Pitocin: Friend or Foe?

Assumption: Pitocin is good for labor because it speeds things up, making birth more pleasant and less dangerous for everyone.

FALSE
While it may speed labor, birth is harder and more dangerous when synthetic oxytocin is used.  This study from New Zealand measures the use of synthetic oxytocin and the outcomes of births that use it versus births that do not use it.  The study shows a marked increase in the need for/use of pain killers, instrumental delivery like vacuum and forceps, and cesarean surgery.  There was also an increase in neonatal morbidity in cases where synthetic oxytocin was used.

http://www.ncbi.nlm.nih.gov/pubmed/22384940

My Views:
I understand that there are very good reasons to use Pitocin to induce or augment labor.  Situations like these are not the norm, however.  Unfortunately, many low-risk women with no medical problems are being induced for the sake of convenience.  There is a reason that studies of birth certificates show a huge discrepancy between births occurring Monday through Friday during “work hours” and those occurring on weekends and “after hours.”  If you have a weekend baby, you are in the minority!  I think the medical community is starting to see the problems these early scheduled inductions are causing and is slowly shifting inductions from 38-40 weeks to 41 weeks, which is a good start.  Still, I feel that women are not told of the risks they are taking by not waiting for labor to start (or continue) on its own.

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Corticosteroids for Preterm Babies

Assumption: A dose of corticosteroids given to women at high risk of preterm labor helps babies’ lungs develop and prevents problems.

TRUE
No negative side effects have been documented, but fewer babies are dying of breathing problems when moms are given an injection of corticosteroids prior to birth.  The corticosteroids help the lungs develop more quickly, preventing respiratory distress.

http://www2.cochrane.org/reviews/en/ab004454.html

My Views:
Since the lungs appear to be the last organs to fully develop, I am so glad women have options that will help their babies breathe if the babies are born early (prior to 37 weeks).  These studies indicated no adverse effects to mom or baby, which is comforting as well.  However, the studies examined in this report examined the effects of ONE does of the steriods.  Multiple doses *may* have effects and should be used sparingly.

Oxytocin and Baby’s Brain

Assumption: Maternal oxytocin benefits mom, but has no direct effect on baby.

FALSE
(Note: The featured study was done on rats, so further research is needed to see if it is true for human brains.)  It appears from this study that oxytocin, the hormone that governs labor,  breastfeeding, and attachment; has a direct affect on a baby’s brain.  During birth, when the baby puts pressure on the cervix, oxytocin is released and the baby receives the hormone through the placenta.  The oxytocin appears to actually slow down the brain and “silence” nerve cells.  Because of this affect, birth itself has less of a traumatic effect on the baby and the baby can actually tolerate oxygen deprivation for up to an hour because the energy needs are reduced.

http://www.sciencemag.org/content/314/5806/1788

My Views:
What a neat finding!  I love it when the researchers discover more ways in which our bodies help us.  One hormone that can do so many positive things… and more being discovered!  It is truly amazing the many ways in which moms and babies are connected physically as well as emotionally.  And oxytocin is involved in both!  It is also important to note that synthetic oxytocin (pitocin) is not the same as naturally occuring oxytocin.  Maybe that gives me a topic to research for later this week!

Hands and Knees Position

Assumption: The hands and knees position prior to labor helps baby move into optimal birthing position.

FALSE
Studies have shown no evidence that babies move into a better position when moms assume the hands and knees position for 10 minutes twice daily in late pregnancy.  This does not mean that there is harm in the position, just that it is not proven to help with positioning.  It can and does, however, alleviate backache during labor.

http://www2.cochrane.org/reviews/en/ab001063.html

My views: Hands and knees can be a very comfortable position for women during the third trimester because gravity allows the baby to move away from the parts s/he is usually pressing on. 🙂  So, if it feels good to mom, there is no reason not to relax in this position.  During labor, this position is particularly comfortable if baby is posterior (facing up).  I have not found any studies that demonstrate whether this position can help a baby turn *during* labor.  I suspect that giving the baby extra room to move doesn’t hurt as baby is aligning him/herself for birth.

Cord Prolapse

Assumption: Walking can cause umbilical cord prolapse (cord coming out before the baby) if waters have broken.

UNPROVEN
Risk factors for cord prolapse include low birth-weight, prematurity (presumably because of small size), breech or transverse presentation (upside down or sideways baby), polyhydramnios (an excessive amount of amniotic fluid) and premature rupture of membranes (water breaking before baby is engaged)

http://www.ncbi.nlm.nih.gov/pubmed/16538441

My Views:
When a client told me she was required to remain in bed (no walking) during during almost all of her labor because her water had broken and they did not want the cord to “fall out,” I was intrigued.  (I often use my clients’ experiences to enhance my own learning about birth!)  I knew that the gush of the breaking water could bring the cord down if the baby was not engaged, but I wondered if, in fact, walking (gravity) would bring the cord down on its own.  I’ve been researching this topic for several days and I have found no evidence that this happens.  However, I also found no evidence that it does not.  What I *did* find is that typing “cord prolapse” into Google results in a great number of websites for … LAWYERS.  These lawyers are apparently anxious to sue any doctor whose patient’s baby experiences complications (often cerebral palsey or death) of cord prolapse.  I guess we can all draw our own conclusions from there.

Food and Drink Restrictions

Assumption: Women in labor should not eat or drink.

FALSE
These protocols were put in place when women would have to be put under general anesthesia regularly when complications arose (1940s).  Now that there have been such advances in anesthesia, there are no proven benefits to withholding food and drinks during a normal, low-risk labor, and studies have shown that it can actually prolong labor.

http://www2.cochrane.org/reviews/en/ab003930.html

This 2013 review of studies that include over 3,000 women concludes, “Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications.”

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003930.pub3/abstract

My Views:
It just makes sense that if a woman needs strength for the marathon that labor can be, she should be allowed to consume food and drink.  Hydration is also important and ice chips are not quite the same as a real drink of water!!  As far as I know, out-of-hospital births routinely involve keeping moms well fed and well hydrated, but in-hospital births usually require an IV for hydration.

Oxytocin for Slow Labor

Assumption: Use of oxytocin during a slowed first stage of labor will lead to faster delivery.

TRUE
In studies of women whose labor had slowed during stage 1, oxytocin did shorten labor by an average of 2 hours.  It did not, however decrease cesarean rates or the use of instruments for delivery.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007123.pub2/abstract;jsessionid=0585DF03B4CB07EB66607F015F19E331.d01t01

My Views:
As people look at the high cesarean section rate in our country, many try to find reasons it is so high.  Some have theorized that if slow labor was augmented by oxytocin the shorter labor would mean fewer surgical births would be necessary.  While the oxytocin did tend to shorten labor, there was no difference in cesarean rates.  That indicates to me that length of labor is not usually the cause of the cesarean delivery in cases of slow progression and that we need to keep looking!