Thursday, May 16, 2013

Let's talk about Pitocin

As some of you know, I'm studying to be a midwife.  I want women to have their babies where they feel the safest and most comfortable, with the people they want in attendance (or none at all), and when the baby is ready to arrive.  My first two children were born in the hospital, mostly because I thought I "had no other choice."  I didn't like what was done there and most people would think they were really good labors.  My first was actually not too bad.  Not what I wanted, but for a hospital birth it was pretty good.  For my second, I felt bullied, betrayed, and tortured. I'm not kidding.  Good thing my labors are fast or it could have been so much worse. I will admit that each experience had their good and bad, but when I talk/think about my bad experience, baby number 2 is where I go.

Birth Story of my Second Daughter

I was induced, even though I didn't want to be, after a botched up amniocentesis (which I still can't get out of my mind was botched on purpose), and "punished" for wanting no epidural.  I'd done my research and didn't want one, nor did I want the amnio, but that's another story.  I felt I needed the induction, only because the doctor botched the amnio and I was worried about my baby.  Without that, I would have gone home and waited it out. I don't fault people who choose or need either for various reasons, but I didn't want them.  The on-call doctor insisted I would need an epidural.  I held my ground.  And I'm pretty sure her form of punishment was the steady increase in my pitocin.  If I'd known better, I would have insisted on learning my Bishop's score and requesting a new non-stress test (although I'm certain baby was a bit stressed by this time!) to evaluate whether it was really necessary to induce right then.

If the labor was the only problem I had with the induction, maybe I could have healed from this experience faster.  My daughter is 3 1/2 years old and I still have major emotional issues about it.  I'm doing better every year about it, but I feel I have a mild form of PTSD from the experience.  And I'm sure it contributed to my postpartum depression.  I did better than with my first, only because I knew to expect it and knew how to overcome it.  And I had great friends who took REALLY good care of me.  But I had trouble bonding with this child. At first, I chocked it up to her being a different baby and every baby has different needs. And I remembered that with my first hospital-born baby, I kept wondering when this kid's parents would come get her.  I was breastfeeding her, bathing her, changing her, rocking her, loving her, and yet somehow she didn't feel like mine until she was around 2 months old.  I've since learned for myself that it had to do with the way the hospital treated her like she was THEIRS and not MINE.  So, I thought, maybe this was just my way of falling in love with my 2nd baby.  It would take some time.  And it did.  I couldn't understand her.  I didn't understand her cues.  I felt like she cried ALL the time.  I wondered if she had "colic." While she did have yeast problems that added to her fussiness, I just couldn't bond with her.  Breastfeeding was painful because of the thrush and I admit I resented that a bit.  When she made achievements and developments, I was happy, but not the same way as with my first.  It BOTHERED me that I didn't connect with her the same way.  I knew I had postpartum depression with her, but I dealt with that so much better than before.  But I still just couldn't understand my daughter: why she did what she did, why I sometimes felt so angry, and why I just couldn't bond with her.  Of course, I love my girls!  All of them!  But my bonding was just not right.  I didn't feel connected with her the way I thought I was supposed to.  I couldn't understand her cries.  I didn't know what she wanted when she cried in different ways.  I felt like an awful mother that I didn't understand my baby! And then I made the mistake of reading about it online where there are some really supportive people and where there are people who say things like, "Well that's just dumb.  Any good mom would know that without having to read this article."  Yeah, that really hurt.  I must not be a good mom, then, I thought.

Trying to Understand and Process My Experience

Then, various experiences happened that made we wonder if she was in the autism spectrum.  She's not, don't worry, but I wondered because I started to realize she and I both had relationship problems.  Then, I wondered if other moms who had been induced had similar feelings.  And how on earth could I get them to share that information with me?!  Who wants to admit that they can't bond with their child when everything around you tells you that you're supposed to be completely in AWE of your baby?  So, this thought stuck with me.  I found a few friends who began to accept my thinking, especially some who had also been induced against their better judgment.  Often these moms had children in the autism spectrum (which from my understanding makes building relationships difficult) or were considered high needs or were diagnosed ADD/ADHD or had some form of learning disability.  I often wondered if there was some correlation.  I'm still waiting for research to catch up with me.  I don't have a Ph.D. so I can't do the research myself, and I realize that all this so far is just anecdotal. But when people would ask my opinion of induction by pitocin, I would add that opinion to my set of reasons I don't like it.  I don't recommend it for any reason, least of them being "baby in distress."  Wisdom tells us if a baby is already distressed, you don't want to put him in MORE distress unless, of course, you needed an excuse to have/give a c-section.

