What’s one of the hardest habits for OB’s and hospital based CNM’s to break?
Nope. It’s using pitocin postpartum to force the uterus to contract to prevent hemorrhage. Because most of my doula clients birth unmedicated, without any clinical intervention at all, I’ve recently noticed a trend. Doctors FREAK OUT about 3rd stage (postpartum) management for these women.
Pitocin…Just in Case
Most OB’s and CNM’s are used to highly managing their clients. There was one doctor in Las Vegas who had “a special” named after him. I will use a pseudo name, but when I had a client seeing him, and she overheard him tell the nurse over the phone to give this woman the “‘His’ Special”, she asked him what that was. He replied, “Pop ‘em, Pit ‘em, Poke ‘em”. Meaning break the water, given them pitocin, and then an epidural. Needless to say, she left his practice.
For the majority of women, though, this is exactly how their labor is managed. And as such, they are given hoards of pitocin postpartum because their poor uterus’s are too overworked and confused to know how to clamp down and contract on their own, and they risk hemorrhaging. Not to mention that a hemorrhage is one of a doctor’s worst fears.
So when a woman labors as far from “‘His’ Special” as she can get in the hospital setting, doctors scramble to control things somehow. They can’t just do nothing at this birth, right? Because they are so unfamiliar with what a normal bleed looks like after delivery, they freak at the first site of blood and get their panties in multiple wads if a mom refuses pitocin postpartum. So much so, that they will try every trick and fear tactic in the book to convince a mom to accept it. And because she is tired, distracted by her baby, and just done with working, she is at her most vulnerable and a lot of times will consent to 3rd stage pitocin just to get staff to shut up so she can focus on her baby. But for those moms who continue to hold their ground, and refuse pitocin, they’ve then got the nurse coming in every 5 minutes to do ” fundal massage” (what masochist came up with the word ‘massage’ to describe it?). With my last client, in fact, the nurse dug so deep when she did this external kneading that I swear she was touching my client’s spine. Of course my client was jumping all over the place simultaneously trying to hold and nurse her infant. And then the nurses will say, “You know, if you’d just do the pitocin, I wouldn’t have to do this.” So, then it becomes ‘do it my way or pay the price’.
But There’s No Side Effects
The trump card for caregivers to convince women to consent to 3rd stage pitocin is this:
“You’ve had the baby now, there are no side effects to you using pitocin. There are no risks at this point.”
Well, besides the fact that it makes the postpartum cramping more painful, I recently ran across this study, that found:
“Oxytocin (aka pitocin) and ergometrine in the third stage of labor and prostaglandins for induction of labor were associated with significant reductions in breastfeeding rates between 6% and 8% at 48 hours, the researchers note.”
6% and 8% don’t sound that big, but believe me, it is. So, there you have it. Postpartum pitocin does have another side effect…reduction in breastfeeding rates. For all you ladies wanting to avoid pitocin in the absence of any emergency, you now have more tools in your toolbox.