Pitocin – a very useful drug that improved obstetrics and gave us options to help women in ways we weren’t able to before!
Pitocin – a very seductive drug that changed obstetrics, increasing risks to mothers and babies in ways that are often not even taken into consideration.
Both of these statements are true – how can that be? I will do my best to explain this complex issue in a simple and straight forward way. Be warned…much of what you are about to read will probably be new to you because these are the things that aren’t being talked about!
I already did a previous blog post on inducing labor and some of the risks/benefits associated with the decision to induce, so I do not want to rehash that once again. The decision to induce is one thing (and a decision that is not to be taken lightly), but what about once the decision is made?
I’m going to simply focus on Pitocin.
Pitocin is a drug used to induce or augment labors here in the US. It is most often given via IV infusion, although immediately postpartum if an IV isn’t already in place it may be given as an intramuscular injection. It was created for the first time in 1953 and became available just 2 years later. Mothering magazine writes, “A survey by Robbie Davis-Floyd, a cultural anthropologist at the University of Texas, found that 81 percent of women in US hospitals receive Pitocin either to induce or augment their labors.” It has been said that only 3% medically require it.
Pitocin- nicknamed “Pit” (and I’ve even heard “Vitamin P”). Whenever I hear it referred to as Pit (which I have been guilty of myself) the following clip from Princess Bride comes to mind…
I have heard many MANY MANY nurses say things such as “Pitocin is just oxytocin…it has the exact same affect on your body.” While the oxytocin in Pitocin is chemically identical to the oxytocin your body produces, this statement is so not true and makes me want to bang my head against the nearest wall.
HOW IS PITOCIN DIFFERENT THAN YOUR BODY’S NATURAL OXYTOCIN?
While the oxytocin your body produces is chemically identical to the oxytocin contained in Pitocin – the way your body recognizes them and responds to them is very different. We have something called the blood-brain barrier. Simply put, the vast majority of substances that enter our blood stream can not pass into the cerebrospinal fluid. Out bodies are made in a way that protect our brain from all but a select few substances going from the blood into the brain (those few things include oxygen and glucose)
Oxytocin is produced by the brain and affects the brain in its natural form. Pitocin is introduced into the blood stream and does NOT affect the brain.
While not always a reliable source of information, this entry from Wikipedia has enough sources sited that I am very confident of its accuracy. Please see the original website HERE to view sources….
“Oxytocin secreted from the pituitary gland cannot re-enter the brain because of the blood-brain barrier. Instead, the behavioral effects of oxytocin are thought to reflect release from centrally projecting oxytocin neurons, different from those that project to the pituitary gland, or which are collaterals from them. Oxytocin receptors are expressed by neurons in many parts of the brain and spinal cord, including the amygdala, ventromedial hypothalamus, septum, nucleus accumbens and brainstem.
- Sexual arousal. Oxytocin injected into the cerebrospinal fluid causes spontaneous erections in rats, reflecting actions in the hypothalamus and spinal cord. Centrally administrated oxytocin receptor antagonists can prevent non contact erections, which is a measure of sexual arousal. Studies using oxytocin antagonists in female rats provide data that oxytocin increases lordosis, indicating an increase in sexual receptivity.
- Bonding. In the Prairie Vole, oxytocin released into the brain of the female during sexual activity is important for forming a monogamous pair bond with her sexual partner. Vasopressin appears to have a similar effect in males. Oxytocin has a role in social behaviors in many species, and so it seems likely that it has similar roles in humans.
- Maternal behavior. Rat females given oxytocin antagonists after giving birth do not exhibit typical maternal behavior. By contrast, virgin female sheep show maternal behavior towards foreign lambs upon cerebrospinal fluid infusion of oxytocin, which they would not do otherwise. Oxytocin is involved in the initiation of maternal behavior not its maintenance, for example, it is higher in mothers after they interact with unfamiliar children rather than their own.
