pitocin to induce placenta delivery?

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

Very.

So is it really necessary? I mean, I can see it'd be useful in some
cases, just wondering if it's so important it needs to be there all the
time?
FWIW - my uterus was contracting and I did push a lot, but like the
baby, the placenta didn't want to budge.


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.

Upon clarification, seems she said midwives *refuse* to give it
insisting instead on a 'natural' procedure and therefore endanger
women's lives, etc....

I suspect relaying this info was SIL's way of saying she was concerned
about our homebirth.


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.

The IV had ripped out during pushing. A nurse tried to insert one
again, multiple times, and failed and just gave up, so there was no IV
in from about 30 mins before DD was born until after the placenta came
out. Another nurse did come later and put one in for fluids, etc.

Dagny wrote:
"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.

The time frame may have been standard, but it was also just when she
got done dealing with DD. See, when DD was born the chief OB
immediately went to working on her and stayed with her while the NICU
staff was working until they took her away. Then she came back to me.
All told that was about 20+ minutes. Meanwhile the resident OB was
attending to me and no placenta was emerging, tho I was pushing. The
chief OB waited a bit, talked with my midwife, and then decided to go
for it. I'll have to ask my midwife more, but at the time when I asked
her about it, she also seemed to think they needed to be proactive in
removing it - possibly given my 3 hrs of pushing to deliver DD
(following 10 hrs of active labor) she thought it just wasn't going to
come on its own, no matter how strong the contractions.


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.

Oh yeah, I couldn't pee. They had to catheterize me - which I *think*
was done in the 10 min window between the chief OB returning to me and
when they decided to go after it.But I could be wrong about the timing.
My midwife had already done it once just before I started pushing.
Peeing was *not* working for me!

So is it really necessary? I mean, I can see it'd be useful in some
cases, just wondering if it's so important it needs to be there all the
time?

no, it's not "necessary", the research I've seen does give it a better
outcome in terms of PPH, but only in terms of loosing more than a certain
volume of blood, not seen any details comparison of what happens after that,
so you could say does it matter if you lose 750ml without the drug, but
likely would have lost under 500ml without it, if there is no further
difference. The numbers you are talking about are in a totally different
range to when a PPH becomes a problem. But all this comes with a side
effect, increase in retained placenta, I don't know if this is the same with
pitocin alone, but I'm guessing it may not be, but then the decrease in PPH
with pitocin alone is probably going to be less than that when ergometrine
is also given.

It's definitely not necessary to give it routinely, heck the human race
survived without it, that's why it's something that ought to be personal
choice, not physician imposed, some people will have a bigger fear or
concern about bleeding and will choose to have the drug. It is one
intervention that a proportion of pro natural birth people choose, for
whatever reason, but if they do, they usually choose to delay
administration, allow the cord to stop pulsing, cut the cord, then inject.

But, it is a necessary drug to be available, even on delivery units, it's
often a case of having it in the room, rather than in the drugs cupboard
down the corridor.

Cheers

Anne

Upon clarification, seems she said midwives *refuse* to give it
insisting instead on a 'natural' procedure and therefore endanger
women's lives, etc....

they may refuse to give women the choice of giving it automatically, perhaps
on the premise that in having a midwifery led birth at home, you've chosen a
natural delivery and that is what you are going to do, every homebirth
midwife I've spoken to would recommend natural delivery of the placenta as
the first plan of action, along with not clamping the cord, presuming baby
is well that time delay is a fantastic time for mum and baby, encourages
initiation of breastfeeding (and there is research that backs up the earlier
the first breastfeed the better). By not giving it automatically, they do
not endanger anyones lives about the only think you could say for sure, is
that they increase the chance of a bit more mess and decrease the chance of
retained placenta, if they then continue to refuse to give it if problems
develop, then that would be negligent and they shouldn't be attending
births, yes there are other techniques to cut down bleeding and there may be
people out there that would want to try all these first, but they'd have to
admit that sometimes without availability of further more medicalised
intervention, that women would die.

Anne

cjra wrote:
Ericka Kammerer wrote:
cjra wrote:
How commonly is this given in the US?
Very.

