"pit to distress"

feebebe23 · Jul 17, 2009

"pit to distress" is not a real order that you are going to see written on a chart. It is a slang term used by L&D nurses and docs. The other more commonly used phrase is "pit'em and commit'em"

What it really means is if someone needs to be delivered 1 of 2 things is going to happen.....the baby is going to tolerate labor or it's not. The only way to tell is to run the pit. Once cervical change is established you stop upping the pit.

I'm not saying pitting someone to distress is never done.....we have all seen it done under certain circumstances....but it is not good practice and can backfire on you real quick!

High-dose pit is an entirely different thing and is only used in cases of fetal demise.

geekgolightly, BSN, RN · Jul 18, 2009

High-dose pit is an entirely different thing and is only used in cases of fetal demise.

Would you consider 6 milliunits q15 "high dose?"

geekgolightly, BSN, RN · Jul 18, 2009

My reasoning for wanting to know are I am pregnant so am researching everything I can about the birth process. My last live birth wasn't so great. My recent fetal demise and subsequent induction was well supported and although sad, I walked away grieving my loss but much reassured about hospital births in general.

Also, at a forum I frequent, the posters are concerned about this concept and I wish that I could allay their fears that this is NOT common, but as I don't know that this is true, I can't do that honestly.

Here is the article (in two parts) that concerns them.

http://www.unnecesarean.com/blog/2009/7/6/pit-to-distress-your-ticket-to-an-emergency-cesarean.html

http://www.unnecesarean.com/blog/2009/7/10/pit-to-distress-2-why-we-are-all-distressed.html

feebebe23 · Jul 18, 2009

6 milliunits Q15 is a bit much, I have a few MDs that like to start at 6 and go up by 6 q30, I will usually go 6-12-16-20 (every 30min), depending on what the baby/ctx pattern is doing. The important thing to remember is when it comes to pit the doctor can write whatever order they want and then the nurse decides what she is comfortable with. (remember the doc is at the office and the nurse is at the bedside) You do not "have" to go up by 6 just cuz that is what the doc ordered. If a patient comes in for induction and is already having some contractions I don't push the pit that hard....it all depends on the situation.

And you can tell your friends on the other board....ask any L&D nurse or any OB/GYN people who are "fixated" on having a lady partsl delivery (no bashing here you just know who they are) always end up with complications....forceps, decels, mec, c-sections.....and people who come into the hospital relaxed and with the attitude of "hey I just want a healthy baby" and trust the RNs and docs...always have nice, normal, deliveries....just my opinion.

It's like a self-fulfilling prophacy....the thing they fear the most is what happens.

NurseNora, BSN, RN · Jul 18, 2009

The high dose protocol was originated in Ireland. It required the woman to be in spontaneous labor and dilated to a certain minimum and no longer making progress or not making progress as fast as the protocol said (it's been a long time since I read about it). The way it was used there resulted in rapid deliveries with a very low C/S rate. I've used it a few times, many years ago, and it worked well.

That being said, the current trend is for much lower doses of Pitocin and less frequent increases in rate. The current guidelines from AWHONN suggest increasing by 1m/U per min q30 to 60 min. There is a new definition of hyperstimulation, now called tachysystoly, of 5 contractions in 10 min. and you are not to increase the pit if this is the situation.

I currently work in a small rural hospital that does not have 24 hr in house anesthesia and I have never heard anyone say "Pit to distress". When I worked in a large, metropolitan teaching hospital with the ability to to a C/S in no time flat, I would sometimes hear someone use that phrase. It was never written because it wasn't a real order. And as a previous poster said, it was only used for those women who had to have their baby today. Perhaps after a serial induction for true medical reasons and the baby really needed to be born today whether it be lady partslly or by C/S

HappyNurse2005, RN · Jul 19, 2009

we've heard people say "pit it out or pit it back" (as in out lady partslly or to the OR). not too often though. most doctors dont order pit 6 by 6. 1.5 years ago some of the residents did it that way. i never did it, and neither did several of the nurses. i'd start it at 2 anyways. (now i start at 0.5mu's/min). one of the residents even said to me once, "if i write for 6 by 6, will you do it?" i said no, so she wrote 2 by 2.

geekgolightly, BSN, RN · Jul 20, 2009

And you can tell your friends on the other board....ask any L&D nurse or any OB/GYN people who are "fixated" on having a lady partsl delivery (no bashing here you just know who they are) always end up with complications....forceps, decels, mec, c-sections.....and people who come into the hospital relaxed and with the attitude of "hey I just want a healthy baby" and trust the RNs and docs...always have nice, normal, deliveries....just my opinion.
It's like a self-fulfilling prophacy....the thing they fear the most is what happens.

Yeah, I've been thinking about this. It seems that the anxiety they feel in what they consider to be a scary environment will stop labor. Ina May talks about being able to open yourself up to the situation and accept things without fear in order to have a safe and healthy delivery. It's unfortunate that so many people are so terrified of the hospital.

I've been thinking about my birth plan and have decided to just have it say, "I want a natural delivery, but more than that I want a healthy baby, so do whatever you need to do and just tell me what's happening so I know, too." and leave it at that.

geekgolightly, BSN, RN · Jul 20, 2009

So it appears that using pit to induce fetal distress and force the hand for a c-section is not common, from the posts here.

RNBelle · Jul 20, 2009

I work in a small rural hospital where we love to induce EVERYONE, but we never pit to distress. If the baby is not tolerating it, we stop. Now that is a stress test for the baby. So if the baby is not tolerating being on pit in the beginning than that can be a sign that the baby may not tolerate labor and can lead to a c/s. I work night shift so I feel I have a little more ability to work pit the way I want to becauser the MDs are not calling and bugging me - they just want to show up to catch. Our high dose orders start at 3 mu's, but I usually start my pt's at 1-2mu's - per new AWHONN guidelines- and go low and slow. And suprise - the inductions go much better.

rdnkmommy · Aug 2, 2009

Like RNBelle, my hospital (large one in Dallas) has physicians that do the same thing. One explained it to me as "declaring" the baby. If baby can not tolerate labor with pitocin, they can not tolerate labor period. They also use 3x3 as the dose. We would immediatly turn it off and take them to the back for a section.

geekgolightly, BSN, RN · Aug 7, 2009

Like RNBelle, my hospital (large one in Dallas) has physicians that do the same thing. One explained it to me as "declaring" the baby. If baby can not tolerate labor with pitocin, they can not tolerate labor period. They also use 3x3 as the dose. We would immediatly turn it off and take them to the back for a section.

Is there any evidence on which to base this practice? Do you agree or disagree?