldn’t mean that abortion causes people to smoke marijuana would it? See the difference between correlation and causation?
1) My readers are intelligent people who make decisions for themselves. Elsewhere in the series I have continually emphasized the importance of working with a skilled professional if homebirth is chosen. The purpose of this series, as I’ve repeatedly said, is to inform women of the potential risks involved with common medical interventions used in hospital birth. At no time have I ever suggested that there isn’t a place for them, or that women should entirely dismiss the possibility of using them.
2) I’m well aware of the difference between correlation and causation. Before you presume to lecture me on that, I wonder if you can provide me with links to RCTs (rather than observational studies) proving a causal relationship between induction at 41 weeks and improved perinatal mortality. Most, if not all of the studies suggesting that outcome are observational in nature. According to this 2009 meta-analysis of the literature
And this 2009 review states:
3) It’s not always easy to establish causation, especially when there are ethical issues involved in designing a study that could do so. As you surely know, for many years there was no causal evidence that smoking caused lung cancer – only correlation. However, using the Hill criteria you outlined in this post, it became possible to determine – even without RCTs – that smoking probably causes lung cancer. While we don’t have direct evidence confirming that Pitocin causes all of the side effects and risks I mentioned, the mechanisms are plausible and the stakes are high enough (potential harm to mothers and babies) that the decision to augment or induce with Pitocin warrants more caution than is currently given in conventional settings.
4) The package insert for Pitocin clearly indicates the risk of all of the side effects I mentioned, and several more. I do not claim that is evidence of causality, but there was sufficient evidence of the possibility of causation that they were included in the insert. Many women have no idea that there’s even the potential for these kind of side effects. They’re usually told Pitocin is safe, period. I think they have a right to know of the potential risks so they can make their own informed decision.
My wife gave birth naturally at home at 41 weeks. We made the decision to have a homebirth after extensive research, and in consideration of our values and what was important to us. That is exactly the advice I give my patients and readers: do your homework, find a skilled practitioner to work with, and make your own decisions.
Well said!
Chris,
Thank you for providing this information. I gave birth to my son this past summer at a hospital with a midwife, who I delivered with thinking she would support a natural childbirth. Instead she was very impatient with me because I quickly dilated to 9-9.5 cm, but then slowed down for a few hours, so she moved the membranes, an hour later broke my water, an hour or two later still at 9.5, so her and the nurse kept encouraging me to take pitocin, saying that it’s a natural hormone and the only side effect is powerful contractions. I wasn’t aware of the impact on the baby and I gave in to their pressure. What’s even more disturbing and unethical is that they told me they would give me a small dosage since I was already so close to delivery. However, I just received an itemized bill and discovered that they ordered 30 units (the max) of pitocin and 2 10 units! 15 min after they administered the pitocin I really had to push, but they made me wait another 15-30 min, during which time they gave me an oxygen mask, it took another 15 min or so to push. I hope the baby is not a victim of the drug’s side effects – he was delivered an hour after the pitocin, but the contractions during that time were extremely intense. They kept me on pitocin a few hours after delivery and the doctor had to help with my 3rd degree tears and even she questioned why I was still on pitocin. It was an extremely disappointing experience. I suppose I should have been stronger and prepared to prevent these invasive techniques. Unfortunately, I wasn’t and didn’t expect such complications with a hospital midwife, who I guess just wanted to get off her shift and follow hospital policies. I just hope my son doesn’t suffer from the pitocin. If I have another child, I will probably have a homebirth with a midwife.
I had pitocin for child 1 and child 4, given because my labors were so incredibly long, yet there was no fetal distress. I’ve always wondered if there have been studies showing long term effects on behavior of the the child, because both of those boys (I had 4) seem to be very similar in terms of their impulsivity, low frustration tolerance, hair trigger tempers. And each is from a different father.
