A nationwide shortage of Pitocin, the intravenous (IV) medicine given to induce labor by mimicking oxytocin’s natural contraction-stimulating effects, is leading many hospitals to cancel elective labor inductions, reserving the medication for medically necessary use only. The shortage is expected to be brief, but it raises important questions about the risks vs. benefits of routine elective inductions, particularly in light of research suggesting that it is the baby who initiates spontaneous labor when he or she is ready [1]. I won’t address all the aspects of this controversial topic, but instead will focus here on explaining the difference between Pitocin and oxytocin and the risks of Pitocin use. I’ll also pose some questions about possible implications for moms and babies from Pitocin-induced labor compared to spontaneous labor.
Why is Pitocin given, and how many women receive it?
I covered the many important functions of the naturally-occurring hormone oxytocin here. Synthetic oxytocin (Pitocin or Syntocinon), which is chemically the same as natural oxytocin, is used to induce labor, to strengthen contractions if labor has “stalled” (also known as dysfunctional labor), and to speed up the delivery of the placenta (third stage of labor). According to Centers for Disease Control and Prevention (CDC) data from 2020, 31% of labors were induced, though the data did not specify how many were elective versus medically indicated. This number could be even higher – a 2013 survey revealed that 41% of mothers felt pressured to be induced by their provider [2].
Pitocin side effects
Labor induction is a necessary intervention in certain cases – in cases of pregnancy complications like gestational diabetes, for example, or if the mother’s water breaks but labor has not begun within 24-48 hours – but as with any medication there are also real risks associated with being induced, or with using synthetic oxytocin to speed up labor. Pitocin is actually one of only a small number of medications considered a High-Alert medicine, meaning that misuse can cause severe harm to mom and/or baby. But the Food and Drug Administration (FDA)’s product label notes that even with appropriate use, harm to the mom and/or baby are still possible. “Even with proper administration and adequate supervision, hypertonic contractions [too strong contractions] can occur in patients whose uteri are hypersensitive to oxytocin.”
The label cautions “Maternal deaths due to hypertensive [high blood pressure] episodes, subarachnoid hemorrhage [brain bleed], rupture of the uterus, and fetal deaths due to various causes have been reported associated with the use of parenteral oxytocic drugs for induction of labor or for augmentation in the first and second stages of labor.”
The label lists the following as possible adverse effects on the mom:
- “Anaphylactic [life-threatening allergic] reaction
- Premature ventricular contractions [heart skipping a beat]
- Postpartum hemorrhage
- Pelvic hematoma (blood collection in the pelvis)
- Cardiac arrhythmia [abnormal, potentially lethal, heart rhythms]
- Subarachnoid hemorrhage (brain bleed)
- Fatal afibrinogenemia [blood clotting problem]
- Hypertensive [high blood pressure] episodes
- Nausea
- Rupture of the uterus [an emergency]
- Vomiting”
Other risks
Besides the risks noted above, and because continuous infusion of Pitocin both leads to strong, painful contractions and doesn’t allow the uterus to fully rest between contractions as occurs from pulsatile oxytocin release during natural labor, induction with Pitocin often leads to use of an epidural injection to relieve pain, which has its own set of risks. Use of Pitocin can lengthen the latent phase of labor (early labor), according to this 2012 study [3]. Additionally, while natural oxytocin is known to boost maternal mood and mother-baby bonding, 2019 research surprisingly found that women who received synthetic oxytocin during labor actually had a higher risk of developing a mood disorder such as anxiety and/or depression in the first year after giving birth [4][5]. Additionally, in this small 2009 study, women who received Pitocin during their labor had lower levels of naturally produced oxytocin several days postpartum than women who did not experience labor induction or augmentation [6]. Perhaps oxytocin has to be in its natural state to be fully beneficial. This lengthy and comprehensive article by Evidence-Based Birth summarizes current scientific research on the pros and cons of inducing (for which Pitocin is used) for being at or past the due date.
