About Pitocin

[zje123]

So, I'm in nursing school now and I've had some experience previously in women's health and OB. I've also been a doula. I hope to be able to work as and L and D nurse when I graduate. My question is for the L and D nurses out there......

About what percentage of laboring moms get pitocin in the hospital? How well informed are the moms about the choice to get pit and the option to decline it? As nurses, when administering pit, do you get to exercise discretion in the amount that you give (if the women and baby are healthy) or is there a set amount that you MUST give per Dr. order? As an RN, I'd be hesitant about giving pitocin, except when medically indicated. Most healthy women who have normal pregnancies and can labor without pitocin and be just fine, in fact they often have way less complication than women who have been given pit. (There are lots of studies.....I can dig them up if anyone want) I'm just asking pit during labor, not after the birth, which is a different story.

[nycRN3]

I know this was directed towards L&D nurses but I thought you may be interested in a Postpartum nurse's answer. The standard order is two 1000mL bags of Pitocin in either D5LR or LR if they are diabetic @125mL/hr. If the mother had a C/S the two bags of Pitocin are followed up with a bag of LR to replace electrolytes.

In my case the patients are not aware of what is in the bag or why they are receiving it. It does bother me not because I have to explain it, but how can a healthcare provider give something to someone without briefly explaining its purpose.

[vintagemother, BSN, CNA, LVN, RN]

In my case the patients are not aware of what is in the bag or why they are receiving it. It does bother me not because I have to explain it, but how can a healthcare provider give something to someone without briefly explaining its purpose.

I'm not a labor nurse or a post partum nurse, I'm just an Lvn who has given birth 3 times.

It made me sad and mad when we were taught to do this in school. 😓 but it is reality.

[Katie71275]

Pitocin is regularly given after birth which is what the above nurse is referencing. During labor we often give it if a patient has been ruptured for a long time and labor hasn't kicked in or perhaps their cervix isn't changing. We always discuss it. pitocin is run at the nurses discretion based on how the fetus looks and contractions are until labor is adequate and established.

[queenanneslace, ADN, MSN, APRN, CNM]

Are you asking about administering Pitocin during labor or postpartum?

I see that you're asking about oxytocin augmentation of labor.

I struggled with this as well when I started because Pit was ordered on just about everybody.

I've often felt that labors were progressing quite normally, but the physicians just wanted to speed it up for their own benefit. I suppose women could refuse it - but often they're not asked.

Many patients come to L&D for induction... so, you know, Pitocin is what we use to induce contractions.

I titrate oxytocin to create a physiologic labor pattern - and often I can do it with pretty darn low levels of oxytocin. I don't go up at every interval, I watch how the mother's body is responding. My preceptor was frustrated that I didn't just increase the pit all the time - but then she saw that my patients would give birth at low levels of Pit 4-8mU - sometimes a little nudge is just what they need.

Now, I do think that many patients who are induced will probably get into active labor on their own and have babies without additional Pitocin - but the nature of the beast is that some OBs like to control this and augment labor and get their patients delivered.

They'll ask to start Pit in second stage when the baby's head is on the perineum because they think 3-4 minutes between contractions is too long. I just start it -because that's what the Dr wants - but I really don't think those 2 drops of oxytocin make a difference in that situation....

If parents want to avoid oxytocin augmentation - if that is important to them - they need to choose providers and hospitals that support physiologic birth.

But yeah, it's rare that a woman delivers in my hospital without oxytocin on board. That's just how it is.

[zje123]

I agree, nycRN3! It's not that I'm totally against pitocin, but I'm and advocate for informed decision making by patients, and most women clearly do not know what pitocin is or why they receive it and it just doesn't seem right to me. I hope that we will move toward educating women more about pitocin. Maybe this is something that can be integrated into birth classes before labor starts?

[zje123]

vintagemother,

I'm in nursing school now and we just learn how important it is to tell each patient what drug they are getting, it's effect, and why it was prescribed. It doesn't make sense why this would not also happen with pitocin.