Cindy,I’m not a medical expert, but I have had the same experience. With two of my five births, I was given pitocin, which caused much harder, more painful contractions. That resulted in me begging for something to cut the pain enough for me to progress. I refused epidurals, but was given Demerol. Both the children that happened with displayed the same behaviors you describe. Not only that, but both had extremely heightened startle reflexes as infants, cried nearly all the time, wouldn’t fall asleep without being in motion, etc… I began asking my friends who had had basically the same interventions, and found that most of them also had those same behavioral problems. One sent me information that she had found, showing that there used to be a warning in the Demerol insert that it should not be used during pregnancy and labor because of an increase in behavioral anomalies like the ones described. She also had spoken to her doctor- who was an older doctor( from the days when breech babies and twins didn’t mean an automatic ceasarean) who told her he had definitely noticed more and more problems in children whose mothers got these now routine interventions. And he told her that in his opinion, interventions in labor were the probable cause of most of the ADHD, learning disabilities, and behavioral problems, as he could see in the statistics that as interventions went up, so did those problems. He then pointed out that countries that do not use those interventions as much have much lower rates of those conditions as well. It isn’t scientific evidence, but it’s enough to make one wonder.
Sherry, that is extremely interesting to me. I did not have Demerol. Son 1 just pit, and pudental block, son 4, epidural (which did not work) and pitocin. So it seems the common factor is the pit. And YES, both of those sons also seemed to have heightened startle reflexes, cried all the time, easily stressed, resulting in terrible temper tantrums that could go on for hours (more so with son 4, but then I had him at age 43 and worked as an ER trauma nurse at the time, so all those factors probably combined to make him more intensely irritable and frustrated)
I fear due to the extremely litigious society we now live in, where people sue at the drop of a hat even when there’s no evidence of wrongdoing, that doctors are between a rock and a hard place, and CYA is the name of the game to protect themselves. Unfortunately, we are slowly discovering that the baby pays the price in subtle, and some not-so-subtle ways. I do not believe all this relatively new interventions in the birth process (other than life-saving) are without consequences, whether short or long term.
The birth of my son 2 years ago was assisted by the use of pitocin. I am now 14 weeks pregnant and hoping/planning for a natural birth, possibly with a midwife due to my experience and research.
My contractions before pitocin were managable. However, once I was given the pitocin I could barely walk from the painful contractions. I went from 2 to 4 centimeters dialated and was begging for an epidural courtesy of the pain.
My son’s heartrate dropped on several occassions during my labor and they had to stop giving me pitocin to bring it back to normal.
I was also put on oxygen during this time though I can’t remember what reason they had for it.
I was prepped 3 times for a c-section as my labor was not progressing at a rate that they liked/thought was safe.
By the time I was ready to push I had been in labor for 20 hours. My son was born during my 24th hour of labor after 2 hours of very painful pushing as my epidural had started to wear off and I wasn’t allowed more.
In addition to all of this I had a retained placenta and the doctor had to manually remove it, causing worse pain then the actual birth.
Thankfully the medication doesn’t seem to have caused any lasting harm to my son. He is very happy, bright and loving.
It keeps me wondering what the process would have been like had I just let thing go naturally.
I do respect your active effort to provide balance in your arguments and points. As a physician, it is clear to me we have a lot of vicious cycles and toxic partnerships in healthcare, which actually promote disease in order to sell “cures.” I believe in modern medicines ability to treat acute problems, but the more I see and study, the more I see that we are weak on chronic illness, and what’s worse, remaining weak on this front is profitable. This is a great frustration to me the more I practice. It feels we are here to keep the machine running than run the machine.
Chris, you make excellent points, and I think you are right. As physician, it simply boils down to this: you don’t want to get sued. The standard of care reflects this: patience and waiting are deathblows in a medicolegal case. Active management of risk is your only protection, ie things you control. Hence, pitocin and c-sections. If you add the fact that liability insurance is huge for OB/GYN say 100 to 200 thousand, and insurances don’t pay, then doctors are under all sorts of pressure to perform in ways that don’t benefit patients or themselves.
Those are excellent points. I agree that physicians are often just as much victims of the systemic problems in medicine as patients.
Thank you for this article. It is very true that both pregnant women and doctors pay a very high price for this type of “defence”medical care. But women and babies pay more. The only way out I can see, is that women will stop givng away their responsibility and control over their bodies during childbirth and health care providers will not force them to do so by any means. On the contrary, they will encourage them to keep their responsibility and controll based on a strong believe, that there is no more competent person to make the best decision for this particular mother and baby in her body, than the mother herself.
