Pitocin (Oxytocin), Hypoxic-Ischemic Encephalopathy, Cerebral Palsy and Birth Injuries
Pitocin is a synthetic form of oxytocin, a hormone produced by the body during labor to induce strong, long-lasting uterine contractions. It is commonly administered via intravenous infusion as a supplement to start uterine contractions, speed up labor, or decrease time between contractions. Contractions induced with Pitocin are stronger and last longer than contractions that are not induced. Pitocin misuse is a risk to the baby’s health – the placenta must have a specific rhythm of contractions and relaxations to deliver enough oxygen to the baby during labor. If contractions are too strong, last too long, or occur too frequently, the placenta does not have time to replenish oxygen supply, putting the baby at risk for oxygen deprivation-related injuries like hypoxic-ischemic encephalopathy (HIE) and birth asphyxia. The effects of Pitocin are unpredictable and highly variable – one dose might not have any effect in one person but will cause hyperstimulation in another. Pitocin is the drug most commonly linked to preventable adverse effects in childbirth, and is recommended for use only for unplanned emergency inductions where continuing the pregnancy poses a health risk to either mother or child.
How Does Pitocin Cause Hypoxic Ischemic Encephalopathy (HIE) and Birth Injuries?
The placenta is a remarkably resilient organ. It can easily handle problems that develop naturally. However, the impatience of the medical team taking care of the mother and baby during labor and delivery can pose a threat. Inappropriate use of Pitocin / Oxytocin is dangerous and can seriously hinder the ability of the placenta to deliver oxygen to the baby.
The placenta is embedded in the wall of the uterus. It consists of a network of the mother’s blood vessels lying next to vessels on the baby’s side of the circulation, across which oxygen and nutrients flow. When the uterus contracts, the flow of blood and oxygen in or out of the placenta slows or stops. Between contractions, the placenta is “at rest” and blood and oxygen flow freely. During a contraction, flow stops or is slowed. For the placenta to work properly, there must be sufficient time between contractions for the placenta to recharge with a fresh supply of blood and oxygen.
Excessive Pitocin / Oxytocin can cause contractions to occur less than 2-3 minutes apart, thereby reducing the ability of the placenta to replenish its oxygen supply. Excessive frequency of contractions is called hyperstimulation. When contractions occur too frequently or are too strong, the baby’s brain may not be receiving adequate oxygen, which can cause brain damage resulting in cerebral palsy, intellectual impairments and other lifelong disabilities.
The Dangers of Pitocin and Oxytocin
Hyperstimulation with Pitocin / Oxytocin is dangerous because there are no precise methods of measuring the effects of oxytocin on the uterus, and both internal and external monitoring techniques leave much to be desired. In addition to having uncertain effects on the uterus, Pitocin / Oxytocin is unpredictable. The effects of any given dose vary widely. They can range from excessive and severe contractions and fetal asphyxia to absolutely no discernible effect on uterine contractility. Furthermore, the drug starts to work very slowly. A standard dose doesn’t reach its full potential until 40 minutes after administration. Thus if the medical team administers additional doses of Pitocin / Oxytocin sooner than 40 minutes after the previous dose was administered, another dose will have been given before the full effects of the first dose were known to the team.
Given the precarious nature of Pitocin / Oxytocin, it is easy to understand why, in 2009, the Institute for Safe Medication Practices added Oxytocin to its list of “high alert medications,” a distinction reserved for only 11 other drugs. In fact, Pitocin / Oxytocin is the drug most commonly associated with preventable adverse events during childbirth. Research shows that Oxytocin’s dose related effects can cause contractions to be less than 2-3 minutes apart, which will cause the baby’s oxygen saturation to progressively decrease. Indeed, Pitocin / Oxytocin can cause severe distress and damage to the baby, as well as serious complications and injuries to the mother.
Birth Injuries Associated with Pitocin and Oxytocin
In addition to causing a drop in the baby’s oxygen level, Pitocin and excessive uterine contractions are one of the most significant risk factors for the baby’s blood being very acidic at birth (fetal acidemia), which can cause damage to all the cells in the body, especially in the baby’s delicate brain.
The following are complications associated with Pitocin / Oxytocin use:
- Fetal Distress
- Hypertentsion (increased blood pressure)
- Bradycardia (slow heart rate)
- Heart rate decelerations
- Tachycardia (fast heart rate)
- Cardiac arrhythmia (disruptions in the heart’s normal rhythm)
- Asphyxia or hypoxic ischemic injury (severely deficient supply of oxygen to the body)
- Fetal acidemia
- Hypoxic ischemic encephalopathy and cerebral palsy
- Neonatal seizures
- Low Apgar scores
- Retinal hemorrhages (abnormal bleeding of the blood vessels in the eye)
- Fetal head trauma, including brain hemorrhages
- Neonatal Jaundice, hyperbilirubinemia
Many injuries can occur when physicians attempt to prolong a vaginal delivery instead of performing an indicated C-section. Improper use of labor hastening drugs and vacuum extractors and forceps 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.
