Pitocin & Postpartum Depression/Anxiety

pitocin

First things first: Pitocin is not oxytocin.

Oxytocin is the “love hormone” generated in labor that primarily contracts the uterus, but as a brain-based hormone its influence spans the body. It’s very active in the birth giver’s brain, and plays a role in protecting certain receptors in the baby’s brain, too.Pitocin is a synthetic form of oxytocin, a pharmaceutical product frequently used to induce labor, augment contraction strength, and prevent second stage hemorrhage. Given as an infusion, it is not known to cross the blood-brain barrier (however bolus injection Pitocin may pass through in small amounts). While it’s a very effective interventive drug for its medical purposes, and it can offer life-saving results with appropriate obstetric indication, it does not come without risk.

The induction rate has more than doubled from 1990-2005, with nearly 23% of birth givers experiencing induced labor in 2013. The 2002 Listening to Mothers survey reported that nearly 50% of respondents had their labors induced. It’s widely recommended by obstetrical care providers to routinely administer Pitocin to all patients to actively manage third stage of labor (placenta delivery) — a tactic that certainly saves threatened lives, but also one encouraged into popularity amid looming liability concerns, as discussed at length in the book Optimal Care in Childbirth: The Case For a Physiologic Approach.

Research and observation (as well as the FDA package insert) has associated Pitocin with increased risk/incidence of the following:

 

For the baby –

  • abnormal fetal heart rate & fetal distress
  • lower APGAR scores for baby
  • neonatal jaundice
  • neonatal retinal hemmorhage
  • neonatal seizures
  • asphyxia (oxygen deprivation)
  • NICU stay for baby
  • permanent damage to baby’s central nervous system or brain
  • …and more, including fetal death

“The situation is analogous to holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air, but not to breathe.” – Doris Haire, birth activist

For the birth giver –

  • failed induction
  • undue/unreasonable pain
  • unnatural labor pattern that is difficult to manage
  • closely spaced or unremitting contractions, causing stress on uterine muscles
  • baby born near-term (when used for induction), thus more likely to suffer negative health outcomes
  • uterine hyperstimulation
  • uterine rupture
  • postpartum hemorrhage (if administered in labor)
  • cesarean surgery (2x increased risk according to this study; timing in conjunction with other factors may alter the relative risk)
  • reduced rate of breastfeeding (abstract)
  • …and more

“Compared to all other study groups, women exposed to Pitocin®in labor combined with an epidural demonstrated significantly lower oxytocin levels during breastfeeding. Overall, the total quantity of synthetic oxytocin administered during parturition was negatively correlated to levels of oxytocin in plasma two days following birth.” – Bell et al, 2014 Jan-Feb;59(1):35-42

When used in labor, Pitocin is one element in a cascade of interventions including possible preparation with effacement aids, IV (through which the medication is dispensed), and continuous Electronic Fetal Monitoring.

The natural hormonal balance of labor is also disrupted; catecholamine levels fail to surge at the time of birth and thus mother/baby interaction and bonding is impacted. Natural oxytocin in released by the body in “pulses,” whereas the synthetic form is typically continuously dosed through an IV. Also, endorphins aren’t released to help the laboring person cope with pain. This increases the odds of a request for epidural pain relief, which comes with its own set of additional interventions, and raises the likelihood of an instrumental or surgical delivery.

“Endogenous oxytocin is a key component in the transition to motherhood, affecting molecular pathways that buffer stress reactivity, support positive mood, and regulate healthy mothering behaviors (including lactation).” – Bell et al, 2014 Jan-Feb;59(1):35-42

 

Keeping all this in mind, let’s discuss how it plays into a birth giver’s postpartum experience.

Research is beginning to look at the effects of Pitocin as they may spill over into postpartum, specifically whether the drug has a role in acquiring postpartum depression and/or anxiety. A 2017 study published in Depression and Anxiety suggests that Pitocin is linked to increased risk of postpartum depression and anxiety, the former of which affects 1 in 7 American birth givers.

Researchers initially hypothesized that individuals exposed to Pitocin would show decreased incidence of postpartum mood disorders, but found the opposite was true. That the researchers made this assumption is alarming news; it shows the science and medical communities still hold the dangerous belief that Pitocin and oxytocin are the same — interchangeable, even.

Subjects with a pre-pregnancy history of depression or anxiety had a 36% increased risk of postnatal mood disorder in the first postnatal year if Pitocin was used in the peripartum period. For those without such history, the risk was increased by 32%. The increased risk was still present even when different births from the same person were factored in, either as index births (such as first births from each) or random births from those who delivered babies on separate occasions.

Only those who received a psychotropic medication and/or had a documented diagnosis of postpartum depression and anxiety were counted; undiagnosed individuals were not included. Alas, it stands to reason the true numbers may be even higher.

“Our data support the idea that synthetic oxytocin administration during labor has a negative impact on postpartum mood,” the study authors stated.

Some have noted problems with the study’s methodology, one of which concluded the findings seem to be more correlation than causation (you can read more in detail here). For example, there is no mention of drug dosing. Also, Pitocin isn’t isolated from its commonly accompanying other interventions in the study. High-intervention births are already associated with higher rates of maternal PTSD, anxiety, and depressive symptoms. This is especially seen with epidurals, which not only block pain-managing nerves but also inhibit the release of natural oxytocin during the Fergusson reflex (as baby’s head presses against the cervix and vaginal wall) and thereby fail to induce positive feelings of joy, safety, ecstasy, well-being and love.

“It is important to note that the effect of synthetic oxytocin administration on endogenous oxytocin levels is unclear, and nothing about endogenous oxytocin levels can be inferred from our dataset […]” the 2017 study researchers wrote.

While the widespread, routine use of Pitocin is being examined by many in the birth and medical communities, perhaps it’s time to dig deeper into the question of how this drug affects birth givers and babies in the long run. More investigation is clearly needed as current literature with this focus is currently scant.

In a press release, one author stated: “Since synthetic oxytocin is such an important and commonly used medicine for peripartum women, further research should examine dose, duration, timing, and reason for treatment so that we can better identify which women may be at risk for developing postpartum depression and anxiety.”

There are many potential casual factors for postpartum depression and anxiety, such as genetic predisposition, biological aspects like hormone and neurotransmitter functionality, stressful personal circumstances or events, and cultural norms in postpartum. Even more reason why it’s important to assess personal risk status, to be aware of the later-term effects (both known and suspected) of various birth interventions, and to utilize preventative strategies when planning for your postpartum year.

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