pitocin to induce placenta delivery?

How commonly is this given in the US?

SIL in Switzerland was telling an MD friend about us (homebirth) and
the woman went on about how there, a drug is given after birth to
prevent hemorrhage, but that midwives don't do it and therefore there's
a higher rate of maternal death due to hemorrhage after homebirths. (no
idea if she had any data on that - but in the US there's plenty of
research showing the opposite)

Someone on another board identified it as pitocin, and it does make
sense to have it available, but is it commonly used in the US? I did
end up giving birth in hospital and did have major trouble getting the
placenta out, but no mention of pitocin was made - the OB just stuck
her arm up and used pressure from the outside (ouch!).

"cjra" wrote in message
oups.com...
How commonly is this given in the US?

SIL in Switzerland was telling an MD friend about us (homebirth) and
the woman went on about how there, a drug is given after birth to
prevent hemorrhage, but that midwives don't do it and therefore there's
a higher rate of maternal death due to hemorrhage after homebirths. (no
idea if she had any data on that - but in the US there's plenty of
research showing the opposite)

Someone on another board identified it as pitocin, and it does make
sense to have it available, but is it commonly used in the US? I did
end up giving birth in hospital and did have major trouble getting the
placenta out, but no mention of pitocin was made - the OB just stuck
her arm up and used pressure from the outside (ouch!).


The vast majority of US home birth midwives carry pitocin to births, whether
or not they are licensed, whether or not they are legal. It is considered a
rescue drug, it is difficult to harm someone medically if you are
administering only postpartum, and sympathetic people with prescription
privileges keep those who do not have legal access in supply. Your midwife
may not have told you she had it, but I bet she did. I had it at my UC.

I think the doc in Switzerland was just being a doc. I believe that
Cochrane has identified a higher risk of "postpartum hemorrhage" as measured
by a certain amount of blood loss if expectant versus active management of
third stage is used, but there's not even talk of maternal death because
it's so rare to die from a bona fide postpartum hemorrhage level of
bleeding. Please someone correct me if I'm ignorant.

-- Dagny

How commonly is this given in the US?

both the Bradley Birth book and What to expect when your expecting (US
edition), mention it as normal, so I guess it's pretty common

SIL in Switzerland was telling an MD friend about us (homebirth) and
the woman went on about how there, a drug is given after birth to
prevent hemorrhage, but that midwives don't do it and therefore there's
a higher rate of maternal death due to hemorrhage after homebirths. (no
idea if she had any data on that - but in the US there's plenty of
research showing the opposite)

sounds very surprising, perhaps she means that the midwifes don't do it
routinely, which wouldn't surprise me at all, but to attend a birth without
something available in case of problems would be negligent.

Someone on another board identified it as pitocin, and it does make
sense to have it available, but is it commonly used in the US? I did
end up giving birth in hospital and did have major trouble getting the
placenta out, but no mention of pitocin was made - the OB just stuck
her arm up and used pressure from the outside (ouch!).

in the UK the drug given is usually a combination of pitocin (synthetic
oxytocin, stimulates contractions) and ergometrine (shuts down the tiny
blood vessels in the uterus and also causes the cervix to close faster), if
a physiological 3rd stage was planned, the fact that the placenta didn't
come isn't necessarily indication to give it, what the OB may have felt was
that the placenta was detached but that you hadn't been able to deliver it
(for future reference, you could try standing up and let gravity have a
chance, also coughing can aid the uterine contraction), but even so I'm
surprised she went straight in for manual delivery without giving drugs
first because had it not been fully detached, she'd have risked tearing it,
or causing an increase in bleeding, my guess is that she had the drugs close
by. How long was it before she went for this? I don't know what average
times are but a natural 3rd stage can be quite long, in discussion prior to
the birth with my midwife, her limit was 2hrs providing mum and baby are
fine, in the end it was 20 something minutes, but it was a deliberate effort
from me after it was thought it was detached, rather than an urge or
anything. There is also the possibility, that if you had an IV line in, that
you were given the drug and didn't know, or it was injected in your thigh,
you'd think you'd notice an injection in the thigh, but even knowing it was
going to happen, I didn't notice exactly when the midwife did it and I've
heard other people say the same.

