Post delivery Pitocin

lilmissdoe · July 2012

Hey all! I am a soon to be first time momma at almost 35 weeks. Planning a hospital birth with a midwife and hoping to go unaugmented. My last midwife visit I was informed about the hospital's standard of care to give Pitocin post delivery to help prevent post delivery hemorrage. Does anyone have any info to consider that this may cause any problems that may outway the benefits? I am 28, no health risk/problems during pregnancy.. plan to breastfeed. I think my body will naturally be ok and want to do my research!

Sorry if this has already been a subject on these boards!

WearingRed · July 2012

https://community.thebump.com/cs/ks/forums/thread/67545616.aspx

This is a link to a topic with this as part of the discussion. It is just a few posts down. Wink

catsinawindow · July 2012

This website would be a good place to start: https://www.who.int/bulletin/volumes/87/3/08-052597/en/index.html

The WHO supports active management of the third stage of labor and reviews the available literature that helped them make that recommendation. They mostly cover the benefits of active management, rather than the risks. Maybe someone else could suggest a good site that covers the risks.

catsinawindow · July 2012

Whoops, I didn't look at the link carefully enough, the thing I referenced above is actually a follow-up article reviewing the use of active management.

Check out this article: https://www.ncbi.nlm.nih.gov/pubmed/10908457

It lists both the benefits and side effects of active management of third stage.

KateLouise · July 2012

My understanding is that it's easier to prevent a hemorrhage than it is to stop one.

Sorry I don't have any useful links.

FWIW DD1 I had active management of the 3rd phase, with the pit being given straight away (I had the needle in the thigh) and had no issues.

DD2 my midwife arrived after she was born. They didn't give me pit until they became concerned about the bleeding. (basically everytime I stood up I gushed blood) Everything was ultimately ok with no problems, but afterwards they told me they were a bit worried, and even at the time I could tell there was a bit of stress between the midwives and ambulance officers.

lilmissdoe · July 2012

Thank you so much for some info!

sschwege · July 2012

The most current research seems to support Pit for the third stage of labor. When I had DD two years ago, it was hospital policy to give Pit on an as needed basis. After DD was born I told them I was fine with Pit if they thought I needed it, they just said, "Let's wait and see" and I never ended up needing it. I just read that article that talked about Expectant vs Active Management and it sounds like women are more likely to have high blood pressure when not given Pit. I do remember that being the case last time. It wasn't extremely high, but I remember my postpartum nurse remarking to my L & D nurse that I should not have been brought to postpartum yet because it was still too high. I wonder if I could have avoided that by having Pit?

StefandTodd · July 2012

sschwege:
The most current research seems to support Pit for the third stage of labor. When I had DD two years ago, it was hospital policy to give Pit on an as needed basis. After DD was born I told them I was fine with Pit if they thought I needed it, they just said, "Let's wait and see" and I never ended up needing it. I just read that article that talked about Expectant vs Active Management and it sounds like women are more likely to have high blood pressure when not given Pit. I do remember that being the case last time. It wasn't extremely high, but I remember my postpartum nurse remarking to my L & D nurse that I should not have been brought to postpartum yet because it was still too high. I wonder if I could have avoided that by having Pit?

Active management was associated with an increased risk of maternal nausea (relative risk 1.95, 95% confidence interval 1.58 to 2.42), vomiting and raised blood pressure (probably due to the use of ergometrine).

Active management = receiving pit before delivery of placenta, so no...pit would have only potentially raised your blood pressure further. It's a risk associated with giving pit across the board.

OP, my hospital does it standard, but I asked to take the wait-and-see approach and my MW was happy to do so. I didn't need it. This time, I'll have a home birth and again will only get pit if it's determined by my MW to be advantageous at the time.

sschwege · July 2012

StefandTodd:
sschwege:
The most current research seems to support Pit for the third stage of labor. When I had DD two years ago, it was hospital policy to give Pit on an as needed basis. After DD was born I told them I was fine with Pit if they thought I needed it, they just said, "Let's wait and see" and I never ended up needing it. I just read that article that talked about Expectant vs Active Management and it sounds like women are more likely to have high blood pressure when not given Pit. I do remember that being the case last time. It wasn't extremely high, but I remember my postpartum nurse remarking to my L & D nurse that I should not have been brought to postpartum yet because it was still too high. I wonder if I could have avoided that by having Pit?

Active management was associated with an increased risk of maternal nausea (relative risk 1.95, 95% confidence interval 1.58 to 2.42), vomiting and raised blood pressure (probably due to the use of ergometrine).

Active management = receiving pit before delivery of placenta, so no...pit would have only potentially raised your blood pressure further. It's a risk associated with giving pit across the board.

OP, my hospital does it standard, but I asked to take the wait-and-see approach and my MW was happy to do so. I didn't need it. This time, I'll have a home birth and again will only get pit if it's determined by my MW to be advantageous at the time.

Thank you so much for responding to that. I no joke read that twice because it didn't make sense, but both times I must have read it in reverse! Thanks!

alanap · July 2012

I did not have this with DD and will request not to again.

RayRay007 · July 2012

I don't have any info to add to that above, but I can say that my MW recommended active mgmt for me b/c of a fibroid and slightly increased risk of hemorhage (sp?) and I had agreed. I ended up with a c/s anyway, so active mgmt of the third stage was the least of my worries.

Hyaline · July 2012

Just as a sidenote--the risk of any postpartum hemorrhaging is 2.9% (for all types of births--vaginal births are much lower than c-section births, so the actual risk to a woman delivering vaginally is much lower--if anyone has vaginal-only stats I'd love to see them!) and the risk of bleeding so badly that you need blood products is much lower (like .26%). So while the pitocin may reduce this risk, be aware that you're dealing with a very low risk of severe hemorrhage in the first place when making your decision. (Stats from https://evidencebasedbirth.com/2012/05/30/the-saline-lock-during-labor/).

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