- According to some studies in animals, oxytocin inhibits the development of tolerance to various addictive drugs (opiates, cocaine, alcohol) and reduces withdrawal symptoms.
- Preparing fetal neurons for delivery. Crossing the placenta, maternal oxytocin reaches the fetal brain and induces a switch in the action of neurotransmitter GABA from excitatory to inhibitory on fetal cortical neurons. This silences the fetal brain for the period of delivery and reduces its vulnerability to hypoxic damage.
- MDMA (ecstasy) may increase feelings of love, empathy and connection to others by stimulating oxytocin activity via activation of serotonin 5-HT1A receptors, if initial studies in animals apply to humans. The anxiolytic Buspar (buspirone) also appears to produce some or all of its effect via 5-HT1A receptor-induced oxytocin stimulation. “
In other words – natural oxytocin is produced by the brain and affects the brain before becoming systemic – Pitocin is never seen by the brain and therefore the brain doesn’t respond to it the same way, releasing the complex cocktail of labor/birth hormones that it does during a naturally occurring labor. It has recently been suggested that due to the blood-brain barrier and the hormonal dance that happens during labor – and due to the recent discoveries of the affect of oxytocin in autistic children – that Pitocin may be a contributing factor to the epidemic autistic rates we are seeing lately.
Another notable difference between Pitocin and our natural oxytocin is the rate in which it’s administered. In the body, during a normal natural labor, oxytocin is released in spurts…ebbing and flowing….up and down….causing contractions, then easing off….released in surges. Pitocin is administered via a steady infusion with a pump. Its levels in the blood remain constant – until the Pitocin is turned up (generally every 15-30 minutes).
WHAT ABOUT SIDE EFFECTS OF PITOCIN?
So many people are given Pitocin without ever hearing a single risk or side effect other than, “it can cause too strong of contractions…but if it does that we’ll just turn it down or off.”
Lets see what rxlist.com has to say (you have to go to PAGE 3):
“The following adverse reactions have been reported in the mother:
Premature ventricular contractions
Rupture of the uterus
Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.
The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.
Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.
The following adverse reactions have been reported in the fetus or neonate:
Due to induced uterine motility:
Premature ventricular contractions and other arrhythmias
Permanent CNS or brain damage
Neonatal seizures have been reported with the use of Pitocin.
Due to use of oxytocin in the mother:
Low Apgar scores at five minutes
Neonatal retinal hemorrhage”
Now is when you get angry when you realize that you were given this drug without any discussion whatsoever of these side effects and risks.
WHAT ABOUT CHLOROBUTANOL?
Chances are that you have never heard this word. Pitocin contains not only a synthetic oxytocin, it also contains 0.5% Chlorobutanol, a chloroform derivative that is in Pitocin as a preservative. While the oxytocin in Pitocin has a VERY short half-life of 1-6 minutes (meaning it’s out of your system within a matter of minutes), Chlorobutanol has a very long half-life (about 10 days!), building up in your system for as long as you are being given this substance and remaining in your body for WEEKS.
According to the article “INACTIVE PHARMACEUTICAL INGREDIENTS: Implications for pregnancy”
“Chlorobutanol crosses the placenta in animals and produces human embriotoxicity. Based on these limited data, systemic preparations containing chlorobutanol should be used with caution during pregnancy. Repeated administration, in particular, should be avoided due to the long terminal half life of chlorobutanol (about 10 days) that may lead to accumulation in the fetus.”
It’s known to affect both maternal blood pressure as well as her heart muscle.
From “Effects of chlorobutanol and bradykinin on myocardial excitation “
“However, chlorobutanol does have direct effects on myocardial cells, acting on the cell membrane and decreasing isometric tension produced by the heart.”
From “The effect of oxytocin on the contractile force of human atrial trabeculae.” – “Chlorobutanol decreased the ability of the heart to contract, while as pure oxytocin had no effect. This explains why maternal blood pressure may decrease and provides impetus to produce oxytocin with another, safer preservative.”
