managing pitocin-induced contractions

Amanda H · 05-22-2007, 06:40 PM

Dear doulas,

What are some of the best ways to manage "pit" contractions?

So far all of my clients who have had pitocin have eventually chosen to have an epidural because the pain was so intense. My next client is scheduled for an induction on Thursday, and she cannot have an epidural, so any suggestions would be welcome.

Amanda H.
Columbus, Ohio

BeautyBirth · 05-22-2007, 06:59 PM

CAn she be induced without using pit right off? Then if she ends up needing get it? The longer you can hold off the less time you have to deal with those pit contractions, but i guess that's based on what staff you have as well.

DoulaCBE · 05-22-2007, 07:04 PM

Quote:

Originally Posted by Amanda H

Dear doulas,

What are some of the best ways to manage "pit" contractions?

So far all of my clients who have had pitocin have eventually chosen to have an epidural because the pain was so intense. My next client is scheduled for an induction on Thursday, and she cannot have an epidural, so any suggestions would be welcome.

Amanda H.
Columbus, Ohio

IMO and IME the biggest factor is doing it slowly.
Starting at the lowest dose and upping the dose every 1/2 hour to every hour instead of the standard 15 minute intervals. Some hospitals will allow an increase of 2-4 milliunits every 15 minutes, but I suggest 2 every 30-60 minutes.

Another huge factor IME is keeping the bag of waters intact. I had a pitocin induced labor with my last baby and found it entirely manageable without pain medications by taking it slow and not allowing my membranes to be ruptured. I've had a few clients attain an otherwise unmedicated birth by using the same approach.

RosyDoula · 05-22-2007, 07:13 PM

Yeah, avoid it if you can!!!

Not to scare you, but I've had two clients now get induced with pit all the way up to the maximum dose (20 miliunits).

Despite my warnings it was going to be hell.

I looked at their strip on the monitor and the peaks of contractions were up into the 100-110s. A nurse told me once that into the 60s will cause cervical change.

Unfortunately, if Mom's body isn't ready, it may take that much to get contractions that are 2-3 minutes apart. Make sure she knows her Bishop Score!

Here's a site that explains it: http://mother-care.ca/bishop.htm

At UofM, its required you stay on external EFM continuously, but the nurse was able to find some way of keeping a tracing and letting my client get in the shower. I didn't know it was possible, so ask!

RosyDoula · 05-22-2007, 07:16 PM

Quote:

Originally Posted by DoulaCBE

Another huge factor IME is keeping the bag of waters intact. I had a pitocin induced labor with my last baby and found it entirely manageable without pain medications by taking it slow and not allowing my membranes to be ruptured. I've had a few clients attain an otherwise unmedicated birth by using the same approach.

Same thing in my experience too. Once the waters were broken, it became unbearable for her.

Also, if the waters aren't broken you haven't started that ticking clock to c-section in 24 hours. If theres no progress made, maybe she can go home.

DoulaCBE · 05-22-2007, 07:43 PM

Quote:

Originally Posted by RosyDoula

I looked at their strip on the monitor and the peaks of contractions were up into the 100-110s. A nurse told me once that into the 60s will cause cervical change. :O

!

Was it an internal or external monitor?

External monitors can't tell how strong a contraction is, just how far apart they are and how long they are lasting. There are many variables that influence how an external monitor registers contractions, among them placement, position of mom/baby and maternal padding (fat).

An IUPC would be required to assess the strength of uterine contractions.

RosyDoula · 05-22-2007, 08:18 PM

Quote:

Originally Posted by DoulaCBE

Was it an internal or external monitor?

It was internal. Baby had been having decels.

They turned off the pit, did an amnioinfusion and then restarted the pit once baby seemed to recover.

Babycatcher · 05-23-2007, 02:34 AM

See if they have nitrous oxide.
What are the advantages of nitrous oxide?
Nitrous oxide:
provides enough labor pain relief for many women
may enable you to avoid, postpone, or limit narcotic or epidural pain medication, which have more serious adverse effects
has a short lag time between requesting the gas and obtaining relief
can be used at any time in labor right up to the birth
increases your sense of personal control, as you choose when you use it
does not appear to interfere with labor progress or ability to push
does not lower your blood oxygen level
does not appear to have adverse effects on the baby's condition at birth
can be discontinued more quickly than other pain medication, as its effects reverse rapidly when you stop inhaling it
does not require the presence of an anesthesiologist for its administration and monitoring.