Maternal Complications and Injuries Associated with Pitocin (Oxytocin)
Pitocin is one of the most common causes of uterine rupture. A recent study found that in one medical center, Pitocin had been administered in 77% of uterine rupture cases. Maternal Injuries and complications associated with Pitocin / Oxytocin include the following:
- Strong and prolonged uterine contractions
- Uterine rupture
- Postpartum hemorrhage (greater than normal loss of blood after delivery)
- Water intoxication (too much water in the system that causes an electrolyte imbalance, which can cause potentially fatal brain disturbances)
- Subarachnoid hemorrhage (bleeding between the brain and the thin tissue that covers it)
- Tachycardia, bradycardia, premature ventricular contractions and other cardiac arrhythmias
- Impaired uterine blood flow
- Hypotension (low blood pressure)
- 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)
Recommended Use of Pitocin
Delivery by C-section is not as dangerous as it once was, and in fact, C-section is relatively safe in the United States. For this reason, as well as Oxytocin’s potential for dangerous complications, current research does not recommend exceeding established physiologic levels of uterine activity in order to force a vaginal birth. In fact, it is recommended that Pitocin / Oxytocin 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 / Oxytocin is not to be used to electively induce labor – its use is recommended only for unplanned, emergency induction of labor.
Pitocin / Oxytocin is contraindicated when the following situations are present:
- Substantial cephalopelvic disproportion
- Unfavorable fetal position or presentation
- Obstetrical emergencies whereby maternal or fetal risk-to-benefit ratio favors surgery
- Fetal distress in which delivery is not imminent
- Umbilical cord prolapse
- Uterine activity fails to progress adequately
- Hyperactive or hypertonic uterus
- Vaginal delivery is contraindicated
- Uterine or surgical scarring from previous C-section or major cervical or uterine surgery
- Unengaged fetal head
- History of hypersensitivity of Oxytocin
Negligent Use of Pitocin and Oxytocin
In 2009, the AJOG issued a Clinical Opinion in which it made the following recommendations for Oxytocin administration:
- Oxytocin should be started at relatively low doses.
- Proper fetal monitoring must be utilized.
- Contractions are considered acceptable if the contractions have a consistent strength and rate or they have a consistent pattern of 1 contraction every 2 – 3 minutes lasting 80 – 90 seconds and are strong.
- Once acceptable contractions have been met, there is no justification for additional increases in Oxytocin dose.
- Oxytocin should be aggressively titrated to the lowest dose compatible with sustained levels of appropriate uterine activity.
- Delivery by C-section (not more Oxytocin) 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 and Oxytocin have long been recognized as dangerous, and researchers have concluded that the well-being of the fetus may be in jeopardy when Oxytocin induced hyperstimulation occurs during labor. It therefore is very important that Pitocin / Oxytocin be used conservatively, that the drug is used for non-elective, emergency induction of labor and fetal monitoring is done.
If the medical team treating a mother and baby during labor and delivery does not act in a manner consistent with these guidelines, it is negligence. If this negligence results in injury to the baby or mother, it is medical malpractice.
Trusted Birth Injury Attorneys Representing Victims of Medical Malpractice with Birth Injuries from Pitocin Misuse
A child’s birth injury diagnosis is one of the most devastating diagnoses that a parent can receive after a difficult birth. If your child has been diagnosed with cerebral palsy, HIE, or another birth injury from Pitocin misuse, we encourage you to reach our to the Reiter & Walsh, P.C. birth injury attorneys as soon as possible. During your free case review, our team will determine the cause of your child’s injuries and, should you have a case, help you obtain the compensation your family needs.
The Reiter & Walsh, P.C. team is based in Michigan, but we handle cases all over the United States. Should you live outside Michigan, our attorneys will travel to your hometown as necessary. Beyond Michigan, we’re able to handle cases in states such as Texas, Arkansas, Mississippi, Ohio, Tennessee, Pennsylvania, Washington D.C., Wisconsin, and all over the United States. We’re also equipped to handle FTCA cases involving military medical malpractice and federally funded clinics.
To begin your free birth injury case review, please contact the Reiter & Walsh ABC Law Centers team in whichever way best suits your needs:
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How Do You Pronounce Pitocin?
Video: Pitocin and Hypoxic Ischemic Encephalopathy (HIE)
Watch a video of birth injury lawyers Jesse Reiter and Rebecca Walsh discussing birth asphyxia and its causes, which include mismanagement of Pitocin during labor and delivery.
- Freeman RA, Nageotte M. “A protocol for the use of oxytocin.” Am J Obstet Gynecol. 2007;197:445–446.
- Clark SL, Rice Simpson K, Knox GE, Garite TJ. “Oxytocin: new perspectives on an old drug.” Am J Obstet Gynecol. 2009; 200 (1):35.e1 – 35e6.
- Rice Simpson K, James DC. “Effects of oxytocin-induced uterine hyperstimulation during labor on fetal oxygen status and fetal heart rate patterns.” Am J Obstet Gynecol. 2008; 199 (1):34.e1-34.e5.
- Cahill AG, Waterman BM, Stamilio DM, Odibo AO, Allsworth JF, Evanoff B, Macones GA. “Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery.” Am J Obstet Gynecol. 2008; 199(1):32.e1-5.
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