I have family in the medical profession, and I can absolutely assure you this is the case. Doctors know deliberately provide sub-optimal care because they can be sued if they don’t (whereas lawsuits for unnecessary interventions routinely fail.) Pushing for extra monitoring and intervention can be necessary to retain the ability to practice medicine.
Chris, I wonder what you think of the use of Pitocin immediately pospartum to reduce the risk of postpartum hemorrhage by causing uterin contractions to get the uterus reduced in size. It’s my understanding this is done, at least in the hospital we’re delivering at, even when the mother did not receive Pitocin before & during labor.
I just gave birth to my sixth baby. Every time I have been given pitocin after delivery to reduce my uterus. I have never had a side effect or problem from the use of pitocin after birth.
Pitocin immediately after birth really should be used only if hemorrhage warrants the need. This is something patients can refuse. Breast
Hi Chris,
Great article, the prevalence of routine inducement is always something that has bugged me. I have even heard of women being induced in order to accommodate doctor’s vacation time!
Along with the issues you have mentioned, I came across a paper (which I can’t for the life of me find now – typical!) when researching my thesis that many male foetus’ gestational age may be incorrectly measured due to males being inherently longer than females, so may of those ’41+’ pregnancies may not be at all.
Hope mama and baby are both doing well!
My very ignorant, Medicaid stepsisters have allowed all their pregnancies to be induced weeks before their due dates to accommodate both theirs and the doctors schedule. The latest was 3 weeks prior to her due date so that she could deliver before Dec 31 and claim the new baby for “earned income credit” tax break on that years taxes.
I have given birth four times without Pitocin and three times with it. All were without pain medication of any kind. I noticed no correlation whatsoever between my level of pain and the use of Pitocin. The only reason I bring this up is to encourage any expectant mothers who read this. Even if you end up needing this one intervention, you don’t automatically need to progress further down the unnatural path by getting an epidural. When I needed Pitocin for the first time, a friend had told me that it wouldn’t hurt any worse. I was so glad she told me that! Now I’m just passing the info along.
I too have been given birth with and without it and the pain with it is a hundred times worse than without it. My natural laborious pains I didn’t really believe were laborious pains because I was compairing them to pitocin pains
I just gave birth recently and was given pitocin because my water was broken for 20 hours and I was not having strong contractions. After 13 hours of pitocin induced labor (back labor) and no epidural I must say that I was in a shocking amount of pain but don’t have anything to compare it to. And to make matters worse it only made me dilate 1cm, even though I was contracting every minute and contractions were lasting almost a minute…for hours and hours and hours… Now one could argue that my body wasn’t ready to be in labor however my water broke naturally. My doctor let me go waaaay longer before intervening than most doctors. The nurses were trying to give me pitocin a few hours after I got to the hospital and were miffed that I refused for so long. In the end though after 33 hours of my water being broke, I was at the point where I wasn’t willing to risk getting an infection so I agreed to an epidural and to having the pitocin turned up. I had to, as I couldn’t tolerate the pain from the amount of pitocin I had already been on. It wasn’t my plan, but I don’t regret it. My baby was born red as a beet, screaming at the top of her lungs and had an excellent apgar score. We had absolutley no side effects afterwards and are both totally healthy and happy. And the rush of feel good hormones didn’t come after delivery because of the drugs, but I got them a few hours later in the recovery room while smelling and nuzzling her head. I was overcome with a tremendous and uncontrollable joy.
I, too have experienced birth both ways and felt that labor with pit. is a nightmare. I never had natural contractions with the pain and intensity of pit. contractions. With that said, it depends on the practitioner and the rate of administration and possibly your body’s response to the medication in general.
Don’t be afraid, because an epidural can be given when you’re dilated to, at least, 3…BUT contractions with pitocin are much worse in most, but NOT all, women. In most, they are much longer and stronger. The reward is so worth it…keep your mind on the prize! You CAN do it.