Thursday, August 28, 2008

Long-term effects of Pitocin

Thanks to a doula from Portland, I learned of a recent study about the long-term effects of Pitocin use at birth. Below is an excerpt from her findings. To read the summary in full, including more information on her study design, click on the study title below:

The Relationship between Artificial Oxytocin (Pitocin) Use at Birth for Labor Induction or Augmentation and the Psychosocial Functioning of Three-year-olds

The focus of my dissertation research study was, as you can see by the above title, an exploration of whether there is any relationship between the use of Pitocin (artificial oxytocin) to start or speed up labor, and the way children born with its use function individually and in their relationships when they are three years old...

The following is a summary of the findings that were statistically significant.

1. Receiving Pitocin resulted in more negative recollections of labor and delivery, suggesting that mothers who received it had a more challenging experience than those who didn’t. However, there was a similar finding for the use of epidural anesthesia and for pain medication, both of which tend either to precede or follow the use of Pitocin.

2. Mothers who received Pitocin spent less time with their babies in the first hour after delivery, and were less likely to feed their babies exclusively at the breast in the first six months. In other words, babies who were born without Pitocin were more likely to be fed exclusively at the breast in the first six months than those born with Pitocin

3. Two factors distinguished children born with Pitocin from those born without Pitocin.

The first was called “Assertiveness”, which describes a socially appropriate way that babies and children communicate their need for help and comfort when they are feeling uncomfortable or unsafe. Typically, crying, using facial expressions and physical gestures, and later, verbalizing their thoughts and feelings, elicits helpful responses from parents, who try to identify and meet the need the baby or child is expressing. However, babies born with Pitocin, whose mothers reported having had a more challenging time during labor and delivery, appear to have a higher need to be assertive because they seem to experience more discomfort, but are apparently less effective in asserting their needs and getting them met when they feel unsafe or uncomfortable.

The second factor was called “Need to Control Environment” and this summarizes what seems to be a higher level of discomfort or insecurity, particularly in response to “outside-in” influences (e.g., reacting to food with digestive problems or being picky eaters; problems coping with other people’s timing and structure, refusing help from others) and increased or exaggerated efforts to control their environment, resulting in behaviors that may be more challenging to their mothers/family. There appears to be some continuity of effects between infancy and age three: for example, children who were described as picky eaters, or as having digestive problems at three, were likely to have been colicky, fussy babies. Interestingly, the hormone oxytocin is very involved in the digestive process: it plays a role in the production of digestive enzymes and as we enjoy our meal, in a positive feedback loop, we produce more oxytocin.

It may be that a process described as “hormonal imprinting,” identified in a considerable number of animal studies since the 1970s, is the mechanism that accounts for these differences between children exposed to Pitocin and those who were not. Using Pitocin to initiate labor may “flood” the available oxytocin receptors in mother and baby, apparently affecting children’s internal comfort levels and how they interact with others, although how this takes place in the babies has not yet been studied. Since both mother and baby receive Pitocin during labor and delivery, it is as yet unclear to what degree each contributes to challenges in their mutual relationship.

Claire L. Winstone, Ph.D.
Santa Barbara Graduate Institute July 2008

26 comments:

  1. I was given Pitocin without my knowledge during labor (I was only told that I was receiving IV fluids). I was understandably upset, as my labor was progressing decently and I would have refused it. My son was very jaundiced and had some of the other symptoms listed here.

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  2. Rixa,

    I am so glad you posted that!!!!!! Thank you so much for passing it along. I was fascinated by the results of the study. It was sitting in my inbox for a month waiting for me to shamefully march over to my neglected blog...

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  3. i was wondering whether or not multiple variables would cast a doubt on the validity of the study. for example, more natural moms would turn down the pitocin and be in favor of responsive parenting, and conversely a more mainstream mom would be okay with pit and parent at arms length(or more)and thus bring about the symptoms in the three year old- just based on attachment theory.

