Pitocin (Oxytocin) Induction and Birth Injury
Pitocin is a synthetic form of oxytocin, which is a hormone produced by the body during labor to induce strong, long-lasting, frequent uterine contractions. Pitocin is commonly administered via intravenous infusion as a supplement to start uterine contractions, speed up labor, or decrease time between contractions. Pitocin misuse is a risk to the baby’s health when it interferes with healthy uterine contractions. The uterus must contract and relax with a specific rhythm in order to adequately pass oxygen to the placenta, and ultimately to the baby. 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) or 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.
Pitocin vs. Oxytocin: What’s the Difference?
Oxytocin is a hormone that is produced naturally in the mother’s body during 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. Pitocin is a medication that must be introduced to the body by medical professionals, whereas oxytocin is a naturally-occurring hormone that the body produces on its own.
Another difference between Pitocin and oxytocin is the way in which they move through the body. The body releases oxytocin in intermittent pulses, which should allow the uterus to rest between contractions. When Pitocin is administered intravenously, however, it moves continuously through the body (not in intermittent pulses), and often produces longer, stronger, and more frequent contractions.
Recommended Use of Pitocin
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 medical necessity.
The Dangers of Pitocin
Pitocin is the drug most commonly associated with preventable adverse events during childbirth. In fact, in 2009 the Institute for Safe Medication Practices added this synthetic form of oxytocin to its list of “high alert medications,” a distinction reserved for only 11 other drugs. The adverse effects of Pitocin stem from two main issues associated with its administration: dosage difficulty and hyperstimulation.
Pitocin induction can be a very dangerous process because there are no precise methods of measuring its effects on the uterus, and both internal and external monitoring techniques provide minimal information about the status of mother and baby. In addition, the effects of any given Pitocin dose vary widely. The side effects can range from excessive, severe contractions leading to conditions that can lead to fetal asphyxia, to absolutely no 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 sooner than 40 minutes after the previous dose was administered, another dose will have been given before the full effects of the first dose set in. Additionally, Pitocin dosage is dependent on the specific patient, so medical professionals must accurately assess the patient to determine the correct dosage.
Hyperstimulation From Pitocin Adminstration
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 effectively stop 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. The placenta is a remarkably resilient organ, but if Pitocin administration causes contractions that are too long or too strong, the placenta may have trouble functioning. This poses a serious threat to the baby.
Excessive Pitocin administration can cause contractions to occur less than 2-3 minutes apart, thereby reducing the ability of the placenta to replenish its oxygen supply. When contractions occur frequently, are long lasting, or are unusually strong, this is known as hyperstimulation or tachysystole. If there is uterine hyperstimulation, the baby’s brain may not receive adequate oxygen, which can put the baby in a very dangerous situation and lead to negative outcomes down the line.
Birth Injuries Associated with Pitocin
If Pitocin is administered in an improper dose, or if the drug causes contractions to be too long, too strong, or too frequent, it can cut off the oxygen supply to the baby. A lack of oxygen flow can have detrimental effects on the baby’s delicate brain. Some of the most common complications associated with the use of Pitocin are:
- Fetal distress
- Hypertension (increased blood pressure)
- Bradycardia (slow heart rate)
- Tachycardia (fast heart rate)
- Heart rate decelerations
- Cardiac arrhythmia (disruptions in the heart’s normal rhythm)
- Fetal acidemia
- Brain Damage
- Hypoxic-ischemic encephalopathy (HIE)
- Cerebral palsy
- Neonatal seizures
- Low Apgar scores
- Retinal hemorrhages (abnormal bleeding of the blood vessels in the eye)
- Fetal head trauma, including brain hemorrhage
- Neonatal jaundice/hyperbilirubinemia
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:
- Strong and prolonged uterine contractions
- Uterine rupture and subsequent hemorrhaging (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)
- Placental abruption
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 medical professions should not use Pitocin, including:
- 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 to Pitocin
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:
- 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 be used conservatively, that the drug is used only for medically necessary inductions, and that 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 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 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.
Trusted Birth Injury Attorneys Representing Victims of Medical Malpractice with Birth Injuries from Pitocin Misuse
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. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with injuries since 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.
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