[cayenne06, MSN, CNM]

I'm a graduate nurse midwife (haven't sat for boards yet) and an LDRP RN. From a midwife perspective, I'll admit that when I ask for pit PP I don't usually give a risk/benefit/alternatives run down to the patient. "More like, I'm going to give you some pit to prevent/control your bleeding." I only do active management for at-risk patients though. But unless we are in an emergent situation, there is time to at least tell mom you are giving it, and give her the opportunity to object/ask questions.

I never, EVER augment/induce without a full discussion of risks/benefits/alternatives. I've also been blessed to work (as a student CNM) in a facility that had strict guidelines about elective inductions, and post-dates IOLs were never scheduled a day earlier than 42.0 (unless there is another reason to induce earlier, obviously). That realllly cuts down on induction rates.

As an LDRP RN, I titrate my pit slowly to mimic natural labor, and absolutely will not increase the pit unless I feel it is safe and necessary to do so. However I do not have control over who gets pit and for what reason. Definitely not a fan of 39 week primip inductions argh.

On a related note- I know that the data is quite clear that universal active management of the third stage reduces average EBL by something like 100-150mL (IIRC, not going to look it up right now). What is NOT as clear to me (and maybe others can enlighten me) is the clinical significance of this reduction in EBL. Does it improve outcomes? And since we know blood volume expands so dramatically during pregnancy and that a certain amount of blood loss is normal at birth, it seems counterintuitive to approach PP bleeding in a way that makes it seem like we are shooting for an EBL of zero (oversimplifying, of course). PPH is a major cause of maternal m&m and i don't mean to make light of that. But oxytocin is a synthetic hormone with systemic effects and known risks, whereas an extra 100mL of blood loss in a healthy, hemodynamically stable woman has not, to my knowledge, been proven to be clinically significant.

I welcome schooling on this matter :)

[klone, MSN, RN]

vintagemother,

I'm in nursing school now and we just learn how important it is to tell each patient what drug they are getting, it's effect, and why it was prescribed. It doesn't make sense why this would not also happen with pitocin.

Honestly, I'm surprised to hear you say that it doesn't. It's every nurse's responsibility to talk to the patients about the medications, what they are, what they do, risks and benefits. I'm appalled at the idea that there may be nurses out there who just go ahead and hang Pit in labor without first discussing it with the woman.

[vintagemother, BSN, CNA, LVN, RN]

vintagemother,

I'm in nursing school now and we just learn how important it is to tell each patient what drug they are getting, it's effect, and why it was prescribed. It doesn't make sense why this would not also happen with pitocin.

We were taught the same thing. Except when it comes to pitocin and labor. You just put it in. I know this is what I experienced irl. I never thought to ask the nurse what she was putting in my iv fluid bag. If moms don't ask this, while in labor, they aren't always told. I recall arguing with my instructor on this point. But this is how it's done, in many settings.😕

[cayenne06, MSN, CNM]

We were taught the same thing. Except when it comes to pitocin and labor. You just put it in. I know this is what I experienced irl. I never thought to ask the nurse what she was putting in my iv fluid bag. If moms don't ask this, while in labor, they aren't always told. I recall arguing with my instructor on this point. But this is how it's done, in many settings.������

The provider must have talked to the patient about it though, right? If not, well then. Wow. I definitely know providers who just say "we're going to give you some pitocin to speed things along," and IMO that is an unacceptable way to present labor augmentation to a pt. But to not even mention it?! I can't even imagine that.

[Red Kryptonite]

The provider must have talked to the patient about it though, right? If not, well then. Wow. I definitely know providers who just say "we're going to give you some pitocin to speed things along," and IMO that is an unacceptable way to present labor augmentation to a pt. But to not even mention it?! I can't even imagine that.

Ha. Ha ha ha ha ha.....

No, my "provider" didn't tell me crap, and several times both before and after birth, nurses put stuff in my IV without saying a freaking word to me. I was a scared 22 year old who knew nothing.

As much as I hate that my first two birth experiences were poor, I learned and grew so much from them that 7 years later I threw a nurse out of my room during my fourth birth. She tried to tell me the opposite of what my midwife said, and I told her to get the hell out.

I know there are good L&D nurses out there....I just never had the good fortune to meet any. In four different states......