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.

[perfexion, ASN, RN]

I get into a lot of trouble at work when it comes to pit augmentations because I'm never very aggressive. I go up every 30-40 minutes and not 20-30. If a woman is contracting every 2-3 minutes I leave it alone, regardless of her Montevideo units if she has an internal monitor. I rarely run pit above 8-10 on VBACs. But like I said, I get into A LOT of trouble for my practices. I'm constantly butting heads with doctors. Ultimately I'm a nurse. I can't overstep the docs. I can't change or cancel the order. If they want to induce or augment a patient with pit so they can make their kid's softball game I can't object. If they get the patient's informed consent there's nothing I can do. I have to run the pit whether I agree with its use or not.

[Upgrading_Status, BSN, MSN, RN, NP]

At my institution a lot of patients come onto the labor floor requesting pitocin. It's a strange phenomenon. Regardless I make it my business to explain to my patients the purpose of pitocin and why they may or not need it. When administering I increase the pit 2mu every 30 min based on normal physiologic conditions. After delivery we hang the bag to gravity (30 units in 1 liter). The only time a patient will receive a second bag is if she's encountered a complication. To my knowledge pitocin administered on the postpartum units.

I don't mean to high jack the thread but I find some nurses lower the IV fluid when increasing pit. I wasn't trained that way but a handful of nurses do that, but we don't have a policy stating the formula and rationale for that (albeit to prevent water intoxication). I read some threads from 2008 here where the nurses made sure the total amount of fluid infusion was 125 ml/hr. How do you know which patients to do this for?

[figureskating]

When I had my babies I was briefly told I was getting Pitocin but I wasn't educated on it. I just went with what the doctor or nurse said. With my last I was more educated and wrote out a birth plan refusing Pitocin, during labor, unless really needed to progress. I consented to Pitocin after delivery to control bleeding. I also requested no IV fluids but consented to a heplock in case of emergency or dehydration. It's sad that most people will get Pit whether they really need it or not, but for now it's kind of up to the patient to educate themselves and know what to say yes and no to.

[figureskating]

I get into a lot of trouble at work when it comes to pit augmentations because I'm never very aggressive. I go up every 30-40 minutes and not 20-30. If a woman is contracting every 2-3 minutes I leave it alone, regardless of her Montevideo units if she has an internal monitor. I rarely run pit above 8-10 on VBACs. But like I said, I get into A LOT of trouble for my practices. I'm constantly butting heads with doctors. Ultimately I'm a nurse. I can't overstep the docs. I can't change or cancel the order. If they want to induce or augment a patient with pit so they can make their kid's softball game I can't object. If they get the patient's informed consent there's nothing I can do. I have to run the pit whether I agree with its use or not.

From my research Pitocin is not ideal for VBACS anyway. I'm wondering about these doctors you're getting in trouble with who are so Pitocin happy for a VBAC. That's scary. I refused Pitocin for my VBAC but my doctor was not a fan of it for VBAC anyway unless really needed. Even if Pitocin had been needed being he would have started with low dose Pit.

[2008CaliRN]

I think that Pitocin is being over-used. I wish that we could allow patients to go in to labor more naturally. It seems like the convenience factor of inducing is trumping the health benefits of waiting for spontaneous labor.

[2008CaliRN]

Lowering the IV fluid rate of the primary bag when giving Magnesium is where I think that practice came from. A total of 125 cc/hour is satisfactory hydration. Pitocin can contribute to patients retaining fluids, too, Is anyone using 500 cc bags with 30 units of Pitocin for this reason? Less volume is needed which can decrease the total amount of IV fluids that would be administered compared to the 1000 cc with 20 units of Pitocin. Years ago, I heard that the 500 cc of LR with 30 units of Pitocin would be the national standard but I have not yet seen this available.