Pitocin (Oxytocin) Induction and Birth Injury

Pitocin is a synthetic form of oxytocin, which is a hormone that (among other roles) induces and strengthens uterine contractions. In a normal pregnancy, oxytocin production should increase around the time the baby is ready to be born, preparing the mother for labor (1). If a pregnant woman does not go into labor on time, if her contractions are weak, or there are other complications, doctors will sometimes administer intravenous Pitocin to start or enhance contractions.

Unfortunately, Pitocin misuse is a major issue. This drug can cause uterine tachysystole, also known as hyperstimulation, which can put both the mother and baby in danger. For the mother, this can cause extreme pain, cervical or vaginal lacerations, uterine rupture, and postpartum hemorrhage. For the baby, there is a high risk of oxygen deprivation (birth asphyxia) because the contractions restrict blood flow between the mother and the baby’s circulatory systems. This can cause subsequent brain damage such as hypoxic-ischemic encephalopathy (HIE) or even fetal death (2). Therefore, physicians must be extremely careful to discuss these risks with the mother, only use this drug as indicated, monitor the health of the mother and baby, and quickly intervene if complications arise.

Pitocin


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Pitocin vs. oxytocin: what’s the difference?

Oxytocin is a hormone that is produced naturally and plays a role in many of the body’s functions, including the labor and delivery process. It helps the body to produce contractions and progress through the stages of labor. Pitocin is a drug made synthetically (outside the body) that mimics the effects of oxytocin when given to the mother via IV.

The difference between Oxytocin and Pitocin

Another difference between Pitocin and oxytocin is the way in which they move through the body. The posterior pituitary releases oxytocin into the bloodstream in intermittent pulses, which should allow the uterus to rest between contractions (3). However, Pitocin may be administered continuously, which can cause the uterus to become hyperstimulated.

Pitocin (Oxytocin), Hypoxic Ischemic Encephalopathy, Cerebral Palsy and Birth Injuries


Current research does not recommend exceeding established physiologic levels of uterine activity in order to force a vaginal birth. It is recommended that Pitocin be used for labor induction only when the risk of continuing the pregnancy presents a threat to the life of the baby or mother. In other words, Pitocin is only to be used when there is a medical necessity (2).


The dangers of Pitocin

Pitocin is the drug most commonly associated with preventable adverse events during childbirth. In fact, the Institute for Safe Medication Practices includes synthetic oxytocin on its list of “High Alert Medications in Acute Care Settings,” a distinction reserved for only 11 other drugs (4). The adverse effects of Pitocin on the baby stem from two main issues associated with its administration: dosage difficulty and hyperstimulation.

Pitocin dosage

The effects of Pitocin vary widely; this drug should be initiated at a very low dosage because some women are hypersensitive to it and likely to experience excessive uterine activity.

If a patient is given intravenous Pitocin, this must be done through the drip method, and medical professionals must continuously monitor the process. Electronic fetal monitoring can help to detect overdose, but it is important to know that only intrauterine pressure recording can provide an accurate assessment of pressure within the uterus during contractions. Doctors should be prepared to quickly discontinue this medication if the health of the mother or baby is in jeopardy (2).

Hyperstimulation from Pitocin administration

Embedded in the wall of the uterus, the placenta consists of a network of the maternal blood vessels, across which oxygen and nutrients flow from mother to baby. When the uterus contracts, the flow of blood and oxygen in or out of the placenta briefly slows or halts. Between contractions, the placenta returns to an “at rest” state, and blood and oxygen again flow freely to the baby. Because contractions reduce the blood and oxygen flow to the baby, there must be sufficient time between contractions for the placenta to recharge with a fresh supply of blood and oxygen (5). If Pitocin administration causes contractions that are too long, too strong, or too frequent, the placenta may have trouble functioning. This poses a serious threat to the baby.


Birth injuries associated with Pitocin

If Pitocin is administered in an improper dosage, or if the drug causes uterine hyperstimulation, it can restrict the oxygen supply to the baby. Oxygen deprivation has detrimental effects on the baby’s delicate brain. Some of the complications associated with the use of Pitocin are:

  • Fetal distress
  • Abnormal fetal heart rate/cardiac arrhythmia (disruptions in the heart’s normal rhythm)
  • Neonatal seizures
  • Low Apgar scores
  • Retinal hemorrhages (abnormal bleeding of the blood vessels in the eye)
  • Neonatal jaundice/hyperbilirubinemia (2)
  • Hypoxic-ischemic encephalopathy (HIE)
  • Brain damage
  • Fetal death

Many injuries can occur when physicians attempt to prolong a vaginal delivery instead of performing a medically indicated C-section. Improper use of labor-hastening drugs can cause very serious and permanent injuries. It therefore is essential that the medical team involved in labor and delivery be skilled in all obstetrical procedures and follow recommended guidelines and standards of care with regard to the administration of high-risk medications such as Pitocin.


