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Sunday, January 17, 2010

Pitocin: the most abused prescription drug in the nation

"Pitocin is the most abused drug in the world today." -- Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists

Depending on how you look at it, I agree with Dr. Caldreyo-Barcia - I think Pitocin is one of the most overused, often abused, prescription drugs in the medical industry today. There are lots of suspected reasons for our out on control c-section rate in this country, but to me, one sticks out like a sore thumb: the number of induced labors.

Sources vary, but it's estimated that one in five labors are induced . (This criteria alone can be a bit murky; to many women, induced labors mean Pitocin and cervical ripening gel. To others, induction can merely be breaking your water artificially, which can start labor for some women. At any rate, it's interference of a non-natural kind.) One day while reading the physicians forum at I "listened in" on a discussion of how a particular OB's rate of inductions was at 66 percent  . Holy crap.

He also went on to note that around 30% of inductions fail. Those aren't very promising numbers, then, are they?

The standard procedure among the vast majority of laboring women is that they approach 40 weeks of labor, sometimes within a few days, and an induction is recommended. A holiday might be around the corner, or you're just miserable and sick of being pregnant. Who isn't, by that stage? Or you're 12 hours over your due date and the doctor thinks your baby should come out now, even though a typical pregnancy goes from 38 to 42 weeks.

What no doctor will probably tell you, is that if you're not ready, an induction will likely fail.

In a lot of news articles I've read about the staggering c-section rate, the increased rate of inductions often fails to even register a blip, which is troubling. Some won't even cite physician preference or convenience as a reason, but rather implicate the parents. Others like to cite the age of a patient as a reason, and still others say that the mother's obesity plays a role. Either way, it seems like the blame is increasingly placed with the mother.

And it seems like if you have a birth replete with interventions and something happens that necessitates a c-section, the patient is grateful to her doctor for 'saving her and her baby.' That's like an arsonist setting a building ablaze and then going in to rescue everyone inside. Until you know he was really to blame, you're going to heap on the accolades because he saved everyone, right?

I often log on to several pregnancy and childbirth-related web sites, and the number of women asking questions about elective inductions is troubling. What's even more astounding is that many either 1) don't know the risks, 2) think it's no big deal, or 3) don't really want to do it but are pressured by their doctors.

One woman, Nicole, asked about being induced at 39 weeks because her baby was 'already weighing over 8 pounds.' She said she'd heard nasty stories about being induced, and wondered if anyone could tell her anything positive about it. (Basically, I'm going to do this, my doctor is making me because he's scared my baby will be 'big,' and I only want to hear the good stories and ignore the truth about what could happen.)

The answers she got were a mixed bag, and a few of us  were honest in telling the original poster what could happen. Of those who had 'good experiences,' one said she ended up with a c-section because her 'daughter was too big,' and presented shoulder first (another risk of induction). Her experience, she noted, was that the induction began at 8 a.m. and got increasingly painful as the nurse upped the dose of Pitocin. By 1:30 she asked for the epidural. She then retorted that of all the answers that included an induction going "well," all of them received a 'thumbs down,' and said she was 'so so sorry that my induction went better than yours.'

Funny, I wouldn't call her experience a good one. (Ironically, her answer was chosen as the 'best answer.') Some of us expressed our concerns, but the majority said don't worry about it ... you'll do just fine!

Just today I answered another question that a poster had about an induction of labor scheduled for tomorrow, because the father was out of the picture and no other family would be present. She is 39w4d.  Of course, I politely chimed in and told her that if her baby's not ready, it's not coming out, short of a c-section. I posted some links, and tried to answer her question as nicely as I could. Then another woman put in her two-cents' worth:
I don't know why people say "oh it raises your chances of c-section, blah blah blah." You run the risk of some type of intervention any time you give birth. I had a friend that went into labor on her own and after 10 hours of not dilating they had to do a c-section on her. So don't let people on here freak you out about that.
Ummm, yeah....whatever! You just go ahead and turn a blind eye, hon....*sigh*

Perhaps you run the risk of some type of intervention because your doctor is pressuring you, and you are blind to the risks and benefits of what you're about to do (because goodness knows, it seems like no one's doctor is telling them these things anymore!). One mom's blog (we'll call her Em) detailed her induction, of which she and her husband laughingly 'had no clue what to expect.' Unsurprisingly, it ended in a c-section. How can you be so unprepared for something they're about to put you and your baby through? How can you not want to know everything about it, and just put blind faith and trust in your doctor?

If people like this continue to be the standard procedure at most OB's practices, then of course those of us who actually have the gall to refuse are going to get harassed. We represent a dangerous contingent of women who are actually informed of our choices and stand to pose a roadblock to what the doctor thinks should happen, regardless of whether it's really needed or not. While these are anecdotes or 'just stories,' I find them the most useful - because they're real experiences of real people, and it speaks louder than any 'study' that can often be flawed or skewed. Whatever the case, it represents a growing trend of medicalizing, and interfering, with birth to the point that we're causing more harm than good.

My question is, shouldn't Nicole and Em have obtained all this information before their induction? What is it that their doctors are (or aren't) telling them?

In other words, these women are probably their OB's perfect patients.