It's essential to use such a drug in c-section deliveries, without uterine
contractions there needs to be something to release it and then cause the
uterus to contract down. I looked on some US websites to see what it said
there and here's one I found
http://parentcenter.babycenter.com/refcap/177.html#5
which says some providers use it routinely, but is only referring to
oxytocin, not the combo, would be interesting to find out a bit more about
where the combo is used automatically and why they do that.

Cheers

Anne

Anne Rogers wrote:
How commonly is this given in the US?

both the Bradley Birth book and What to expect when your expecting (US
edition), mention it as normal, so I guess it's pretty common

I guess I should have said *routine*. Something may have been lost in
translation, but she said it was given automatically, which i find very
odd.

Someone on another board identified it as pitocin, and it does make
sense to have it available, but is it commonly used in the US? I did
end up giving birth in hospital and did have major trouble getting the
placenta out, but no mention of pitocin was made - the OB just stuck
her arm up and used pressure from the outside (ouch!).

in the UK the drug given is usually a combination of pitocin (synthetic
oxytocin, stimulates contractions) and ergometrine (shuts down the tiny
blood vessels in the uterus and also causes the cervix to close faster), if
a physiological 3rd stage was planned, the fact that the placenta didn't
come isn't necessarily indication to give it, what the OB may have felt was
that the placenta was detached but that you hadn't been able to deliver it
(for future reference, you could try standing up and let gravity have a
chance, also coughing can aid the uterine contraction), but even so I'm
surprised she went straight in for manual delivery without giving drugs
first because had it not been fully detached, she'd have risked tearing it,
or causing an increase in bleeding, my guess is that she had the drugs close
by. How long was it before she went for this?

I am sure drugs were close at hand given we were in hospital. It was 30
mins. She said something like "it's been 30 minutes, we need to get
this out now!" No mention of drugs.

times are but a natural 3rd stage can be quite long, in discussion prior to
the birth with my midwife, her limit was 2hrs providing mum and baby are
fine, in the end it was 20 something minutes, but it was a deliberate effort
from me after it was thought it was detached, rather than an urge or
anything. There is also the possibility, that if you had an IV line in,

The IV was ripped out.

How commonly is this given in the US?

both the Bradley Birth book and What to expect when your expecting (US
edition), mention it as normal, so I guess it's pretty common

I guess I should have said *routine*. Something may have been lost in
translation, but she said it was given automatically, which i find very
odd.

it may still be routine in Switerland, I'm not sure where they stand on the
choice given to women etc. I remember someone on here who was delivering in
Italy, they were still doing routine shaving and enemas. I'm not sure if I'd
quite say it was routine in the UK, but certainly at the hospital I
delivered at (also planned homebirths, but both transferred in prior to
labour), it's a box you tick on the notes whether you want it or not, but
you expect a fight if you tick no, first time around, when we were told we
"had" to have it, we didn't know enough to say no, given there was oxytocin
going in the IV, it wasn't as necessary as they made it sound, the combo of
ergometrine and syntocinon, makes for a fairly unpleasant drug, caused me to
vomit violently, 2nd time around given the experience first time, I
definitely wasn't having it, but still had to fight and got to the point of
my husband stateing that consent was denied and he would physically prevent
it from being given.

Someone on another board identified it as pitocin, and it does make
sense to have it available, but is it commonly used in the US? I did
end up giving birth in hospital and did have major trouble getting the
placenta out, but no mention of pitocin was made - the OB just stuck
her arm up and used pressure from the outside (ouch!).

in the UK the drug given is usually a combination of pitocin (synthetic
oxytocin, stimulates contractions) and ergometrine (shuts down the tiny
blood vessels in the uterus and also causes the cervix to close faster),
if
a physiological 3rd stage was planned, the fact that the placenta didn't
come isn't necessarily indication to give it, what the OB may have felt
was
that the placenta was detached but that you hadn't been able to deliver
it
(for future reference, you could try standing up and let gravity have a
chance, also coughing can aid the uterine contraction), but even so I'm
surprised she went straight in for manual delivery without giving drugs
first because had it not been fully detached, she'd have risked tearing
it,
or causing an increase in bleeding, my guess is that she had the drugs
close
by. How long was it before she went for this?