Maternal complications and injuries associated with Pitocin

In addition to the many threats it poses to the baby (detailed above), Pitocin can also put the mother in danger during and after the labor and delivery process. Because of this, it is crucial for physicians to ensure that the decision to proceed with Pitocin induction is not only safe for the baby, but for the mother as well. Maternal injuries and complications associated with Pitocin include the following (2):

  • Strong and prolonged uterine contractions
  • Uterine rupture and subsequent hemorrhaging (greater than normal loss of blood after delivery)
  • Water intoxication with convulsions (this can occur because Pitocin has antidiuretic effects)
  • Subarachnoid hemorrhage (bleeding between the innermost two membranes that cover the brain)
  • Cardiac arrhythmias
  • Hypertension (high blood pressure)
  • Anaphylaxis (a life-threatening allergic reaction)
  • Nausea and vomiting
  • Pelvic hematoma (accumulation of blood in the soft tissues of the pelvis)

Negligent use of Pitocin

Because of the high-risk nature of Pitocin, there are strict guidelines for the drug’s use. It is mandatory that medical professionals follow these guidelines and only administer Pitocin when it is absolutely necessary. If they do not follow the proper guidelines, and an injury occurs, it is medical malpractice. There are certain defined circumstances in which the FDA recommends against the use of Pitocin, including (2):

This is not a complete list of circumstances under which Pitocin and labor induction may be ill-advised. Physicians should also be aware of maternal and fetal risk factors such as the presence of scarring from a previous C-section/uterine surgery, and carefully counsel expectant mothers on various courses of action in order to obtain their informed consent (6).

The clinical opinion on Pitocin

To further ensure that Pitocin is used in a conservative and safe manner, the American Journal of Obstetrics & Gynecology (AJOG) issued a Clinical Opinion in 2009 with the following recommendations for synthetic oxytocin (Pitocin) administration (7):

  • Pitocin should be started at relatively low doses.
  • Proper fetal monitoring must be utilized.
  • Contractions are considered acceptable if they have a consistent strength and rate, or there is a consistent pattern of strong contractions every two-three minutes, lasting 80-90 seconds.
  • Once acceptable contractions have been met, there is no justification for additional increases in Pitocin dose.
  • Pitocin should be aggressively titrated to the lowest dose compatible with sustained levels of appropriate uterine activity.
  • Delivery by C-section (not more Pitocin) is indicated when acceptable levels of uterine activity have been met at the lowest dose, but the labor is not progressing in a suitable manner.

Pitocin has long been recognized as a dangerous drug, and researchers have concluded that the well-being of the fetus may be in jeopardy when induced hyperstimulation occurs during labor. It, therefore, is very important that Pitocin is used conservatively, that the drug is used only for medically necessary inductions, and that fetal monitoring is done throughout the labor and delivery process.

If the medical team treating a mother and baby during labor and delivery does not act in a manner consistent with the standard of care guidelines for the administration of Pitocin, it is negligence. If this negligence results in injury to the baby or mother, it is medical malpractice, for which there may be recovery under the law.


The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice. If you have questions about Pitocin, please consult with a medical professional.


If you’re seeking legal help for an injury resulting from misuse of Pitocin, it’s critical to choose an attorney and firm that focuses closely on birth injury cases. ABC Law Centers is a national birth injury law firm that was established in 1997. Our attorneys have won numerous awards for their advocacy of children, and are leaders within the Birth Trauma Litigation Group (BTLG) and other industry associations.

We have helped obtain compensation for lifelong treatment, therapy, and a secure future for children with birth injuries. Our firm has numerous multi-million dollar verdicts and settlements that are a testament to our success, and you pay nothing unless we win or obtain a favorable settlement.


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Sources

  1. Prevost, M., Zelkowitz, P., Tulandi, T., Hayton, B., Feeley, N., Carter, C. S., … & Gold, I. (2014). Oxytocin in pregnancy and the postpartum: relations to labor and its management. Frontiers in public health, 2, 1.
  2. Pitocin® (Oxytocin Injection, USP) Synthetic[PDF]. (2014). FDA.
  3. Bell, A. F., Erickson, E. N., & Carter, C. S. (2014). Beyond labor: the role of natural and synthetic oxytocin in the transition to motherhood. Journal of midwifery & women’s health, 59(1), 35-42.
  4. High-Alert Medications in Acute Care Settings. (n.d.). Retrieved February 14, 2019, from https://www.ismp.org/recommendations/high-alert-medications-acute-list
  5. Marsal, K. (2004). Fetal and placental circulation during labor. Fetal and Neonatal Physiology, 758-758.
  6. (n.d.). Retrieved February 14, 2019, from https://www.uptodate.com/contents/cervical-ripening-and-induction-of-labor-in-women-with-a-prior-cesarean-delivery?
  7. Clark, S. L., Simpson, K. R., Knox, G. E., & Garite, T. J. (2009). Oxytocin: new perspectives on an old drug. American journal of obstetrics and gynecology, 200(1), 35-e1.

Video: Abnormal labor patterns