How to avoid Pitocin

enigmasara

I'm relatively new to this board.  I have lurked a bit, but not a ton, so I apologize if this question has been talked to death.  The more research I do, the more my H & I feel like we really want to avoid me getting any Pitocin.  It seems like it just starts a downward spiral, which can be beat, but is more difficult.  I'm only 28 weeks now, but I want to try to get a possible plan in place in case the OB suggests Pitocin during labor, or they suggest getting induced. 

My question is what are some other options?  I know that I can obviously refuse any treatment that I don't want, but if things really do seem to need to be moved along, what can I or my H do to help?

sschwege

Part of it comes down to why it is being given.  If you were being induced at 35 weeks for preeclampsia then I don't think there's much avoiding it.  You could discuss the option of using a cervical ripener the night before so your body is more ready, then request Pit be started at the lowest dosage and work your way up, further requesting it be shut off once you are in a good contraction pattern.  

If it is being given because your bag of water broke and you are not having contractions, you could always ask for more time, walk around that type of thing.  My comfort level would probably be 12 hours and I would decline internal checks at that point.  You could also try a breast pump/nipple stimulation, that's my MWs' go to when water breaks and contractions don't start.  

If you are looking at it because you are past your EDD, I guess I would want to have a plan in mind for how far you would be willing to go past your due date.  My comfort level would have been induction at 42w, provided tests showed baby was doing fine.  So avoiding Pit by being willing to wait for baby to come on its own.  Also trying natural forms of induction first, sex, walking, nipple stimulation, membrane sweep, etc.  If I made it to 42w and no baby I would consider letting them break my water first.  That's kind of a tricky one, but if I was dilated far enough, maybe 4cm and there was a good chance my body would take over I would consider that as a last ditch effort to avoid Pit.  As I said that's a tricky one, you are obviously putting yourself on the clock and increasing your risk of infection, but I guess my thinking would be, at 42w the clock is already ticking.  

If they want to start Pit because labor has stalled, I would try other methods of getting things going first, again a breast pump would be a good place to start.  If water is still intact and baby is looking good, going home might be an option to consider as well.

In all reality the best way to avoid Pit once you are in labor is to labor at home.  Providers are far less likely to push interventions if you arrive late in the game.  

Have you discussed your hope for a low intervention birth with your provider?  If you haven't now is the time, it's never too early! 

enigmasara

@sschwege Thank you for all of that info.  I have not yet talked to my OB about my desire for low intervention/natural birth.  My original thoughts on L&D were basically give me all of the drugs, but now that I have done more research I have almost done a complete 180.  I wanted to be as educated on my decision as possible before talking too much with her about it in case I changed my mind again.  I think at this point I'm pretty set on my decision, so next appointment I will bring it up with her. 

GPeterson24

I agree with all of the things the PP suggested/mentioned.  Also, staying at home as long as possible provides less chance for interventions, changing positions frequently, staying active, etc.  Trusting your body, reading up on labour/birth, and not trying to force anything is usually your best bet.

However, sometimes despite our best intentions, Pitocin may be needed.  I have seen women who just need a little "kick start" and then there body takes over and the Pit is stopped.

aylafsu88

@sschwege had great information and advice. The big thing is to understand the situations that you may need it and the times when your OB/MW just wants to speed thing along. Being education on the things (pitocin, breaking your water etc) is critical to making informed choices and not fear based decisions in the hospital.
'If you are low risk and go into labor on your own stay home as long as possible. If you are at home longer and have less time in the hospital your provider has less time to push needless interventions. Also staying active during labor can help. Keep walking, change positions etc. These things will help your contractions and keep the labor momentum going.
 

mb314

sschwege said:

Part of it comes down to why it is being given.  If you were being induced at 35 weeks for preeclampsia then I don't think there's much avoiding it.  You could discuss the option of using a cervical ripener the night before so your body is more ready, then request Pit be started at the lowest dosage and work your way up, further requesting it be shut off once you are in a good contraction pattern.  

If it is being given because your bag of water broke and you are not having contractions, you could always ask for more time, walk around that type of thing.  My comfort level would probably be 12 hours and I would decline internal checks at that point.  You could also try a breast pump/nipple stimulation, that's my MWs' go to when water breaks and contractions don't start.  

If you are looking at it because you are past your EDD, I guess I would want to have a plan in mind for how far you would be willing to go past your due date.  My comfort level would have been induction at 42w, provided tests showed baby was doing fine.  So avoiding Pit by being willing to wait for baby to come on its own.  Also trying natural forms of induction first, sex, walking, nipple stimulation, membrane sweep, etc.  If I made it to 42w and no baby I would consider letting them break my water first.  That's kind of a tricky one, but if I was dilated far enough, maybe 4cm and there was a good chance my body would take over I would consider that as a last ditch effort to avoid Pit.  As I said that's a tricky one, you are obviously putting yourself on the clock and increasing your risk of infection, but I guess my thinking would be, at 42w the clock is already ticking.  