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  4. This study seems like it belongs in the creative writing department and should not be passed off as scientific in the least bit. What in the heck is the Santa Barbara Graduate Institute anyway? Can I send in my $2 and become a minister from their school?

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  5. Just a reminder here--let's refrain from sarcasm and snarky remarks please.

    Sarah--I would be very upset, too, to receive Pit without my consent. What was the excuse for giving you Pit (and not asking you first)? Did you ever lodge a complaint about it? After all, hospitals are supposed to uphold informed consent, which includes a patient's right to refuse a procedure after having been educated about the full range of risks and benefits.

    Elizabeth, good questions to ask.

    Certainly no study is perfect, and authors always will acknowledge the limitations as well as strengths of their research. This does raise interesting, and still unanswered for the most part, questions about the long-term effects of a drug that the majority of women receive during labor.

    To the other poster: I had asked you a while back not to comment on my site, and you know that anything you write (even if it's "Rixa rocks!" LOL) will be deleted.

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    1. I was given pitocin right after delivery i had opted for the cord to be clamped 10 mins after birth. But was wondering if the unnecessary pitocin negated some of the benefits of delayed cord clamping...My placenta came out fast and the midwife could go home early, but i suspect my baby got less oxygen than she shud have as the placenta was already outside my body and due to the fact that pitocin hinders oxygen supply...my baby is 6 months now and has some motor delays, i m just hoping its not because of pitocin!

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  6. I think elizabeth makes a good point, but am happy to see this topic being considered. It seems reasonable to me that changing the hormonal soup of a natural process will have unwanted repercussions. There may well be a time and a place for pitocin, but like much else, it's often being used as a matter of course, and often without consent (informed or otherwise). Hopefully more in-depth, controlled studies will follow.

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  7. I'm glad to see correlational research being done on aspect of obstetrical practice. I hope more of these studies will be conducted (and that I'll have a chance to conduct them too!) Thank you for sharing this summary, Rixa.

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  8. I found your blog through a friend. I was induced at 41.5 weeks using Pitocin on the agreement of the midwife that as soon as I was progressing well they would turn off the Pit and let me labor naturally.

    When I was 6 cm and 90% effaced I asked for this to happen and they refused saying that my labor would stop. Instead, they cranked the Pit up to the highest setting, saying I was progressing too slowly. I was having contractions 1 minute apart and didn't have the energy to fight them, although I did beg. It seems heartless to do such a thing and I hope that your research and others will help change the overuse of Pitocin in birth.

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  9. There was no excuse except that the nurse just didn't bother to tell me. I found out after my labor. I'm going to review my records before deciding whether to issue a complaint or not. As my son is healthy and I signed a "general consent", it saddens me to think there is no point in it.

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  10. Interesting, although I would wait for it to be published in a peer-reviewed source before attaching too much significance. Even the best of PhD committees fail to catch errors (as do reviewers). That said, I would do as much in my power as possible to avoid Pitocin based on the horror stories I've heard.

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  11. ok Rixa I am gonna try with all the self control I have not to be snarky....Really. What about the long term effects of methergine, cytotec, hemabate? These are all used to stop a woman from bleeding to death.

    I agree that we use too much pit. I have a floor full of failed inductions with epidurals.

    However, pitocin has saved many lives. Has induced many woman who were inducable (bishop score) whose baby may have been a cord accident if left to their own devices.

    Yes, there is no reason to Pit you if your labor is moving along reasonably. I have worked per diem in an institution that the Dr. wanted me to keep pushing the pit and I refused since she was dilating according to the Freedman curve and was contracting every 2 minutes strong.

    The Doctor said "just give me one decel and then I will back off." I told her that could be the decel that rips the placenta off the uterine wall and I can't afford the lawyer bills.

    I no longer work for that institution.

    But don't throw the baby out with the bath water. Pitocin, epidural, cytotec: these are all tools to be used wisely. They all have side effects. But they are not the work of satan either.