Pitocin is not indicated for elective inductions, according to the FDA
Certainly, Pitocin is the typical drug of choice for women undergoing labor induction, elective or not. And yet, the FDA’s own label for Pitocin specifically reads: “Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefits-to-risks considerations, Pitocin is not indicated for elective induction of labor.” How many women are made aware of this precaution from the FDA when discussing possible induction with their healthcare provider?
Considering the risks, it is surprising not only how many women end up being induced, but also how many providers are quick to recommend it. As this fact sheet points out, the best predictor of a safe birth is to let the baby be born when the baby is ready.
What might the implications of lack of natural oxytocin release during labor be for mothers?
One of the potential issues with Pitocin use is the mother missing out on the benefits of natural hormone release during spontaneous labor, which normally includes secretion of oxytocin, endorphins, catecholamines, and prolactin [1][7]. One wonders whether the mother’s body might respond differently if she were allowed to begin labor on her own, without the mounting pressure to induce because of fears such as having a “big baby” or being past her due date (even though due dates are often inaccurate) or even just because it’s more convenient for her own schedule or her provider’s?
One wonders how her body might respond differently if she were listened to during labor, fluorescent lights were dimmed, unnecessary needles and tubes were avoided, and she was given space and time to labor with her loved ones without feeling rushed?
Undoubtedly, Pitocin has a role to play in evidence-based medicine. But Pitocin appears not to effect the laboring woman’s body the same was as her own natural oxytocin does, and the implications of that difference, for both mom and baby, physically and mentally, are not yet fully understood.
This article was updated on Nov 17, 2022 to include several more resources.
References:
[1] Amis D. Healthy Birth Practice #1: Let Labor Begin on Its Own. J Perinat Educ. 2019 Apr 1;28(2):68-80. doi: 10.1891/1058-1243.28.2.68. PMID: 31118543; PMCID: PMC6503903. [2] Declercq, Eugene R et al. “Major Survey Findings of Listening to Mothers(SM) III: Pregnancy and Birth: Report of the Third National U.S. Survey of Women’s Childbearing Experiences.” The Journal of perinatal education vol. 23,1 (2014): 9-16. doi:10.1891/1058-1243.23.1.9 [3] Harper, Lorie M et al. “Normal progress of induced labor.” Obstetrics and gynecology vol. 119,6 (2012): 1113-8. doi:10.1097/AOG.0b013e318253d7aas [4] Hanan A. Badr, Jaclene A. Zauszniewski, “Kangaroo care and postpartum depression: The role of oxytocin.” International Journal of Nursing Sciences, vol. 4, issue 2 (2017): pp. 179-83. https://doi.org/10.1016/j.ijnss.2017.01.001. [5] Kroll-Desrosiers AR, Nephew BC, Babb JA, Guilarte-Walker Y, Moore Simas TA, Deligiannidis KM. Association of peripartum synthetic oxytocin administration and depressive and anxiety disorders within the first postpartum year. Depress Anxiety. 2017 Feb;34(2):137-146. doi: 10.1002/da.22599. PMID: 28133901; PMCID: PMC5310833. [6] Jonas, W et al. “Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin, in response to suckling during the second day postpartum.” Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine vol. 4,2 (2009): 71-82. doi:10.1089/bfm.2008.0002 [7] Bell AF, Erickson EN, Carter CS. Beyond labor: the role of natural and synthetic oxytocin in the transition to motherhood. J Midwifery Womens Health. 2014 Jan-Feb;59(1):35-42: quiz 108. doi: 10.1111/jmwh.12101. Epub 2014 Jan 28. PMID: 24472136; PMCID: PMC3947469.Additional Reading:
How you can know when you conceived and why it matters
Is a “big baby” a good reason to have an induction?
Preterm premature rupture of membranes (PPROM): What happens when your water breaks too early?
Cervical checks during pregnancy: what they can- and can’t- tell you