And before anyone starts thinking I don't use doctors for ANYTHING, let me tell you.  I am so incredibly grateful for modern medicine.  Western medicine is THE BEST at dealing with acute, medical crises, and accidents.  If a surgery is necessary, I'm grateful I live in a country that has some of the best surgeons in the world.  If I'm in a major car accident, please take me to the hospital.  But birth in general isn't a medical emergency.  Some women need a c-section.  It's rare to be an actual need, but when it is, I'm so grateful we have surgeons who can help.  In those cases, they often save the lives of mother and child, making the 6 extra weeks of recovery worth it, I suppose.

My Break-through Arrives

Back on topic.  I had trouble bonding with my second daughter until she was about 2 years old.  And, miracle of miracles, do you know what also happened when she was 2 years old?  I had my third daughter.  At home. In my bed.  With my husband, midwife, and mother-in-law in attendance.  My daughters were watching a movie with their Pappy.  I was able to do anything I needed.  No one thought I needed an IV, or a fetal heart monitor, or continuous blood pressure cuff.  No one stopped me if I wanted to move.  Everyone helped me when I asked for it.  I felt completely and totally supported and safe.  I didn't feel self-conscious or weird asking my father-in-law and husband to give me a priesthood blessing (a priesthood ordinance of prayer, blessing, healing, and comfort) just before I went into transition.  No one insisted I have a cervical exam to check my progress.  And I'm convinced it would have slowed me down to be forced on my back so someone could make a clinical decision about my progress when I was so obviously working things out on my own.

And why was I suddenly able to bond with my daughter?  I truly and honestly believe it's because I finally had the appropriate balance and flow of natural hormones, including oxytocin.  There is a major difference in the way artificial oxytocin (brand named Pitocin) and natural oxytocin acts on the body. Oxytocin is the same hormone released when you fall in love, when you kiss or hug or orgasm, when you deliver a baby, and when you breastfeed.  It is a natural hormone whose purpose is to help you build a loving relationship with your spouse and children.  It is a defense mechanism for your baby.  When you are so desperately in love with your baby, you become the she-bear you were born to be.  You will defend that tiny bundle with every part of you.  You understand their needs better because you have bonded and understood this baby.  So with this major flow of natural oxytocin I fell in love with my new baby and I fell in deeper love all over again with my bigger girls.

ACOG's New Position

Now let's fast forward to today.  The American College of Obstetricians and Gynecologists (ACOG) is the leading authority in the United States on medical management of pregnancy, labor, and birth.  Rarely, I agree with them, sometimes I despise them and sometimes I wish they'd look at the research before making a statement.  Today, I'm a little more satisfied with them.  They released this report discussing a research study that finds adverse effects of pitocin on the newborn.  Always before it had been about the mother and any risks or benefits to her.  Now they've finally accepted that it can have serious effects on the neonate (I added the bold for emphasis,):
Researchers found that induction and augmentation of labor with oxytocin was an independent risk factor for unexpected admission to the NICU lasting more than 24 hours for full-term infants. Augmentation also correlated with Apgar scores of fewer than seven at five minutes. 

To clarify, use of Pitocin in labor greatly increased the rate of admission to the NICU, when it wasn't previously expected due to other risk factors.  AND, using Pitocin to speed up labor (augment) correlated to more babies having a tougher time transitioning to life on dry land.  Despite the seriousness of the report, researchers made this confusing conclusion:
 The analysis suggests that oxytocin use may not be as safe as once thought and that proper indications for its use should be documented for further study. “However, we don’t want to discourage the use of Pitocin, but simply want a more systematic and conscientious approach to the indications for its use,” Dr. Tsimis said.

So they say that artificial "oxytocin use may not be as safe as once thought," but "we don't want to discourage the use of Pitocin."  I'm confused.  I thought ACOG's work focused mainly on
  • Serving as a strong advocate for quality health care for women.
  • Maintaining the highest standards of clinical practice and continuing education for its members.
  • Promoting patient education and stimulating patient understanding of and involvement in medical care.
  • Increasing awareness among its members and the public of the changing issues facing women's health care. (This was taken directly from the ACOG website.)

I'd say they managed to "increase awareness" and "promote patient education" but aren't doing so well in the other areas.  It's an improvement, though, I suppose.  And gives women more ammunition when being lead to an unnecessary induction.

Disclosure:  I am not your healthcare provider.  This information is here to inform you of my experience and ACOG's own research.  I suggest you do your research and make your choices about your body and your baby's body, then discuss it with your healthcare provider, whether an obstetrician, family doctor, nurse midwife, professional midwife, other midwife, or who ever you choose to attend you in labor.

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