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  12. Pinky--
    I agree that Pit, like any other drug or procedure, has its time and place. And it, of course, isn't the work of Satan (and I certainly never said that myself anywhere!). I am very concerned about its widespread use, though. It is a powerful drug that should be approached with a lot of caution and respect. I also hope that we will continue to conduct research on the long-term effects of commonly used drugs at birth. Doesn't mean that their use will be eradicated, but it's important to know what implications Pit during labor may have down the road. Some women may be okay with accepting that set or risks; others may not be.

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  13. I may be the unusual with being induced with pitocin. I was induced at almost 42 weeks and my l & d was very fast, fairly painless (I took no pain meds, and had no epidural). Intense, yes! But then isn't that what labor is? Anyway, I didn't rip, and my baby came out looking like a c-section baby. She's super healthy, rarely gets sick, and I nursed her from minute 2, to month 18.
    I am glad I induced as I was in such great discomfort, that I was unable to sleep well, and was becoming more and more tired. I think that if I had waited for nature to take it's course, then I may have been too tired to go w/o pain meds, or the epidural.

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    1. My case almost exactly! I was happy with the way everything turned out... quickly and intensely :)

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  14. I would definitely not try to convinced anybody to go or not go with Pitocin. However, personally I am going to make sure that my doctor knows I do not want it unless necessary and after I am told about it. Like Elizabeth, I was not told that I was being given Pitocin in my IV. At the same time, it was my due date and it was unnecessary since I was 5 cent. dilated in four hours (when I got to the doctor's office) and by the time I got to the L&D room (1 hour later) I was already 6 cent. My labor was going fine, I just think that my doctor wanted to get out of there early. I had a healthy pregnancy with no complications whatsoever. If my doctor would have told me he wanted to go home early, I would have gave him my blessing because the nurse was amazingly smart, professional and I could have had this baby with her without problems. What really irritated me was besides not being necessary for me, receiving Pitocin carries the risk of receiving other interventions. My contractions where so strong that my Dr. told me I had to receive an epidural (which made me horribly tired and did not take the pain away, AT ALL) before he broke my water, then I could not get out of bed (because of the epidural)so I had to get a urinary catheterization to empty my bladder and my baby was under stress (not surprisingly) and the doctor was getting ready to do a c-section when the nurse told him NO. I am positive, I would have had a much better experience if the Dr. would have left nature do its job, since I was fine before I got to the Birthcenter. This time, I would stay home until my contractions indicate that the baby is close to come. The only way I will let them give me Pitocin is if the baby gets to big and I need to be induced.

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  15. It seems to me that the use, or non-use, of pitocin is just a proxy for other factors that contribute to the psycosocial behavior of those babies at age 3.

    Questions:
    1. Why age 3? Why not age 2? Or age 5? Etc.
    2. How did you account for/cancel out other variable factors, besides pitocin, that existed at the onset and duration of labor?
    3. What about pitocin given after birth, to help the delivery of the placenta? (This is when I received pitocin.)

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  16. I am so glad people are bringing up legitimate concerns with this post. I had 3 babies, all with pitocin AND epidurals AND I nursed them all for a year AND they are all bright, happy, accomplished kids.

    The part that correllates a mom not breastfeeding because they had a pit labor is rediculous. There are so many factors involved with choosing to breast feed or not, I can't even believe this "fact" was allowed in an academic paper.

    I think Elizabeth hit things right on the nose about the questionability of this paper.

    I'm sad people have had these horror stories, but I hope it simply helps people to make an educated decision about where they deliver...most of the stories seem to be about a person that doesn't listen to their patient more than a horror story about pitocin.

