Pitocin and Birth Injuries

When the time for a baby to be born finally arrives at the end of pregnancy, the mother’s body starts releasing a unique hormone called oxytocin. Oxytocin is what triggers uterine contractions and basically fuels the process of labor and delivery.

Pitocin (and Syntocinon) is a synthetic reproduction of the oxytocin hormone. Doctors often dispense Pitocin to pregnant mothers to induce the start of labor by stimulating uterus contractions and/or to accelerate labor and delivery. Pitocin is widely utilized in labor and delivery rooms and can be highly effective when used carefully and responsibly. However, the use of Pitocin to induce or speed up labor often results in overstimulation and fetal distress which increases the risk of birth injury.

Pitocin is not a bad drug. But it is a dangerous one with dangerous side effect. The side effects can usually be managed by attentive obstetricians and delivery nurses.

What Is Pitocin?

Pitocin is an artificial form of oxytocin. Oxytocin is a natural hormone released by the pituitary gland and it serves a critical function in the childbirth process. Oxytocin stimulates the muscles of the uterus to contract and start the process of child labor. Oxytocin continues to fuel the labor and delivery process by prompting the body to release prostaglandins which further increases the frequency and intensity of uterine contractions. Pitocin is administered intravenously in order to stimulate contractions.

The Pitocin is quickly absorbed into the bloodstream and triggers the same biological reactions in the mother’s body as oxytocin. Pitocin binds to receptors in the uterus. This actives the woman’s uterine muscles to facilitate contractions.

OB-GYNs typically use Pitocin for one of 2 reasons: (1) to induce the start of labor when the baby is overdue; and (2) to stimulate contractions and jump-start labor that is not progressing fast enough.

Problems With Pitocin

Pitocin has its critics. Several studies have demonstrated that the use of Pitocin increases the risk of birth injuries and other negative events during childbirth. There are 2 underlying issues with Pitocin that account for this: (1) dosage response; and (2) hyperstimulation.

Administering the proper amount of Pitocin is very problematic because the effects of the drug on women vary dramatically. Some women who receive Pitocin tend to over-respond to the drug and start having overly strong and frequent contractions. But in other women, the same dose of Pitocin may have little or no effect at all. This problem is often compounded by the fact that once Pitocin is given doctors have no real way of measuring its effect. Adding yet another layer of complication is the delayed reaction time to Pitocin. The effects of Pitocin do not kick in until 30-45 minutes after it is administered. As a result, second doses of Pitocin are often given before the effects of the initial dose can be fully assessed.

The second issue that makes Pitocin so problematic is a potentially dangerous side effect known as hyperstimulation. When oxytocin is overdosed or a woman over-responds it has a tendency to hyperstimulate the muscles of the uterus. This type of overstimulation can trigger contractions that are too powerful, too frequent or too long which can overstress the placenta and threaten the health of the baby.

Ultimately, induction puts the patient into labor. Labor causing contractions. Contraction can affect the blood flow and the oxygen delivered to the placenta. The placenta is a key organ that develops inside the womb and attaches to the wall of the uterus. The placenta is responsible for delivering oxygen and nutrients from the mother to the baby until the baby is born and starts breathing on its own. Each time uterine contractions occur during labor, the placenta gets momentarily compressed and blood flow to the baby is restricted until the contraction subsides. This makes ample rest time between contractions very important because they allow the baby a chance to get oxygen before the next contraction.

So if there is any compromise in the blood flow of oxygen to the fetus for any reason, contractions will exacerbate the problem, leaving the baby in need of critical oxygen.

Hyperstimulation from Pitocin can result in intense contractions with as little as 2 minutes of rest time in between. This can critically impair the functionality of placenta during labor and restrict oxygen delivery to the baby. Oxygen deprivation during childbirth is extremely dangerous and one of the leading causes of neurologic birth injuries which can result in permanent disabilities like cerebral palsy.

Anecdotally, some women believe that delivery with an oxytocin enhancer is more painful. This may well be true but there is no medical literature that supports this theory. Here is one more along the lines of “people think that….” There is also a theory that heavier women need more Pitocin to induce contractions than leaner women. There is a clinical trial at the University of Arizona looking into this theory.

Guidelines for Pitocin

The inherent dangers of Pitocin have led to the development of very strict medical guidelines for the appropriate use of the drug. These guidelines instruct that Pitocin should be administered conservatively starting at a very low dose with careful fetal stress monitoring. Once uterine contractions reach a normal pattern no further Pitocin should be given. Finally, if labor is still not progressing even after Pitocin has triggered normal contraction activity doctors should resort to C-section delivery NOT more Pitocin.

The American College of Obstetricians and Gynecologists (ACOG) recommends that every hospital should develop and implement clear guidelines for the administration of Pitocin and that these should include both lose-dose and high-dose regimens. Almost all hospitals in the U.S. have followed this advice and formally adopted Pitocin administration guidelines.

Pitocin and Postpartum Hemorrhage

Misuse or overdosing of Pitocin for labor induction has also been linked to an increased risk of postpartum hemorrhage in the mother. Several studies have reported higher rates of postpartum hemorrhage among patients who were induced with Pitocin compared to those who did not receive Pitocin.

Scientific Studies on Pitocin

Feldbaum, Victor, Maurice Hord, and Tiffany Tonismae. “Comparing delivery outcomes of concurrent use of mechanical dilation with low dose versus medium dose pitocin versus balloon catheter only.” North American Proceedings in Gynecology & Obstetrics 3.2 (2024). A retrospective analysis that compares delivery outcomes when labor was induced with manual dilation/induction versus the use of Pitocin at both high and low dose levels.

Hermesch, Amy C., et al. “Oxytocin: physiology, pharmacology, and clinical application for labor management.” American journal of obstetrics and gynecology 230.3 (2024): S729-S739. General medical overview of the use of Pitocin for labor induction.

Kette, Bethany, Rebecca L. Chornock, and Sara Iqbal. “Postpartum Hemorrhage Risk due to Prolonged Pitocin or High Dose of Pitocin Exposure.” American Journal of Obstetrics & Gynecology 226.1 (2022): S541-S542. This study attempts to quantify the maximum exposure time and dose levels for Pitocin at which the risk of postpartum hemorrhage starts to increase significantly.

Cryer, Alicia M., et al. “Factors Associated with Increased Risk of Uterine Rupture in the Intrapartum Period.” American Journal of Obstetrics & Gynecology 226.1 (2022): S402-S403. Evaluates various factors, including the use of Pitocin for induction, that can increase the risk of uterine rupture during labor.

Phung, Laura C., et al. “Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis.” American journal of obstetrics and gynecology 225.3 (2021): 250-e1. Study evaluating the rates of postpartum hemorrhage as it correlates to the dosing level of Pitocin for labor induction.

Birth Injury