How does your facility utilize pitocin for post-3rd stage?

mitchsmom · Oct 16, 2006

baby to breast works best.
had a mom deliver fast in the er. she was planning to bottle feed, but placenta wasn't coming (no iv). i asked her if she was willing to put baby to breast just for the placenta's sake. she agreed. i put baby to breast, suckling well. in about 5-7 minuntes, out came placenta beautifully - uterus clamped down nice as you please - bleeding minimal - nervous er doc was glad for my intervention. mom was much more comfortable and baby was happy to boot.
our maker's design far surpasses ours any day.

:) when i had my third baby (and a harrowing shoulder dystocia) we realized that my iv was infilitrated just a couple minutes after the birth and the nurse was like "oh, you're fine, you're nursing, i'm not going to restart this". i was cramping away and no troubles.

SmilingBluEyes · Oct 17, 2006

Baby to breast does work best. However, so often, this does not seem to happen where I work for one reason or another.....

THAT is another subject altogether, I realize.

33-weeker · Oct 17, 2006

i realize that baby to breast is not possible in every case, certainly. i just find myself taking a step back to look at the bigger picture once in a while. we've gotten so used to technology - like pitocin drips - that we forget there is a natural way that god intended to supply what our bodies need. so many people think of breastfeeding as just a feeding issue, when it incompasses so much more.

if it weren't for inventions like pitocin, bottlefeeders would be in trouble. :biere:

klone, MSN, RN · Oct 17, 2006

I totally agree that breastfeeding works best. Unfortunately, we can't NOT carry out doctors' orders, and all the OBs, without exception, have an order for 20 in the bag (or, in the case of the one aforementioned OB, 5 in the line and 5/15 in the bag).

NJNursing, ASN, RN · Oct 17, 2006

We use 20 miliunits in 1000ml of LR, 3 miliunits upped every half hour for inductions and some will even up it q 15 minutes. After the placent is out, we run it at 500ml/hr (because it's through the pump) for about an hour then down to 125ml/hr for about another hour or two and then stop it.

Methergine for severe bleeding.

dansmom6 · Oct 18, 2006

Our standard is 20u Pit in 1000 ml LR, wide open until bleeding normal. Then @125 for 8 hours (which I think is excessive), where I worked before, couple hours (or when appropriate), IV DC'd.

However, we have a couple that like things different. One likes 10 units IV push, 20 in 1000. He is an old Doc and "that's the way I've always done it".

Another one likes 40 units in 1000, wide open until stable, and if they're bleeding what she thinks is heavy, which is never what any of our nurses would call heavy, by any means, she just LOVES to give hemobate.

SmilingBluEyes · Oct 18, 2006

Just a cautionary note to those "opening the pit wide" after placenta delivers:

BE AWARE OF FLUID COUNTS thoughout the patient's stay and in labor/delivery!

Pitocin acts much like ADH (antidiuretic hormone) and will cause fluid retention and/or overload, quickly, when given in high doses or with lots of fluids already on board (think epidural bolusing). Always keep scrupulously accurate and careful track of your I/O and ONLY keep pitocin fluids bolusing just until the fundus is firm and active bleeding has slowed down. If after massage and bolus of 200-300 ml, you still have active bleeding and/or boggy uterus, request an order to administer hemabate, methergine, or cytotec--- as per your institutional policy and patient medical status.

I only say this because I personally have seen pulmonary complications from careless over-administration of IV fluids and pitocin -----one case that got so ugly, this (normally healthy) patient was sent to ICU for 24 hours due to this complication. Always be careful. We tend to become cavalier over time about pitocin, due to its extensive (and arguable) overuse in our OB patients today.

Ok off my silly soapbox now.

hope3456, ASN, RN · Oct 18, 2006

2 questions I have wanted to ask OB RN's

*Have you ever dealt with a PPH that you felt was caused in part by the physician - bad judgement or otherwise?

*Do you see any difference between family practice MD's and OB's in terms of how they handle L&D?? Any preference for one or the other?

Based on my own experience - but have just always been curious. Thanks!!

33-weeker · Oct 18, 2006

i totally agree that breastfeeding works best. unfortunately, we can't not carry out doctors' orders, and all the obs, without exception, have an order for 20 in the bag (or, in the case of the one aforementioned ob, 5 in the line and 5/15 in the bag).

true, but we can educate the publlic about the whole thing, in hopes that more moms will refuse it or insist that the infusion be stopped once the birth is over and all is well.

have any of you heard of a correlation between pitocin administration and edema pp?

SmilingBluEyes · Oct 19, 2006

33-weeker: Please read my post on the last page. I discussed Pitocin and its antidiuretic effects at some length there. Of course, you are correct; it's related. Pitocin is *well-known* to cause fluid retention. That is why I caution people not to over-bolus this drug (and IV fluids) post partum. In the worst case, it can lead to pulmonary edema if the nurse is not watching closely the I/O of her patient.

And to the poster who asked about differences. Yes, I do see differences in how OBs and family practice docs do "business".....seems the family practice docs have traditionally been more patient and respectful of the natural process of labor and delivery in my experience (but not all are so). I find midwives the MOST patient and respectful, in most cases. Although, I have also observed CNMs who have adopted a more medical model of practice in the hospital environment, over time.

It does indeed vary by practicioner.

inanna · Oct 19, 2006

We push 10 units in the line, and add 20 units to current fluids, only 10 if less than 500ml; then we bolus 500 ml. We then give 1 to 2 bags of LR with 20 units of Pitocin added at 125ml/hr depending on the amount of bleeding.

jzprple · Dec 18, 2006

I just started at a new hospital and some of their protocols are a bit different than what I'm used to. I'm wondering if any of you can give me a little clarification. Where I was working, we did all IV's to gravity and only ran pit, mag, insulin etc on a pump. Our standard was 20 units Pitocin to 1000 cc's Normusol (which is similar to LR). After delivery of placenta, we ran the Pit wide open until bleeding stabilized and could add up to 40 of Pit if the MD desired before going the miso, methergine, hemabate route. At my new hospital, they do 30 units of Pit in 500 cc's of D5W on the pump during labor and then keep it at 125/hr after delivery. However, if the pt hasn't been on Pit during labor, they add 10 units of Pit to 1000cc's LR and keep it at 125/hr. I'm curious--will this minimal amount of Pit really stop the bleeding/keep the fundus firm? I'm sure that my old hospital probably handed out Pitocin like it was candy so to speak...but this minimal amount of Pit especially in a multip concerns me. My other question (which noone can seem to answer at my new hospital) is in the use of the D5W. If you have a GDM patient, is using D5W appropriate? Even though it is a minimal amount of fluid infusing, I still think it could throw off BS. Any thoughts?? Thanks!!!