Pitocin Question

[AnnieOaklyRN, BSN, RN, EMT-P]

Hello,

I just have a question.

I work on the ambulance as a medic and one of our crews got called for a woman in labor (it was a planned home birth).

On their arrival it was just the mom and father, and the baby had already been delivered. The midwife arrived shortly after we did and immediately gave the patient IM oxytocin and then repeated it a few minutes later. I cannot comment on how much bleeding there was unfortunately as I was not there. They were actually called because the placenta still had not delivered and transported for that reason.

My question is wouldn't giving Pit cause the uterus to clamp down and trap the placenta? Or would it increase the chance of the uterus contracting and the placenta delivering?

It is in our protocol to administer IM Pit after lady partsl birth, but only after the placenta is delivered.

Thanks

Annie

[klone, MSN, RN]

Most providers give it as soon as the placenta delivers, but some research suggests that starting Pit as soon as the anterior shoulder is delivered helps actively prevent PPH.

The uterus won't fully involute until all contents are evacuated (which is why retained placenta can cause continued bleeding/hemorrhage). Continued contractions are needed to assist the placenta in detaching, and Pitocin will of course stimulate them.

[klone, MSN, RN]

This page on 3rd stage of labor talks about physiologic vs active management of 3rd stage, and benefits of each.

Management of the Third Stage of Labor: Overview, Clinical Presentation, Management

[AnnieOaklyRN, BSN, RN, EMT-P]

Thanks for the info Klone!

I am just wondering though, as all the resources I have read stated that IM Pit was contraindicated for a retained placenta and an IV infusion would be indicated instead?

Annie

[klone, MSN, RN]

IV Pit is preferable because it's faster acting. However, we will give IM if a woman does not have IV access. For homebirths, the midwife will typically give IM Pit if it's needed, because a woman birthing at home typically would not have a running IV.