Tuesday, April 17, 2012

One of the Most Common "Pit-falls" of Birth Today- the "Drip"!

Pitocin (synthetic oxytocin) is used in over 50% of births today to induce or augment labor. The use of Pitocin has become so common today, that many mothers and doctors don’t question its necessity.  So this is me raising a red flag and urging you (and your doctor) to consider long and hard before turning on "the drip."

Even without any medical knowledge, a rational person must ask, is it reasonable that more than 50% of the birthing population today is unable to produce enough natural oxytocin to birth their own babies requiring us to rely on the use of synthetic oxytocin to do so? Oxytocin is a chemical produced in our brain. We rely on oxytocin to help us cope during stressful experiences, feel joy and euphoria as we bond with those we love, and relax and let go of inhibitions during intimacy. It is essential for childbirth, lovemaking, and forming bonds and relationships with others. If we are unable to produce our own oxytocin to birth, what’s next? An IV drip in the bedroom?

Recently, while attending a birth as a doula here in Kuwait, I was surprised by how seemingly little the attending doctor understood about the use of Pitocin and how easily she dismissed all concerns raised about its use. The mother’s water had broken and the labor was progressing, but not fast enough for the doctor. In the Dr.’s attempt to convince (or rather bully) the mother into accepting Pitocin to augment her labor, she ran through a series of inappropriate strategies, finishing with the most disappointing one of all: willful misinformation. 
First, she told the mother in essence: “You came to me as your doctor, that means you trust me, and therefore you must accept my medical advice.” In other words, I am the expert, and your opinions are not relevant at this stage because I have a medical degree and you do not.

Second, in response to the mother’s request to accept a round of IV antibiotics and continue to labor without Pitocin, she first made something up about antibiotics “masking an infection” and then proceeded to use a shameful scare tactic by telling the mother a scary story about another mother in a completely unrelated circumstance whose baby eventually ended up in the NICU.
Third, when I tried to help articulate the mother’s hesitation by expressing her concern that she was already very tired, and once they gave her Pitocin the quality of her contractions would change- the Dr. became defensive. She claimed that “there is no difference between the oxytocin created in the brain and the synthetic form,” and that “they effect the body the same."
This doctors claim that synthetic and natural oxytocin effect the body the same is not only false, but it is dangerous. Yes, synthetic and natural oxytocin are chemically identical. But the natural oxytocin that is produced in the brain circulates in the cerebral-spinal fluid, whereas the synthetic oxytocin pumped into her veins never crosses the blood-brain barrier.

In addition, the body only produces enough oxytocin to meet its needs, where as synthetic oxytocin is pumped by steadily increasing amounts over a short period of time to much higher levels than what the body would naturally produce.

Furthermore, while naturally produced oxytocin is responsible for creating the mothers powerful and rhythmic contractions that eventually birth her baby, it also has a softer side: oxcytocin floods our body during romantic and platonic intimacy, creating feelings of elation, warmth, love, and closeness, reaching its highest peaks during the most intense part of labor, and helping the mother move into an ecstatic or alternative state of mind in order to cope with labor and flooding her body with love and affection for her baby and partner. A whole series of feedback hormones are also triggered with the natural production of oxytocin, including endorphins and prolactin (for milk production) to prepare her for the final moments of birth and her initial encounters with her baby.

Synthetic oxytocin, on the other hand, produces more intense contractions over a shorter period of time, without the softening effects of natural oxytocin or the benefits of endorphins. This does more than just change the quality of the contractions- making them more intense and painful for the poor mother. It also increase mother and baby’s risks for harm, something the doctor was unwilling to acknowledge openly, but which neccessitated her order for continuous fetal monitoring.
These risks include postpartum hemorrhage through what is called uterine atony: essentially, the synthetic oxytocin has a diminishing return of effectiveness by the end of labor, leaving the uterus soft and weak, unable to contract to stop postpartum bleeding; and fetal distress: the sudden-hard and fast-squeezing contractions produced by synthetic oxytocin induced contractions diminishes the baby’s placental oxygen supply more often and for longer periods of time than natural contractions creating disturbing fetal heart rate patterns and necessitating continuous fetal monitoring, and more often than we would like, cesarean surgery.

The crazy thing is that despite the use of pitocin in over 50% of births these days, research shows that the average length of active labor (4-5cm to complete dilation) is longer than it used to be 50 years ago, and the number of cesarean or vaccum/forceps assisted births has not been decreased. So if oxytocin isn’t making labor shorter, or preventing cesareans or assisted vaginal births, what benefit is it providing?
In addition, early research suggests that pumping synthetic oxytocin directly into a baby's bloood stream through the mother during an infant brain’s formative stage of development (as it is transitioning from fetus to infant and is experiencing oxidative stress) might allow the synthetic oxytocin to cross the blood brain barrier and damage the baby’s oxytocin receptors, possibly leading to autism, drug-addiction, depression and anxiety later in life. 
Perhaps all too soon we will realize that we are paying too high a price for merely the illusion of control, and the real answer here is to let go of the illusion, and allow birth to move forward at each mother's own pace. That might be hard for some doctors to accept.

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