Pitocin is a synthetic version of the natural occurring hormone, oxytocin. The female body naturally produces its own oxytocin in the pituitary gland, which causes uterine contractions. When labor starts, oxytocin continues to be released by the pituitary gland to drive the labor pattern.
If the body makes its own oxytocin, why would synthetic Pitocin need to be administered?
Synthetic Pitocin is administered for a couple of different reasons:
- To start or induce labor. If labor has not started on its own, sometimes a physician will decide to use synthetic Pitocin to help the body get labor started.
- To augment labor. Once labor has started, sometimes physicians will administer synthetic Pitocin to speed things along or to increase the strength of the contractions that are occurring.
Are there risks associated with the use of Pitocin?
Yes. In fact, Pitocin is what is known as a high alert medication, meaning there is an increased risk of causing significant harm if Pitocin is used incorrectly.
What are the risks of Pitocin Use?
There are several risks if Pitocin is used incorrectly. Most notably, Pitocin can cause:
- Risk of causing contractions that are too strong or intense. This can cause damage to the uterus and even rupture or tear or the placenta to separate from the uterine wall too soon. These intensely strong contractions can also interfere with the flow of oxygen to the baby. This happens because the umbilical cord, which is the baby’s lifeline and only source of oxygen, gets compressed during contractions. If these contractions are too intense, that compression can disrupt the flow of oxygen to the baby.
- Risk of causing contractions that are too close together. If contractions are too close together, there may not be enough rest time to allow the baby to recover. Rest intervals are critical for the baby’s health, to recover from the restricted flow of oxygenated blood that occurs during the contraction. If there are inadequate rest intervals, the baby will use up their oxygen reserves, which can result in brain damage to the baby.
Causing Brain Damage to the Baby
If Pitocin is mismanaged during labor, it can cause severe injury to the baby. Hypoxic ischemic encephalopathy (HIE) is typically the result when Pitocin leads to hypoxia during labor. HIE will often lead to a diagnosis of Cerebral Palsy. Studies have shown that between 45% and 71% of HIE malpractice cases involved the excessive, incautious use of Pitocin. It is a dangerous drug and should be administered with extreme caution and care.
What are the Responsibilities of Health Care Providers
and Facilities When Administering Pitocin?
Because Pitocin is a high-risk drug, health care providers must exercise extreme caution and carefully monitor patients who are receiving Pitocin. This means that the hospital, the doctor, and the nurses all have responsibility for ensuring that Pitocin is safely administered for both the baby and the mother.
Responsibility of the Hospital or Healthcare Facility
The hospital has the responsibility to ensure that their labor and delivery staff, doctors and nurses included, are properly trained. This means that the staff is competent enough to interpret fetal heart monitoring (FHR) strips correctly, know what kinds of interventions to use if the strips look concerning, and know when FHR strips show signs of a fetus in distress that needs to be delivered emergently with a c-section.
The hospital also has a responsibility to ensure that there are policies and protocols in place which govern the safe administration of Pitocin. Policies and protocols should be written to protect the patients from harm and should follow FDA recommendations, ACOG guidelines and AWOHNN guidelines.
Pitocin protocols need to provide clear instructions to the nursing staff, advising them of when the physician should be contacted and how to titrate the Pitocin according to each patient’s individual response to the medication. Protocols should not be written in a way that provides a cookie cutter approach to dosing of high-risk Pitocin but rather, should customize the dosing to the patient’s individual response to the medication.
Responsibility of the Physician
Physicians have the responsibility to write orders that properly dose Pitocin according to the individual patient.
Physicians have the responsibility to ensure that there is a valid reason to adminster Pitocin in the first place. Note that scheduling an induction for convenience or to speed labor along without a valid indication is beneath the standard of care.
Pitocin dosing orders need to include very clear language from the physician as to when he/she wants to be called when not physically present during labor.
Safe Pitocin orders should be written to explain that the goal of Pitocin dosing is to achieve an adequate labor pattern. Details should be provided that indicate what constitutes an adequate labor pattern. Once this goal is achieved, the Pitocin orders need to specify that the dose can be lowered or turned off, allowing labor to progress on its own under the drive of the naturally occurring oxytocin.
While the patient is receiving Pitocin, physicians also have a responsibility to respond to any concerns from the labor and delivery nurses. If the nurse is seeing something concerning on the FHR monitor, the physician has a responsibility to personally evaluate the fetal heart rate strips and the patient. They have a responsibility to intervene when needed.
While a patient is receiving Pitocin, one of the most important responsibilities for the physician is to be ready and willing to perform an urgent or emergent c-section at any time, should the FHR tracing show ominous signs. The FHR strip can show signs the baby is in serious trouble and needs delivered now. Physicians have a responsibility to be ready to deliver emergently. Industry standard is that there should be 30 minutes or less between the decision to perform a c-section and the incision time.
Responsibility of the Labor & Delivery Nurse
Because the nurses typically spend the most time with a laboring mom, there is a lot of responsibility on nurses to ensure this high risk medication is delivered safely. Because Pitocin is a high alert medication, nursing staff must perform a dual verification before administering the medication. This means that another RN must read the physician order and compare it to the Pitocin being given to make sure that the dose is correct.
One of the most important responsibilities for the Labor and Delivery nurse is to provide constant close monitoring of the FHR strips the entire time the patient is being given Pitocin.
It is the responsibility of the labor & delivery nurse to ensure that the Pitocin is being managed in a way that ensures the baby is always getting adequate oxygen as evidenced by the FHR strip. The nurse must be well trained to recognize a baby’s “calls for help” on the FHR strip and step in with proper interventions in BEFORE there is an emergency. A nurse’s Intervention prior to an emergency may be to turn the Pitocin down or off for a period of time.
The labor nurse must communicate to the physician if he/she sees any indication of emergency on the FHR strip. If the physician does not respond appropriately and safely, the nurse has an absolute duty and responsibility to advocate for her patients by utilizing what is known as the chain of command. This means that the nurse goes to the next level after the physician to get help, and keeps going up that chain of command until he/she gets a result that will rescue the baby from harm.
Can Pitocin be administered safely?
While a high-risk drug, Pitocin can be administered safely. It requires care, attention, and proper training of all involved. The healthcare providers entrusted with the health and safety of both mother and baby owe an absolute duty to their patients to be sure they are always practicing within the standard of care when administering a drug such as Pitocin.
If you had Pitocin administered to you during labor and believe it may have contributed to an injury to your or your baby, our staff nurse will be happy to talk with you and answer any questions you may have about Pitocin use or injuries that were sustained as a result.
Learn more about recent court verdicts relating to birth injuries due to misuse of Pitocin.