So is it really necessary? I mean, I can see it'd be useful in some
cases, just wondering if it's so important it needs to be there all the
time?

I don't think it is that necessary. I went without
it all three times (no troubles getting the placenta out or
excessive bleeding). I think it is certainly necessary *some*
times, but not always. On the other hand, when something
becomes this routine, you get sort of a chicken and egg
effect where if you waved a magic wand and stopped its routine
use, it might be more dangerous because current caregiver
aren't used to working without it.


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

Upon clarification, seems she said midwives *refuse* to give it
insisting instead on a 'natural' procedure and therefore endanger
women's lives, etc....

Eh. I think most midwives are quite aware of the pros
and cons and many clients (like me) prefer a natural third stage
when possible. As far as I'm aware, study results are a little
hard to interpret. Some seem to suggest a slightly increased
risk of PPH with home births, but when you look closer, the
studies don't necessarily say that.

I suspect relaying this info was SIL's way of saying she was concerned
about our homebirth.

Probably. People have many back-handed ways of
saying that ;-)

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.

The IV had ripped out during pushing. A nurse tried to insert one
again, multiple times, and failed and just gave up, so there was no IV
in from about 30 mins before DD was born until after the placenta came
out. Another nurse did come later and put one in for fluids, etc.

It's also possible they gave you a quick jab and
you didn't notice it. It would be interesting to check
your charts and see. It's hard for me to imagine not noticing
being jabbed, but many women apparently don't notice it.

Best wishes,
Ericka

It's also possible they gave you a quick jab and
you didn't notice it. It would be interesting to check
your charts and see. It's hard for me to imagine not noticing
being jabbed, but many women apparently don't notice it.

can't remember where on earth I heard this, but as this injection in the leg
is one that causes significant bruising, it seems some people only notice
when they find a bruise on their leg and wonder what it is

however I hope this is a case of something that happened in the past and
wouldn't happen now, talking to my mum and other women who had babies at a
similar times, it seems everything was done as a matter of course, with no
explanation, or even any information about what was being done, same with
vit K injections in newborns, my mum thought it was some new thing, but it
turns out it's been around for a lot longer and people just didn't know it
was being done, unless they found a plaster and asked why it was there.

Anne

Anne Rogers wrote:
It's also possible they gave you a quick jab and
you didn't notice it. It would be interesting to check
your charts and see. It's hard for me to imagine not noticing
being jabbed, but many women apparently don't notice it.

can't remember where on earth I heard this, but as this injection in the leg
is one that causes significant bruising, it seems some people only notice
when they find a bruise on their leg and wonder what it is

however I hope this is a case of something that happened in the past and
wouldn't happen now,

Sure it happens now. Sad, but true.

Best wishes,
Ericka

"Anne Rogers" wrote in message
...
It's also possible they gave you a quick jab and
you didn't notice it. It would be interesting to check
your charts and see. It's hard for me to imagine not noticing
being jabbed, but many women apparently don't notice it.

can't remember where on earth I heard this, but as this injection in the
leg is one that causes significant bruising, it seems some people only
notice when they find a bruise on their leg and wonder what it is

Funny, if it typically causes bruising, cause I bruise really easily, and I
never had a bruise from the injection either time. And no, I didn't notice
it being done, but dh saw them do it. He told me that he'd seen it done (it
was on my birthplan) when I commented that it hadn't been done. I bruise
extra easily during pregnancy and for about 6 weeks afterwards too.
Debbie

Funny, if it typically causes bruising, cause I bruise really easily, and
I never had a bruise from the injection either time. And no, I didn't
notice it being done, but dh saw them do it. He told me that he'd seen it
done (it was on my birthplan) when I commented that it hadn't been done. I
bruise extra easily during pregnancy and for about 6 weeks afterwards too.

dunno how true the bruising thing is, but we were told it in antenatal class
and I remember my HV saying something about it too. I can't offhand think of
any reason why you wouldn't bruise in this one instance, but I bet there is
some explaination, I don't know what the reason for the bruising is in
general, you'd think that all IM injections would do the same, but they
definitely done, there is one ketoprofen, an antimflamatory that really
hurts at the injection site, sometimes for a really long time, I think one
time I had it I still had pain in my buttock 3 months later. A one off shot
of pethidine doesn't seem to do much to the area, but multiple and you
really feel like a pincushion, but once you stop it heals up pretty fast,
odd really, I doubt it's the kind of thing that google will show up a
friendly explaination of!