I am sure drugs were close at hand given we were in hospital. It was 30
mins. She said something like "it's been 30 minutes, we need to get
this out now!" No mention of drugs.

times are but a natural 3rd stage can be quite long, in discussion prior
to
the birth with my midwife, her limit was 2hrs providing mum and baby are
fine, in the end it was 20 something minutes, but it was a deliberate
effort
from me after it was thought it was detached, rather than an urge or
anything. There is also the possibility, that if you had an IV line in,

The IV was ripped out.

ah well, definitely no drug given then, if the combo drug is given because
of the effect of the ergometrine on closing the cervix, if the placenta is
not delivered within 7mins you are almost guaranteed retained placenta. Even
so your OB sounds fairly arbitrary in her time scale, if you were fine, the
placenta is not delayed, there is no need to get it out, if you weren't
fine, then the chances are that you would be needing drugs anyway and giving
those along with some gentle encouragement would probably have been enough
and avoided manual removal. In the main, at least here, manual removal is
done after other things have failed and is often done in theatre with
additional anaethesia. What we were told in antenatal class was not having
the drug does increase the risk of PPH, but having it increases the risk of
retained placenta. Seemed to me it was better to say no, because it's not as
if once you've said no they won't let you have it later if you need it!
Also, PPH is only measured by being a certain amount of blood lost, I don't
think the increased risk of PPH then goes on to apply to increased number of
blood transfusions, or deaths.

I've never really looked into this at all, because I just accepted it was
the choice to have the combo drug, or not have the combo drug, but it seems
like when drugs are given in the US for the delivery of the placenta it's
just oxytocin and I'd be interested to find out what the research says, I'd
still choose natural initially, but with such a bad reaction to the
ergometrine part of the combo drug, if anything was to happen, I'd still
want to leave that for later use (on some of the webpages I looked up, it
was saying stuff about oxytocin, then "other" drugs later on in the
management of PPH, ergometrine probably comes in here).

Cheers

Anne

I think the doc in Switzerland was just being a doc. I believe that
Cochrane has identified a higher risk of "postpartum hemorrhage" as
measured by a certain amount of blood loss if expectant versus active
management of third stage is used, but there's not even talk of maternal
death because it's so rare to die from a bona fide postpartum hemorrhage
level of bleeding. Please someone correct me if I'm ignorant.

I don't think you are ignorant Dagny, you're right it's difficult to compare
death rates because you'd need such a huge study to get even 1 death and
even then it might not be due to PPH. It's important then to compare number
of blood transfusions (making sure same criteria were used) and number of
hysterectomies, not sure if there are other things that should be compared.

FWIW I lost half the volume of blood in my natural 3rd stage to my assulted
managed 3rd stage, but I don't know if they counted the blood I lost prior
to delivery and I also lost significantly more in the 12hrs following
delivery compared to my natural ("you do know you are increasing you risk of
PPH").

Cheers

Anne

"cjra" wrote in message
ups.com...


I am sure drugs were close at hand given we were in hospital. It was 30
mins. She said something like "it's been 30 minutes, we need to get
this out now!" No mention of drugs.

Yes, well. Sounds like the standard of care, but many people, after
reviewing the evidence, do not elect to do anything at the 30-minute mark if
they have not birthed their placentas.

Neither of my placentas took much time, but I was over at a friend's third
stage that was pretty unhindered and she birthed the placenta at about 90
minutes. You could barely find blood where she birthed and there was almost
none with the placenta. I just checked on whether she seemed happy/healthy
once in a while and tried to bother her very little. I only hindered her by
doing things like suggesting maybe it would fall out once she was able to
pee. Wish in hindsight I'd just kept my mouth shut but fear is so ..., even
us UCers.

