Sunday, November 29, 2009

further...

I also wanted to mention something I learned about Pitocin from Pushed. Pit is the synthetic, pharmaceutically developed drug that mimics oxytocin, a natural hormone produced in humans. Pitocin is used to begin labour (induction: usually used in combination with a cervix softening drug that is placed on the cervix), or to augment labour that is slow or stalled. There are medical indications for induction and augmentation, but Pitocin is overused, especially in some hospitals. I personally know of no one who had a augmented labour, though I know several people who have been induced. I think augmented and managed labour is more prevalent/popular in America (though I can't speak for Canada beyond BC, and I have heard that the further West you go in Canada, the more physiological/natural birth tens to be), but it was interesting to read about Pitocin labours. Pit mimics oxytocin in stimulating the uterus to contract, but this stimulation tends to be on the strong side. Pitocin labours are reported to be much more painful than natural ones, and contractions stimulated by Pit are measured to be longer and stronger than your average natural contraction. Contractions that continue at that intensity are often hard for the baby to handle, too, because of the stress of being compressed, and because oxygenation of the placenta is reduced during contractions, so the baby has less oxygen in a Pit contraction than during an average natural one. Some babies get so deprived that they go into distress; hence, the higher need for cesareans with induced/augmented Pit labours.
But another interesting fact is that oxytocin crosses the blood-brain barrier, but Pitocin does not. Oxytocin crossing the blood-brain barrier causes endorphin release (pain relief!) AND stimulation of prolactin, which is the bonding and breastfeeding hormone. Pitocin not only doesn't stimulate endorphins and prolactin, it supresses the body's natural oxytocin, REDUCING the amount of oxytocin available to stimulate endorphin and prolactin release. SOOOO interesting! And so many implications!!
The pain of labour often stimulates fear, which also reduces oxytocin levels and increases pain perception. If women are well supported during labour and understand the fear-tension-pain cycle, they are generally better able to cope with the intensity of contractions. Pushed indicates that it is possible that pain in labour acts much like other pain, in that it gets you to move. If you burn your finger, moving it away from the source of pain is pretty important: if you sprain your ankle, moving it around helps you identify what feels best and what feels worst, and how to protect it. Same with labour. Movement in labour actually shortens the duration of labour because it wiggles the baby down through its tight squeeze journey from uterus to the outside world, so anything that stimulates that movement would be a good thing.
I've often felt that the pain of labour is meant to capture and focus a woman's attention. The pain says, "This is a really important event! You need to find a safe, private place to give birth! You need to pay attention! You need to focus on this important physiological process!" Without which, birth would be less safe.
So, between natural pain relief through endorphin release, natural bonding and breastfeeding physiology, and encouragement of movement and capturing the labouring woman's focus, natural oxytocin is superior to pharmaceutical pitocin.
I'm continually surprised by the amount of things there are to learn....

8 comments:

Caryn Ouwehand said...

I was augmented with Pit at 10 cm to assist in pushing out a big baby that was poorly positioned in my pelvis. Within the hour we were downstairs doing a c-section & baby was born with an APGAR of 2.

...I'm not saying that the Pitocin alone caused all the complications I had at the end of my delivery... but I dont think it helped at all. I remember begging them to turn it off, but they said it was "helping me push out the baby."

Ugh. It hurts to talk about it.

amy frances said...

I love to read your blog. Like, seriously.

Tonya said...

You "crack" me up - birth crack. :-) When I was having liver problems w/ Seth, they were considering having to use pit. I was terrified! But I had a good midwife. :-) She said that the midwives use almost NO pit and can get labor to start - with a very very tiny amount. And if they have to increase the amount, they increase it in tiny amounts. MUCH better than the standard usage - start everyone at some number and then crank it up higher ang higher. She said the dr's were always amazed they could get labor going with such a small amount.

I ended up getting started with some cervical gel (praise God) and didn't need pit. :-)

nancy said...

oxytocin use to augement labour is alive and well in BC hospitals! Not as common as in inductions but still used if a labour slows down (or Dr in a hurry)
We used to call it pitocin but for decades it is called oxytocin - will do some investigating to see if it is synthetic or not!

Asheya said...

Sooooo good to read your blog again!!! I was augmented with my first son during the pushing stage, as my doctor said my contractions were getting weaker and I was getting worn out. No kidding. She had me doing directed pushing and in all sorts of positions that were either not effective for pushing or exhausting (up and down to squat hanging onto the bar above the bed for every contraction...I was basically doing gymnastics during labour).

My two labours at home were so much better!

Asheya said...

Sooooo good to read your blog again!!! I was augmented with my first son during the pushing stage, as my doctor said my contractions were getting weaker and I was getting worn out. No kidding. She had me doing directed pushing and in all sorts of positions that were either not effective for pushing or exhausting (up and down to squat hanging onto the bar above the bed for every contraction...I was basically doing gymnastics during labour).

My two labours at home were so much better!

Dana said...

I was augmented with Eva... after 10 hours of active labour and maybe a cm of progress. I remember clenching against the contractions as I paced the halls. My midwife consulted with the OB on call and when I spoke to her in June she still felt it was absolutely the right call. I probably relaxed after laying down, and I so just had a small amount of pit because things started moving along. I didn't feel a difference in the contractions from the pit and didn't need pain meds because of it. I am so glad I had a birth attendant who didn't just crank it up regardless of how things were going- I've read some horror stories.

Rachel Clear said...

"Pushed" is next on my reading list. Thanks for the info, Mel!