Anne

I never used to use prophylactic pitocin in the 3rd stage, but recently
more evidence has emerged that it appears to be beneficial and I
started doing so for all patients who already have IV's. I realize this
is not systematic, but I have been impressed with the shorter duration
of second stage and especially the reduced maternal blood loss. In my
experience the difference has been quite dramatic. In many of my
deliveries now, I am seeing essentially no bleeding at all.

There is another Cochrane review underway now, with the somewhat
broader scope of "active versus expectant management of 3rd stage" -
active management encompassing medications, fundal massage, and/or cord
traction. I will be interested to see these results.

I do not consider the evidence completely established on this issue,
but it is definitely worth looking at when one considers that
postpartum hemorrhage accounts for a large portion of all maternal
morbidity and mortality.

-------------------------------------------------
The Cochrane Database of Systematic Reviews
The Cochrane Library, Copyright 2006, The Cochrane Collaboration Volume
(2), 2006, [no page #]
Prophylactic oxytocin for the third stage of labour
[Reviews]
Cotter, A; Ness, A; Tolosa, J
Date of Most Recent Update: 24-August-2005
Date of Most Recent Substantive Update: 17-July-2001
Cochrane Pregnancy and Childbirth Group
Dr Amanda Cotter, Assistant Professor of Clinical Obstetrics and
Gynecology; University of Miami, Department of Obstetrics and
Gynecology, PO Box 016960 (D-53), Miami, Florida, USA, 33101. Phone: +1
305 2434020, E-mail: .
Abstract
Background: Complications of the third stage of labour are a
significant cause of maternal mortality worldwide.
Objectives: To examine the effect of oxytocin given prophylactically in
the third stage of labour on maternal and neonatal outcomes.
Search strategy: We searched the Cochrane Pregnancy and Childbirth
Group's Specialised Register of Controlled Trials (December 2004).
Selection criteria: Randomised or quasi-randomised controlled trials
including pregnant women anticipating a vaginal delivery where oxytocin
was given prophylactically for the third stage of labour.
Data collection and analysis: The review authors independently assessed
trial quality and extracted data. Analysis was by intention to treat.
Subgroup analyses were based on extent of selection bias, oxytocin in
the context of active or expectant management of the third stage, and
timing of administration. Results are presented as relative risks, and
weighted mean difference, both with 95% confidence intervals using a
fixed-effect model.
Main results: Fourteen trials are included.
In seven trials involving over 3000 women, prophylactic oxytocin showed
benefits (reduced blood loss (relative risk (RR) for blood loss greater
than 500 ml 0.50; 95% confidence interval (CI) 0.43 to 0.59) and need
for therapeutic oxytocics (RR 0.50; 95% CI 0.39 to 0.64) compared to no
uterotonics.
In six trials involving over 2800 women, there was little evidence of
differential effects for oxytocin versus ergot alkaloids, except that
oxytocin was associated with fewer manual removals of the placenta (RR
0.57; 95% CI 0.41 to 0.79), and with the suggestion of less raised
blood pressure (RR 0.53; 95% CI 0.19 to 1.52) than with ergot
alkaloids.
In five trials involving over 2800 women, there was little evidence of
a synergistic effect of adding oxytocin to ergometrine versus
ergometrine alone.
Authors' conclusions: Oxytocin appears to be beneficial for the
prevention of postpartum haemorrhage. However, there is insufficient
information about other outcomes and side-effects hence it is difficult
to be confident about the trade-offs for these benefits. There seems
little evidence in favour of ergot alkaloids alone compared to either
oxytocin alone, or to ergometrine-oxytocin, but the data are sparse.