-- Dagny

cjra wrote:
How commonly is this given in the US?

Very.

SIL in Switzerland was telling an MD friend about us (homebirth) and
the woman went on about how there, a drug is given after birth to
prevent hemorrhage, but that midwives don't do it and therefore there's
a higher rate of maternal death due to hemorrhage after homebirths. (no
idea if she had any data on that - but in the US there's plenty of
research showing the opposite)

Many midwives, particularly CNMs, carry pitocin to
homebirths. Some use it routinely. Others only use it
when necessary.

Someone on another board identified it as pitocin, and it does make
sense to have it available, but is it commonly used in the US? I did
end up giving birth in hospital and did have major trouble getting the
placenta out, but no mention of pitocin was made - the OB just stuck
her arm up and used pressure from the outside (ouch!).

Are you sure they didn't give you any? It's so
routine that they might not even have mentioned it. If
you had an IV, they could have just put it in there without
sticking you separately. They often do it immediately following
the birth, well before it's known whether there will be any
problems with the placenta.

Best wishes,
Ericka

Dagny wrote:
Neither of my placentas took much time, but I was over at a friend's third
stage that was pretty unhindered and she birthed the placenta at about 90
minutes. You could barely find blood where she birthed and there was almost
none with the placenta.

During my first delivery (Monkey Boy, nearly precipitate, no IV, no
drugs of
any kind), the CNM started to fuss about getting the placenta out, and
she
told me I needed to push as the "clock" was running and it was at about
30
minutes. She explained if the placenta does not come out before the
cervix
closes then it is much, much harder to get out. I consciously diverted
my
attention from my baby long enough to find my center again / get back
in the
zone, relax, let build the urge to push, and help the push along. I
think that
was finished maybe 10 minutes later?

My delivery of both baby and placenta involved no more than smears of
blood. I also had minimal and very brief lochia. Perhaps because,
after
delivery, I was instructed to massage my uterus through my abdominal
wall,
to help it contract and further clamp off the uterine blood vessels
that had
supplied the placenta.

After my MC last year at 12w, my CNM prescribed an oxytocin-like drug,
in
oral pill form. That was several days after the MC, and she had not
had a
chance to examine me sooner (when the MC came, during a long weekend,
I was 3 hours' drive away) . I think, all together, I bled a little
more with the
MC than when I delivered Monkey Boy.

I suppose the problem is you don't easily know the status of the
cervix, so
one protocol is to fall back on a time rule: allow 30 minutes, then
use drugs.
Waiting for Monkey Boy's placenta, I recall my CNM holding the cord,
with
a far-away "listening" look on her face. I think she was sensing the
status
of things inside.

There is a measure of art and intuition in the practice of midwifery.
I chose
my current high risk OB in part because the nurse who first recommended
him to me mentioned his intuition.

cjra wrote:
How commonly is this given in the US?

SIL in Switzerland was telling an MD friend about us (homebirth) and
the woman went on about how there, a drug is given after birth to
prevent hemorrhage, but that midwives don't do it and therefore there's
a higher rate of maternal death due to hemorrhage after homebirths. (no
idea if she had any data on that - but in the US there's plenty of
research showing the opposite)

Someone on another board identified it as pitocin, and it does make
sense to have it available, but is it commonly used in the US? I did
end up giving birth in hospital and did have major trouble getting the
placenta out, but no mention of pitocin was made - the OB just stuck
her arm up and used pressure from the outside (ouch!).

It's given as standard in Australian hospitals. I have a vague memory
of this being part of the antenatal classes I attended before #1's
birth, as soon as the baby is born they grab the needle and stick it in
your leg to encourage the placenta to detach and come out. Because of
the high of giving birth I've had it 3 times now (one was an induction
so I already had syntocinon in a drip) and I've either not noticed or
forgotten immediately 3 times. After Shrimp was born I remember
looking down at my left thigh the next day while I was showering and
wondering where this perfectly round small bruise had come from, then
remembering about 2 hours later that it must have been the syntocinon.

Cheryl