Inducing Labor with Pitocin: Making the Choice

Week 39, and you haven't had a good night's sleep in a month. You're running to the bathroom every 15 minutes and you probably feel more like a beached whale than a woman. Pregnancy has been exciting, but all good things must come to an end…including this! You've had enough and you want this baby out!

For many pregnant women entering their 40th week, induction is a seductive concept: whether they're worried about not having their doctors around for the delivery, or fearful of delivering huge babies; whether they're hoping to deliver their babies on a specific day, perhaps for sentimental reasons, or they're just tired of being pregnant. An elective induction suggests control. Besides, it's done all the time, it's easy, and it's virtually risk free, right? Well, that all depends on when and how your doctor performs the induction.

Pitocin

Pitocin and Syntocinon are commonly used brand names for the drug Oxytocin, a hormone found naturally in the pituitary gland used to help start or continue labor and sometimes to control bleeding after delivery. The drug, given intravenously, is also used to help a mother expel the placenta post delivery, to shrink the uterus post miscarriage, and to help get a mother's milk flowing for breastfeeding.

An advantage of Pitocin is the ease with which it can be controlled as needed during delivery. Cervical-softening gels may also be used during inductions, but while this administration is easy, doctors may find it more challenging to remove or control the progression should they wish to stop the effects. The ease with which Pitocin can be controlled is why Dr. Gerard M. DiLeo, MD, a Louisiana-based obstetrician, often tells his patients that he aims to use the drug just to get their labors started. He then weans them off as soon as their bodies take over. Dr. Tracy Kritz, MD, a family practitioner in Los Angeles, agrees that when used properly and when medically necessary, Pitocin can be "really useful stuff."

But what does "medically necessary" mean? Pauline Ratta, a certified nurse midwife with Massachusetts General Hospital in Boston, highlights three instances when inductions are necessary:

• If a woman is approaching the 42-week mark and still has not delivered.
• If labor needs to be augmented, i.e. a membrane has broken but contractions have not begun.
• If an epidural has slowed down the labor process, which may happen on occasion, and induction will resume it.