What is my care provider not telling me about Pitocin and epidurals?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Potentially, a lot. Because significant research is being done on these drugs, some care providers hesitate to share all the details because the data is always emerging and evolving. But there are also care providers who hold back information that has been well proven, in favor of supporting their agenda.

One mama I was the doula for (let’s call her Sasha) was told by the ultrasound tech at her doctor’s office that she had low amniotic fluid levels. When Sasha was retested at the hospital, she was told her fluid levels were normal. The on-call doctor said she and baby were healthy and good to go home. But when Sasha’s doctor arrived, he disagreed and insisted she be induced with Pitocin immediately. She asked why. He said, “Because your baby could die if you don’t induce.” Stunned, Sasha asked if Pitocin came with risks. “No,” he said. “The risks only come with not inducing.” She turned down the Pitocin, but he had scared her and she didn’t feel comfortable going home.

Sasha allowed this doctor to give her three rounds of Cervidil— a medication used to soften the cervix — over three days, but she stood her ground about not receiving Pitocin. Despite her and the baby’s continued health, the doctor kept suggesting she was putting her baby’s life at risk by not inducing. He wore her down, and she accepted the Pitocin. But it didn’t work. After twelve hours on it, Sasha had only dilated to four centimeters and was exhausted. The doctor insisted she get an epidural so she could sleep. The epidural gave her a headache so intense she could not sleep. When the doctor insisted on a C-section, Sasha fired him and hired a midwife with privileges, or permission to treat, at that hospital. The midwife gave her medication for the headache, and she was finally able to rest. I knew this midwife, and she pulled me into the hallway to share all the information about Pitocin and epidurals that the doctor had failed to provide. This is the summary of what she shared:

Regarding both drugs…

You’ll be stuck in bed. Once Pitocin or an epidural is started, you will need constant monitoring and will be connected to an IV, meaning it will be tough to move around.

You’re not allowed to eat. Because of concern over aspiration during an emergency C-section (which isn’t actually a risk if general anesthesia isn’t used), most hospitals won’t let you eat after receiving Pitocin or an epidural. While many mamas don’t have much of an appetite while on these drugs, this moratorium on food can lead to exhaustion if you have to be on them for an extended period.

It might not work. If you’re already having contractions, the Pitocin will likely make them stronger. But if you’re showing no signs of labor, Pitocin may do very little. And while an epidural almost always provides the desired effect of significant numbing from the waist down, it’s possible (although unlikely) that you receive little to no relief from it.

There’s an increased chance of cesarean birth. There’s something called a “cascade of intervention,” which implies that each intervention could lead to the need for another intervention. One of the ultimate interventions during childbirth is a C-section. While plenty of women who receive Pitocin and/or an epidural have a vaginal birth, both of these labor drugs might increase your chance of needing a C-section.

Regarding Pitocin…

Contractions might be so unbearably strong you need an epidural. Many women who do not want an epidural find that it’s a necessity after receiving Pitocin, as it can cause extremely strong (and painful) contractions.

Fetal distress could occur. If Pitocin creates contractions so strong and close together that your body and baby don’t have time to rest, the baby may not receive enough oxygen, which could lead to distress and the potential need for an emergency C-section.

Regarding an epidural…

You’ll likely need a catheter. Because you won’t be able to walk to the bathroom, a catheter is almost always inserted after the epidural has taken effect.

It could lead to a need for Pitocin. Sometimes, an epidural slows down contractions so much that Pitocin is needed to keep labor going.

It could extend labor. According to a study published in the journal Obstetrics & Gynecology, women with epidurals typically have to push for nearly two and a half hours more than women without epidurals.

Instrumental birth is more likely. Because it can be trickier for a mom with an epidural to push baby out (or breathe baby down), epidural use means a higher chance that forceps or vacuum extraction will be used to deliver baby.

You might have a drop in blood pressure. This could also make baby’s heart rate drop. However, the IV fluids you’re given before the epidural is placed reduce this risk.

Fever could occur. A study done by Harvard Medical School found that women who receive an epidural are more likely to develop a fever that could lead to the baby having poor muscle tone, a low APGAR score, seizures in the newborn period, and the need for resuscitation and evaluation for sepsis. The study also noted that high maternal fever has been linked to brain injuries like cerebral palsy.

You might get itchy. The opioids in the epidural may make you itchy, which can often be alleviated by changing the medication or giving you an itch-relieving medication.