If they want to start Pit because labor has stalled, I would try other methods of getting things going first, again a breast pump would be a good place to start.  If water is still intact and baby is looking good, going home might be an option to consider as well.

In all reality the best way to avoid Pit once you are in labor is to labor at home.  Providers are far less likely to push interventions if you arrive late in the game.  

Have you discussed your hope for a low intervention birth with your provider?  If you haven't now is the time, it's never too early! 

This is a great answer!  Unfortunately there are situations when an induction is necessary.  You and your DH need to figure out under what circumstances you would be comfortable with induction.  I had pre-existing high blood pressure, and my midwife wanted to induce me at 40 weeks when my blood pressure was creeping up, but still not high.  DH and I really researched it and discussed it, and we asked for a non-stress test and a sonogram before agreeing to induction to see how the baby was doing.  In the end, the signs pointed to the baby being under some stress, my fluid levels being low, and the induction seeming like a good thing, so we agreed to it.  Thankfully, DS came on his own less than 24 hours after we had the non-stress test and had agreed to the induction, so I did avoid pit.  But that's just to say that sometimes an induction is necessary or seems necessary, and you need to take each situation under careful consideration. 

If you go into labor on your own, laboring at home as long as possible could help you avoid pitocin.  Also, hiring a doula could be really helpful because she could help suggest positions/movements/techniques for moving your labor along. 

Laceyd2014

I agree with previous reaponses. If you're not being induced and you go into natural labor stay home as long as possible, walk walk walk, yes walking when you're in labor is easier said than done but it helps. Also with my dd I used a giant exercise ball it helped with the pain and also opened my hips up to allow her to come down further there for dilating me quicker. Best of luck!

jenn43

I think learning as much as you can is a great suggestion.  I would also find out your OBs views on natural birth.  I ended up changing to a midwife around week 20 when I decided to go natural.  My OB was great, but for my midwife natural birth was her default, rather than a special situation.  And I'm very glad I did change- my water broke at home, and labor did not start on its own.  My midwife was comfortable letting me stay at home much longer than I think most OBs would have (the 12 hour mark was 2 am, so she had us stay at home until the next morning since both I and the baby were doing fine).  She also ran through the options for induction (e.g. pitocin vs cytotech) and let me choose what I was comfortable with.  Overall, it was a fantastic experience.  And even in those instances where Pitocin was needed (e.g. to start labor at 42 weeks), I know several women who went dpi-free even with the pit.  Good luck!

H&H2014

All great answers! And I second getting a birth doula and educating yourself as much as possible. There are evidence based birth sites and improvinginbirth.org that are great resources.

funchicken

The PPs have great advice, but you can still have a positive experience even if you have to be induced.

I was induced with DD3, and honestly, I found the pitocin contractions to be very manageable. It wasn't what I had planned since I went into labor on my own with my first two, but it ended up being a great experience and I was able to go pain med-free.  

MommyAtty

I've had two babies naturally. The first time I had to be induced for a non-preeclampsia high blood pressure spike. The second time, I went into labor at home, got to the hospital, had extremely high blood pressure, and they needed to get the baby out fast. My options frankly were a c-section or pit. I took the pit. Again, both times, I had the babies naturally. No epidural, no c-section, no issues. So, seriously, pit is not evil. There is no death-spiral that comes with it. My first time around, my birth plan had in all caps NO PITOCIN. I think the hype that came out of The Business of Being Born is just that: hype. So, seriously, worry about tons of other things, but don't worry about pitocin any more than you do any other intervention. (BTW, in my experience, labor even with pitocin was less painful than a bad migraine. If you teach your body to relax through the pain, you've got this, pitocin or no pitocin.)

jinnymb

All great answers above!! 

I would just add I avoided induction by insisting on non-stress tests once I was overdue and getting a Bishop Score.  I said if you can scientifically tell me I need to be induced because I failed a non-stress and I have a high Bishop Score then I will do it.  I had one passed and schedule another one for a couple of days later.  That night my water broke, so happy I made them wait. 

Also, while in labor decline internals except for say every 2 hours or every 3 hours, until you start transition.  This will keep them out of your room more and keep pressure off on how you are progressing or not.

Make sure your DH or birth support is willing to tell them to back off a bit if necessary.  Labor is 80% mental, %15 physical, and %5 luck.  Don't let them get in your head, you get in your zone and keep envisioning that baby coming out.