When I was 38 weeks, 3 days pregnant with my second child and first daughter, my doctor recommended I be induced with Pitocin so we could better assess an ovarian cyst seen on ultrasound. (If you’re wondering how we found the cyst, my OB ordered an ultrasound because I’d felt my daughter move less than usual that day. And if you’re wondering how things turned out, when she was only two days old, her surgical team removed 8 ounces of clear fluid from her ovarian cyst!) Though I went into the hospital that night to “begin” the induction, Pitocin was only titrated up once the day shift nurse arrived the following morning.
Throughout the day, the contractions intensified until they got quite strong and close together. I told my labor and delivery nurse, a veteran with 32 years of experience, that I wanted to avoid an epidural as long as possible. My epidural experience with my first child had been less than desirable. (It didn’t occur to me at the time that you could be induced but not have an epidural for pain management.) With my nurse’s assistance and encouragement, plus a shot of IV Nubain pain medication when I was eight centimeters dilated (but no epidural), my daughter entered the world around suppertime.
Could turning off Pitocin in active labor limit the need for an epidural?
Later on, I wondered why the Pitocin (which is chemically the same as the body’s natural oxytocin, but processed differently by the body than natural oxytocin is) hadn’t been shut off once my contractions got hot and heavy. Surely I didn’t need it any longer at that point? And had the intensity of these artificially-stimulated contractions been the reason I needed pain medication? Two unmedicated births (one with nitrous oxide, one without) after that, my suspicion is that I could have done without the Nubain (which was effective, but also made me so sleepy I could hardly stay awake in my daughter’s ‘golden hour’ after birth) if the “Pit” had been shut off once I achieved active labor, around six centimeters dilated.
I wondered about shutting off Pitocin during active labor specifically in order to avoid IV pain medication, but even more importantly, what effect might stopping Pit have on the likelihood of Cesarean section (C-section)? The relationship between Pitocin induction and C-section is admittedly complicated. However, one of the reasons Pitocin is given is specifically to decrease the risks of prolonged labor, which include infections in mom and/or baby, and the necessity of a C-section.
On the other hand, we know that “too much” Pitocin—and this dosage can vary from woman to woman and one pregnancy to another—can lead to uterine hyperstimulation. In turn, uterine hyperstimulation can lead to fetal distress, indicated by concerning dips in fetal heart rate, aka “late decelerations.” Late decelerations will generally resolve with decrease or discontinuation of Pitocin, but could necessitate a C-section. According to the American College of Obstetricians and Gynecologists (ACOG), other potential but unlikely risks of Pitocin use include chorioamnionitis (infection of the placenta, amniotic fluid, or amniotic sac), fetal infection, and uterine rupture.
Can turning off Pitocin during active labor decrease C-section risk?
But is there research evidence behind the idea of shutting off Pitocin once a mother reaches active labor to reduce C-section risk? A 2021 randomized controlled trial research study from Norway and the Netherlands published in the BMJ compared 607 women who had their Pit stopped once they were six centimeters dilated to 593 women who did not. Of the women who had their Pit stopped, 17% went on to have a C-section, compared to 14% of the women who had continuous Pit until birth [1].
The 2021 study summarized previous research on the connection between stopping Pitocin and subsequent C-section risk. They noted that while four meta-analyses and two other recent studies supported the idea that labor would continue if Pit was stopped once active labor was established, which should in theory decrease rates of C-sections related to uterine hyperstimulation, a Cochrane review of studies found the sum total of research evidence on this topic to be low quality due to study design limitations. The reviewers wrote, “Discontinuing IV oxytocin stimulation after the active phase of labour has been established may reduce caesarean delivery but the evidence for this was low certainty.“
And yet, the 2021 study researchers found, alongside the 2% increased risk of C-section in women who stopped Pit once they achieved active labor, there was a more significant decrease in uterine hyperstimulation (4% of women who had Pit stopped compared to 13% of women who did not) and a significant decrease in fetal distress (28% of women who had Pit stopped compared to 41% who did not).
What the studies show
The 2021 study researchers observed, “In a setting where close monitoring of both mother and baby can be guaranteed, routine discontinuation of oxytocin stimulation may lead to a small increase in the rate of caesarean section, but the significantly reduced risk of uterine hyperstimulation and abnormal fetal heart rate may be an important advantage in settings where monitoring resources are limited.”
The 2021 study researchers observed, “In a setting where close monitoring of both mother and baby can be guaranteed, routine discontinuation of oxytocin stimulation may lead to a small increase in the rate of caesarean section, but the significantly reduced risk of uterine hyperstimulation and abnormal fetal heart rate may be an important advantage in settings where monitoring resources are limited.”
Even more recently than the 2021 research study, a 2025 systematic review plus meta-analysis* published in the American Journal of Obstetrics and Gynecology found that shutting off Pit in active labor reduced C-section likelihood along with rates of uterine hyperstimulation and fetal distress. On average, labor lasted half an hour longer in the group who stopped Pit compared to the group who did not [2].
The 2025 researchers examined the results of 15 randomized controlled trials, totaling 5,734 women who received Pitocin either to induce labor or to augment it (to speed up labor that had stalled). On average, participants were 39 weeks and 6 days pregnant at the time of labor induction, and 26 years old. Most had a normal body mass index (BMI) and were first-time mothers.
For women who received Pitocin for either augmentation or induction, stopping Pit in at six centimeters dilated correlated with a 20% decreased risk of C-section. For women who received Pit specifically to induce labor, stopping Pit correlated with a 30% decreased risk of C-section. Women who received Pit for either reason had a 55% decreased risk of uterine hyperstimulation and a 36% decreased risk of fetal distress.
For women who received Pit specifically to induce labor, stopping Pit correlated with a 30% decreased risk of C-section.
The bottom line on stopping Pitocin once a woman reaches active labor
If you have a medical reason to have labor induced, be sure to talk to your healthcare team about stopping Pitocin once you’re in active labor (i.e., around six centimeters dilated) to decrease your risk of C-section, uterine hyperstimulation, and fetal distress. You should also know that there may be options for labor induction beyond Pitocin, and you can read more about them here.
*A Boston cardiologist helpfully suggests differentiating a systematic review from a meta-analysis in terms of a systematic review identifying or finding all the pieces that go with a particular puzzle, and a meta-analysis as putting those pieces together.