And finally, from an article on Methadone and its effects – “Chlorobutanol or chlorobutanol plus methadone, rather than methadone alone, may be the cause of cardiac toxicity in patients treated with IV methadone. Chlorobutanol has a very long half-life, extending beyond 10 days, and one report showed a serum concentration of 85 mg/mL (0.480 mM) of chlorobutanol in a patient receiving IV morphine preserved with 0.5% chlorobutanol. Furthermore, in a controlled clinical trial that led to the discontinuation of chlorobutanol from heparin, chlorobutanol was found to decrease blood pressure in patients. Chlorobutanol also causes significant negative inotropic effects on human atrial tissue, and this was the postulated cause of the hypotension seen in patients receiving oxytocin preserved with chlorobutanol.”
The thing that really upsets me is this: the study on Chlorobutanol affecting the heart which concludes with a call to find another, safer preservative….was published in 1998. We have known about this problem for at LEAST 12 years. Why is this not big news and why have we not explored other safer preservatives for Pitocin? I told you I’d try and make this issue simple: Money. I wonder how many of the 81% of mothers who have received Pitocin in labor have ever heard of chlorobutanol.
OTHER INTERVENTIONS AND THEIR RISKS
Hopefully by now you understand that Pitocin is NOT “exactly the same as going into labor on your own”, that it affects the body differently, and that there are definite risks to both Pitocin and it’s preservative chlorobutanol – but can you really talk about Pitocin without talking about the list of interventions that are likely to come with it?
Think about this:
Chlorobutanol is known to be an anti-diuretic (meaning it will make you retain water) – this is why on Pitocin’s list of side effects and risks you will see “severe water intoxication with convulsion and coma”. We are going to dilute the Pitocin into IV fluid, ensuring that you get a LOT of fluid into your system along with the Pitocin. (it is commonly mixed with 3-1 or 6-1 in the IV bag) Because the oxytocin in Pitocin doesn’t affect the brain the same way your natural oxytocin does, you are likely to experience much more intense FEELING contractions without the good oxytocin feelings that the brain experiences during a natural labor and therefore it is interpreted much more negatively by your body – in other words, you are much more likely to request an epidural anesthesia. Epidural anesthesia is notorious for dropping your blood pressure (I refer you back to the study on Methadone and that chlorobutanol causes significant decreases in blood pressure). Knowing the propensity for the epidural to drop your blood pressure, our answer to this is to make sure to pump enough fluids into your blood to attempt to compensate and keep your blood pressure stable.
Are you beginning to see a problem here? And we haven’t even touched on the fact that chlorobutanol is easily crossing the placental barrier and can affect the baby for the next two weeks! Or the risk of a cesarean that is increased when we use Pitocin, often due in large part to continuous monitoring of the fetal heart rate that is done while the mother is on Pitocin and that brings with it a 90% false positive rate for detection of fetal distress.
This is such a complex game of Russian roulette that we are playing, and there are a lot more bullets in the gun than we are being told. There are definitely times when we should thank our lucky stars that Pitocin has been created and it has saved moms and babies from undergoing cesareans or from having other complications such as postpartum hemorrhage which is a common cause of DEATH in lesser developed countries…but it is NOT the same thing as just encouraging your body to do it! Rather than fixing the problem of stalled labor by acknowledging the relationship between the mind and body and baby and working within it’s natural balance, we resort to trying to put a bandaid on it and don’t even stop to ask what kinds of problems covering the wound might cause.
My solution? Start by recognizing that our bodies are much more complex than we are acting like they are. Recognize that labor and birth is a whole body experience, not just a uterine experience. Treat the cause of the stalled labor, not just the uterus, and give this mom and baby ample time to both start and complete this process. Making her feel safe, nurtured, secure, able to be vulnerable and relaxed and free….carries a heck of a lot less risks than Pitocin does.