Pitocin induction-pit rates

  1. what rate do you run pit at for induction/augmentation

    generally, we start it at 1-2 and go up by 1-2 q15min, with start at 2, up by 2 most common. one doc liked to come in and write to start at 6 and up it by 6 each time. of course, practically none of us would do it that way.....
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  2. 37 Comments

  3. by   leannek90
    We do the same for our pitocin inductions. I try to keep it as low dose as possible, making sure I bolus her first with LR to get rid of any contractions due to dehydration. I also let more than 15 minutes go by before I increase it quite often. I attended the AWHONN conference in Maryland last summer and they said that low dose is the way to go, and you need to let that first dose sit in her system for about an hour before you even think of increasing it. And on top of that, you should wait 30 minutes between increases, not 15.

    We also had a doctor that wanted us to start at 6mu and increase by 6 and we all looked at her like she was crazy. It made it a little difficult because she was also our chief! Needless to say, when none of the nurses would increase the pitocin like that, she went back to starting at 1-2mu and increasing by 1-2 q 15-20 minutes.
  4. by   eden
    Start at 1 and increase by 1-2 q 30 min.
  5. by   ragingmomster
    Quote from leannek90
    I also let more than 15 minutes go by before I increase it quite often. I attended the AWHONN conference in Maryland last summer and they said that low dose is the way to go, and you need to let that first dose sit in her system for about an hour before you even think of increasing it. And on top of that, you should wait 30 minutes between increases, not 15.
    We will occasionally get an order from one of the residents for 4x4 pit q15 minutes. Of course things go a bit slower than that.

    I had never heard of the whole idea of letting the first dose sit for about an hour before "cranking up the pit".

    Wondering if you can point me to some research that says the same, please?
  6. by   JaneyW
    Don't you have policies in place? Our MD orders state that we are to run pit per policy and procedure. The reality is that I wouldn't run it any other way even if the order were written for something different. Maybe it has come back around to that after trouble in the past--I don't know.
  7. by   babyktchr
    AWHONN has an entire publication on Pitocin augmentation and induction, with their guidelines and recommendations. There is also referenced work. The newest literature I teach in the FHM course thru AWHONN is low dose pit, increasing every 30 mins. I pulled the research on this and there is really some great defense in using low dose pit. I think it works better in an augmentation situation rather than induction. I have used the new guidelines and have found them to be quite effective.

    There are many who believe you must pit to distress to induce....or is mom isn't feeling the contractions, neither is the baby. We know this is not true. Contractions are a stressor to the fetus, and over time, if we hyperstim, we suck the reserves right out of an otherwise good baby. Lets get rid of 9-5 obstetrics and maybe there will be better pitocin outcomes.

    You should have a good pit policy in place, one that protects the patient and gives you the authority to manage it, including discontinuing it if circumstances are not optimal (lack of monitoring, unable to monitor because of maternal size or fetal postion). I personally think that doctors and midwives should NOT be taught to use an infusion pump. No one but the nurse should be turning up that pit. Just my humble opinion.
  8. by   mauxtav8r
    I'm a nursing student and haven't worked in OB at all. This comment is strictly from a patient's perspective.

    My doctor induced both my kids. She "doubles pitocin". We started at 2, went to 4, etc.

    One of the nurses told me the doctor had done quite a bit of research on this topic and found that for low risk moms like me, there was less stress on the baby and mom due to less time in labor. Also lower numbers of c-sections.

    I was on the drip for five hours with baby #1 and seven hours with #2. Also, she gave me cervidil the night before, which started mild but regular contractions overnight.
  9. by   Mrs.S
    we have a couple different protocols that the docs pick from. the vast majority of the time it's start at 2 and up by 2 every 15 minutes. one doc likes to do this one that starts at 6, up by 6 every 40 minutes until ROM, then halve the pit and go up by 1 every 40 minutes...only used on primips
  10. by   SmilingBluEyes
    Quote from babyktchr
    . lets get rid of 9-5 obstetrics and maybe there will be better pitocin outcomes.

    .
    the very crux of the matter is in this statement right here!!!!
  11. by   SmilingBluEyes
    we do the same as Eden. Start at 1mu/min and go up 1-2 every 30 minutes.

    I agree 100% with Babyktchr otherwise. Low and Slow does it just as well and much more safely.
  12. by   HappyNurse2005
    Yes, we have a policy. It says 1-2mu's to start, up by 1-2 q30min, but the docs have to write if they want it up q15min.
  13. by   eden
    I imagine the slower starts also allow mom to adjust a little better to the contractions so mom does not go completely beserk from the onslaught of contractions.

    I also know from observation that in most cases the lower levels are all that's necessary to achieve an adequate contraction pattern (I read one study that at 6-12 mu most mom's will have an adequate contraction pattern). I know alot of our doc's do like to push the pit and I often but heads with them because I am known to be a little more conservative with it, however rarely do my patients fail to progress so they really can't complain:wink2:. I know of one doc in particular who wants it increased even if the patient is contracting q2-3 min and can get a little snippy if I don't but I that's okay since it's my butt onthe line should anything happen. I can't use the excuse that the dr told me to do it, that's where my judgement and intuition come into play.
  14. by   strn96
    Our P/P is typically start at 1-2 and up by 1-2 q 30min. One of our docs will occasionally write for start at 6 and up by 6 q 30 for primips.
    I have a new question for you though. One of our FP docs (doesn't deliver any more) had us start pit in am per protocol (2x2) but then at 10pm if no ROM and mom not over 5cm he would have us turn pit off for an hour, let mom shower and walk and then restart Pit and run at 2mu through the night, then start increasing again p 6am. Have any of you heard of this "low dose overnight" procedure before? Personally, I think he just wanted to get a good night's sleep, but wondered if any of you know anything about pros/cons of this. It seemed to me that these patients usually ended up not only with extremely long labors, but also ultimately needing higher doses of pit in order to deliver. Any input?

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