Nausea or vomiting is possible. This is another potential side effect of the opioids in the epidural.

There might be breastfeeding complications. Because an epidural blocks oxytocin — the hormone that helps milk come in and facilitates bonding — it could cause breastfeeding challenges. In addition, a mom and baby impacted by an epidural are more likely to be drowsy after delivery, which could make breastfeeding more difficult.

A spinal headache might be triggered. A rare phenomenon, a spinal headache is caused by an accidental puncture being made in the bag of fluid surrounding the brain and spinal cord when the epidural is placed. If spinal fluid leaks out, an intense headache ensues — it can last for weeks.

Nerve damage is possible. Another rare side effect is nerve damage caused by the epidural needle. If a blood vessel is damaged while the epidural is being placed (also uncommon), blood may collect and press on the nerve. This is one reason why women with a blood clotting disorder and those taking blood thinning medication may not be able to receive an epidural.

An epidural abscess is possible. In rare cases, women develop an epidural abscess, which is an infection of the central nervous system caused by bacteria entering the epidural space. According to the book Spinal Epidural Abscess, only 1.2 in 10,000 women experience this.

Those are the potential outcomes of Pitocin and epidurals that are widely recognized — the possible side effects your care provider should share with you. But what about the potential outcomes they won’t share? The outcomes that haven’t been conclusively proven, but are interesting to consider? Following are possible risks with labor drugs still being researched, as of 2020:

There is a possible increased chance of baby developing autism. Limited research has found that babies of women who had Pitocin and an epidural during labor were 2.77 times more likely to exhibit an autism phenotype. Because not all babies of women who received labor drugs in these studies went on to develop autism spectrum disorder, it’s believed the drugs must interact with other factors to cause autism. These other potential factors are being studied.

There is a possible link between Pitocin and bipolar disorder. A study published in the Journal of Affective Disorders found that babies exposed to Pitocin during birth had 2.4 times increased odds for developing bipolar disorder than babies not exposed to Pitocin. They also found a potential connection between Pitocin and cognitive impairment in childhood.

While this is compelling research to keep an eye on, I don’t believe it’s a reason to turn down labor drugs if they’re really needed. Both studies acknowledged that continued research is needed.

So what happened to Sasha? She had her baby, after crazy-high amounts of Pitocin were used to force her body into labor, and the epidural was kept in for over twelve hours so she could handle the abnormally strong contractions. She had a vaginal birth but was exhausted and dissatisfied with her birth experience. She and baby both had an infection, which a nurse suspected was caused by all the vaginal exams Sasha received over four days in the hospital. When we processed the birth experience, Sasha said she never would have said yes to the labor drugs if the doctor had provided all the information.

On the flip side, I’ve been to many births where Pitocin and epidurals were used after the mother received all the up-to-date information and made an informed decision she felt good about. But the key here is receiving all the up-to-date information. While this section provides a jumping off point for arming yourself with information, ongoing research means this information is ever changing. There’s a lot you can do to make sure you’re getting as much current data as possible.

What to do

Ask a lot of questions before saying yes to any intervention, and don’t let anyone brush away your concerns or questions. Demand thorough answers.

Here are questions to help ensure you’re well informed about your unique situation and options:

Is this an emergency? If the situation is actually an emergency, the care provider should be able to succinctly state why it’s an emergency, and what the wisest course of action is. This is the primary reason we have care providers at birth — in case of an emergency.

Is there an evidence-based medical reason you’re recommending this intervention? If so, explain it to me. Some care providers recommend an intervention based solely on their personal experiences, and not on evidence-based research. This is fine if they’re up-front about it, but you can better understand where the recommendation is coming from by including the term evidence-based in your question.

Is this intervention really necessary? What are the alternatives? An article published in the Journal of Perinatal Education reported that when these two questions are asked, the rate of unnecessary intervention significantly drops. It’s believed this occurs because these questions inspire meaningful discussion that allows the mother to make a well-informed decision.

Can you give me time alone with my birth companion so we can discuss this? This one’s in the form of a question just to be polite. If it’s not an emergency, the caregiver should absolutely give you privacy to make a decision with your birth companion.

After you’ve received all the information, make a decision that feels right for you. Maybe your questioning revealed that an epidural, Pitocin, or both could actually minimize your chance of needing a C-section. Or maybe you determine the potential benefits of receiving the labor drugs aren’t worth the risk. It’s not a black-or-white choice — the decision to accept or reject these drugs is never “right” or “wrong.”

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