There are very valid reasons to be induced. Any condition that threatens the life of mother and/or baby, such as pre-eclampsia, intrauterine growth restriction, etc., is more than enough reason, and issues such as placenta previa (where the placenta covers the cervix and baby cannot be born vaginally) call for an immediate cesarean. The benefits of pitocin and/or major surgery vastly outweigh the risks in these situations.
But what about post-dates pregnancies? Possible big babies? Mom being tired of pregnancy? Convenience? These may seem like valid reasons, but when you weigh them against the risks to both mother and baby, it might make you re-think the situation. Pitocin is far from risk-free, and the adverse effects on both mom and baby are enough to give anyone pause. Induction of labor can raise the chances of a cesarean delivery by as much as 50% (as I have previously cited), so if you wish to avoid a surgical or interventionist/medical delivery, and your situation is not urgent, induction is likely not the best choice for you. If the benefits, such as saving the life of mother and baby, outweigh the considerable risks, then it may be the right choice. But there is a lot to consider when you might need or want to be induced, for whatever reason.
If you want to be induced because of social reasons, a feeling of being "done" with pregnancy, or simply being past your EDD (estimated date of delivery), you might want to take a look at these side effects (which are more likely than most OB's would have you believe) of pitocin, the most common labor inducing drug, before you make any decisions.
The following list of adverse effects to mother and baby is from the FDA:
"Adverse Reactions
The following adverse reactions have been reported in the mother:
| Anaphylactic reaction | Premature ventricular contractions |
| Postpartum hemorrhage | Pelvic hematoma |
| Cardiac arrhythmia | Subarachnoid hemorrhage |
| Fatal afibrinogenemia | Hypertensive episodes |
| Nausea | Rupture of the uterus |
| Vomiting |
The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.
Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.
The following adverse reactions have been reported in the fetus or neonate:
| Due to induced uterine motility: | Due to use of oxytocin in the mother: |
| Bradycardia | Low Apgar scores at five minutes |
| Premature ventricular contractions and other arrhythmias | Neonatal jaundice |
| Permanent CNS or brain damage | Neonatal retinal hemorrhage |
| Fetal death | |
| Neonatal seizures have been reported with the use of Pitocin." |
There are further warnings (http://evidencebasedbirth.com/crank-up-the-pit-2/):
- Oxytocin (Pitocin) is a high-alert medication, meaning that this drug has a high risk of causing significant harm if a drug error is made. It also has a black box warning, which is the FDA’s strongest warning for drugs. In this black box warning, the FDA says that Pitocin should only be used when induction of labor is medically indicated (never for “elective” induction), or in “select cases” of stalled labor. Medical indications of induction (according to the FDA) include blood Rh problems, maternal diabetes, pre-eclampsia at or near term (when delivery is in the best interest of the mother or fetus), or premature rupture of membranes (when delivery is in the best interest of mom or baby). (UpToDate, 2012).
- Pitocin has many potential adverse reactions. For the mom, Pitocin can cause heart rhythm problems, high blood pressure, nausea and vomiting, post-partum hemorrhage, too frequent contractions of the uterus (called uterine tachysystole), constant contraction of the uterus (called uterine tetany), uterine rupture (more common in second-time or more moms), and severe water intoxication.
- For the baby, oxytocin can cause heart rhythm problems, slow heart rate, permanent brain damage, seizures, jaundice, retinal hemorraghe, fetal death, and low Apgar scores. Contractions of the uterus temporarily interrupt blood flow to the baby. The stronger, longer, and more frequent contractions caused by Pitocin can lower oxygen levels in baby. This leads to bad changes in the baby’s heart rate patterns on the monitor, and could possibly result in mom being rushed to an “emergency” C-section—an emergency that was caused by the induction drug itself.
- In a recent Cochrane review, researchers found that augmentation of a “slow” labor with Pitocin shortened labor by two hours. However, it did not increase or decrease the C-section rate. The early use of Pitocin increased uterine hyperactivity, which means that moms had stronger, more frequent, longer contractions. The sample sizes are not big enough to look at infant or maternal deaths. The authors of the Cochrane review conclude that although Pitocin has been used for 40 years to reduce the need for C-section, it is not at all effective in doing so. Healthcare providers may feel the need to speed up labor, but doing so exposes a woman and baby to a drug that—in this case—has no benefits and may have dangerous adverse effects (Bugg et al., 2011). My personal advice to moms out there– before agreeing to Pitocin augmentation, ask your provider, “Am I okay? Is baby okay? Then give us more time, please.”
- Using pitocin reduces the body’s production of Oxytocin. This can create difficulties with the bonding and breastfeeding process after birth.
- Pitocin, on the other hand is a super scary thing. The insert in the Pitocin package is very clear about the risks of using this drug during labor and delivery.
- Risks include (per Pitocin package insert):
- -fetal heart abnormalities (slow hear beat, PVSs and arrhythmias)
- -low APGAR score
- -neonatal jaundice
- -neonatal retinal hemorrhage
- -permanent central nervous system or brain damage
- -fetal death
- -fetal asphyxia and neonatal hypoxia
- -blood supply to uterus is greatly reduced
- -contractions are closer together and stronger-reducing the rate at which baby receives oxygen (which can have life long effects on baby’s brain)
- Risks for birthing women:
- Postpartum hemorrhage (due to prolonged exposure to non-pulsed Oxytocin)
- -reduce natural hormones that assist in lactation and bonding with baby
- -hormonal disruption can lead to reduced rates of breastfeeding
- -increased risk of epidura
- -higher intensity contractions
- -higher rate of complications in labor and delivery
- -higher rate of placental rupture and separation