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  17. I took the Bradly method birthing classes and loved them. My water broke 3 1/2 weeks early at work, except it was a very slow drizzle. I was having no contactions. I call my sister who paniced and told the hospital I had waited more than 24 hours after my water broke. I felt cornered and overwhelmed and finally went to the hospital, still without contactions. I was put on petocin (and antibiotics), I went along willingly, which I now regret. I didn't call my birth class teacher. AT the age of 38 I had 4 hours of labor and pushed my daughter out in 20 minutes.
    She is 15 now, and I've always wondered did I hurt her, could I have waited, could they have encouraged me to wait alittle long, till my own contractions kicked in. My daughter is troubled, she is mildly ADD and very disorganized with her body, I can't explain it but it's like something is off, and I can't put my finger on it. More studies should be done, thank you.

    Thanks
    Paula
    Arlington, Vermont

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  18. My wife had an ultrasound about 1.5 weeks before our son was due. During the ultrasound, they deemed that the amniotic fluid was too low. The OB recommended immediate induction [with Pitocin]. Her birth plan got tossed right out of the window (as "most do anyway" at hospitals - this coming from a nurse in the maternity ward of a different hospital).

    What followed would be one of the most difficult births that the rotating nurses would yet see. Not only were contractions MUCH more intense and painful for my wife, but the labor was long and much more exhausting.

    Baby's heart tones dropped coming through the birth canal, and the OB was almost ready to call for a C-section, when my son's beautiful little head started popping out.

    Approximately 30 minutes after he was born, my wife began feeling intense pain 'down there'. The nurses passed it off as soreness from the delivery. "Yah just had a baby sweetie! Of course you're hurtin'!". Nah, that wasn't it. She had developed a very large and growing hematoma from the extra intensity of her contractions, probably aggravated by a lowered ability to sense natural-feeling pushes during delivery (she got an epidural).

    The pain was so intense that she begged for help in whimpers. It brought me to tears as I saw her endure significantly more pain than the labor and delivery could ever have imposed - but this time it was constant.

    Morphine was administered to control pain, and she was unable to breastfeed and bond with our new son. I was scared. It took us 2 months to get him comfortable with breastfeeding.

    I have no idea what the potential long term effects will be, but my son is healthy and active at 6 months old. My wife and I both wish we'd never have gone to that last appointment for the ultrasound.

    Pitocin is horrible...

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  19. Hi All,

    I'm a WHNP/CNM student and I am beginning my research on the informed consent process with regards to pitocin. The L&D unit where I am currently located does not have specific, detailed guidelines for the consent, but rather a general medical consent form which only refers to augmentation. Therefore, it appears (on paper) that women are not fully informed about the their rights surrounding the infusion of this specific medication. I am also curious to start a discussion on what the perceived nurse's role with regard to informed consent is. For example, how can a nurse caring for a laboring woman who has just been ordered pit accurately assess whether true informed consent has occurred? Should nurses be quizzing patient's on their knowledge of the drug? Should they ignore their role in the informed consent process and assume the prescriber gave detailed information on the benefits, risks and current evidence-based research? I have not found this nursing role to be well defined, and I am quite curious to hear other mothers' stories. The reason I am so interested in this is because if we are to empower our patients and advocate for their autonomy, shouldn't we be taking on the responsibility of making sure they are as educated as possible? We want them to be partners in their own health, do we not? But where do we draw the line, and when is that line crossed over?

    I look forward to your varying opinions!

    -Nurse H

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  20. Nurse H--

    When you register at the hospital you sign a general or blanket consent form. This pretty much covers the hospital for legal "on paper" consent for any and all treatments the docs want to do. The only time they get specific additional consent is for anesthesia or surgery. Some hospitals now have women sign a c/sec consent form upon admission to the hospital...As a patient, I would HOPE that if the nurse had good reason to believe my right to informed consent/refusal had been violated or was not being respected, she would uphold the ethics of her profession & fight for patient advocacy, by informing me herself and/or confronting the doc about his failure to do so. I would hope she would also file complaints with the proper departments to ensure this practice was halted. I know I'm living in a dream world...BUT if all nurses did this & all patients accepted no less than true informed consent/refusal, this problem would disappear.

    Pit is a drug. it is a medical intervention/treatment. Just like any other, it carries very real side effects & risks. There are times when those risks outweigh the risks of continuing the pregnancy. But not always. 60% of women are induced w/ it and 40% are augmented with it. That means a majority of women are not able to go into or proceed through labor without it? Statistically Impossible!

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  21. I am interested in the study of the effects that Pitocin and other drugs have on both the mother and baby. However, in reading the summary findings of this study, it seems the sample is both small and biased. From what I can tell, the survey questions were given to mothers who had already sought therapy for their child who was exhibiting troublesome behaviors. As a therapist myself, I know that peoples' behaviors are often a result of many variables, not just one and many times there is both nature and nurture at play. Also, one must be very careful to draw conclusions about cause and effect when the evidence really only suggests a correlation. Additionally, I am curious as to whether the survey was given to any moms who did not receive pitocin. Lastly, I believe that there is a strong possibility that those who choose to have pitocin for non-medical reasons may have different parenting styles than those who choose to have an unmedicated birth. In my work with children, I have seen that a parent's style of relating to, nurturing, and discipling his or her child, plays a significant role in the child's responses to other people and to his or her environment.

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  22. I was induced with Pitocin at 41.5 weeks. I held off as long as possible but nurses and doctors were really adamant about administering Pitocin. A pregnant woman is vulnerable during this time and it’s really difficult for them to resist doctors and nurses who are trying to convince them. You almost feel bullied or like a bad mother if you don’t take it. I had read all the side effects and even read an online label which stated all the side effects. I requested to read the box, label and pamphlet at the hospital but it said nothing of those same side effects, which I thought was strange. Anyway, it was my second child and my labour was excruciatingly painful. My first was all natural and way more tolerable in terms of pain. When my baby was born, she cried almost constantly, could not get comfortable and was easily startled awake. I did breastfeed and only had problems in the first two months, which can be normal. Until recently, she refused to fall asleep anywhere but in my arms and would only sleep in my bed. She woke frequently and always had to touch me to fall back asleep. She is now almost two and stills wakes several times at night. She has always had digestion problems, major constipation and she is a picky eater. She is very sensitive and will cry at sad songs, gets upset when other babies cry, gets angry quickly when things don`t work how she wants them too (that could just be quick temper). She is incredibly loving and needs a lot of love and attention, constantly. I do not know if the cause for these is Pitocin or not but this is my story.

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    1. I too was induced with Pitocin and had a very hard labour. My son's experience sounds similar to your daughters. When he was only days old he a scowl on his face (we have the pictures to prove it). He would only sleep in my arms and never went into a deep sleep. It took until he was 7 years old for him to sleep through the night (and he would still wake up once pretty much every night until he was 8). He is sensitive to taste, smell and noise. This is getting better as his tolerance levels increase. He had and still has attachment issues. In school he is doing fine with learning and in the classroom but struggles with his social skills. I have been researching more on the brain and wonder if the pitocin had an effect on his brain development. I am now trying to find guidance on how to support him. If anyone has any information or guidance on how I could nourish my son's needs I would appreciate hearing them.

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  23. Wow,

    I have exactly the same story with my son. I wanted to have natural delivery without epidural and Pitocin.
    I dilated 8cm on my own. I had nice contraction. Then doctor came and said that she will start Pitocin. I said "No" to her 3 times. Doctor yelled at me. She seemed very busy. After Pitocin, I could not stand pain or speedy contractions and requested for epidural. Pitocin was then disconnected because baby's heart would not take it.
    My son was born, screamed day and night. He was colicky, would wake up all the time. I had to put him on my shoulder and jog all the time. It would help his to stop screaming. He screamed and screamed all the time, could not sleep as normal newborn do. He was exclusively breastfed,pooped with blood. Now he is 3. His attention span is very short. I'm afraid that he will be diagnosed with ADHD. He wakes up at night all the time. He can not sleep longer that 3-4 hours at a time.

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