Keep in mind the mask should NOT be attached to the mom,, and the MOM should be holding the mask. Why? because when she has had enough, she will drop it and the nitrous will leave her system, but if someone is holding it FOR her, she can get too much and it may make her a tad woozy.
It is a GREAT way to take the edge off of the peak of the contraction...

HOWEVER, I have been maxxed out on pitocin before...OMG. That is all I can say. If it gets too painful she will just do what I did and pass out at the contraction's peak, and wake up when it ebbs....That's a kind of agony I wouldn't wish on anyone, though! Breaking the water is a pain I cannot describe. I couldn't even breathe...and you DO panic when you are in that much pain, but you can't vocalize it because it hurts too much to even scream, so you panic...so keep that in mind if she gets too quiet on you..
My contractions were in the 100's, too. With back labor (he came out looking at the ceiling) I was induced with a bishops score of, like, TWO, and the Cervadil did nothing...I was a fingertip and 50% effaced AFTER having that stuff in all night...grr...and they started pitocin ANYWAY.

I would def tell her to pay attention to that Bishop's score..and if her baby is doing great and there is no medical reason for induction, I would strongly urge her to give it some thought, start using some EPO to get that cervix ready, start drinking some RRL tea, whatever she can do to get her body ready so when that pit is started her body will be receptive to it.
Also, see if the Dr will strip her membranes when they put in the cervadil..That may help it get a good start, too, and if she is in a good pattern she may not even need pitocin.

Best of luck!!

MothertheMother · 05-23-2007, 09:15 AM

I'd say focus on getting endorphins up. The oxytocin your body releases triggers the release of the endorphins...hence being able to tolerate the pains better. With synthetic pitocin this does not happen, you don't get the endorphin release to counter the pain. With this in mind I'd say pay a lot of attention to things that get the endorphins going

dim lights
music
light massage
sitting on birth ball (I learned recently that the pressure on the va-jay-jay releases endorphins)
a lot of sweet encouragment from partner
slow dancing
rocking/swaying
pleasing scents (if allowed)

Ok...so these are all things that are good anyway lol

I ask clients in a prenatal if they've ever had a professional massage or a really good one from their honey. I tell them that the dreamy feeling after a great massage is all of the endorphins. Our goal is to get mama in that dreamy state and keep her there as much as possible.

AmandaB · 05-23-2007, 10:09 AM

How about, not at all!! No I mean, is there a medical reason and being 10dys post date is not a medical reason to induce.

Yes, I would agree with the slower process as in starting with the gel and letting things start on their own. And there is always an option of stopping the Pit once her body gets in the groove, although no one ever asks! It is about her and her baby, the staff will just keep managing if no one says anything. I also provide my clients with the CIMS (coalition for improving maternal services) report on inductions. It is available for free in PDF so it is a good resource to have. I also have an Induction B.R.A.I.N handout that I wrote so PM me if you would like a copy. Best of luck and help empower her to make the best decisions. Sending positive vibes.

Amanda H · 05-23-2007, 02:29 PM

I wish that I could convince her to delay or avoid the induction. She only has a vague understanding of why her doctor recommends it (high levels of amniotic fluid -- but my client doesn't know how high), but her husband is in favor of inducing and she will probably go with what her doc and husband want.

I will definitely try to convince her to have them start with the prostaglandin only and then, if she ends up with pit, to begin with very small amounts. Wish us well everyone!

Amanda

JerseyJess · 05-23-2007, 03:10 PM

I've had two pitocin inductions myself and also found it very manageable until my water was released. I did it without pain meds and have had many clients do it as well-I think not starting out exhausted or hungry is HUGE. Getting a good night's sleep the night before and eating a meal before they begin will help. For me, not being restricted to bed was key. Yes, I had continuous monitoring but I was never in the bed-I was sitting on the birth ball, pacing, sitting on the toilet (extended bathroom trips).

I've had at least 4 clients go into labor from just cervadil alone-no pitocin needed. Even if it's not indicated (meaning her cervix is soft, thin and at least 2cm-it can still play a role in starting labor)

My last two "induction" clients were 4 and 5cm and chose just to have their water released-within 6hrs both were in labor, and no pitocin was needed.

I agree with the others-if she chooses pitocin, not having her water released until the last minute will make it much easier.

I agree with Christy-atmosphere is important. You can try doing light touch massage (any stroking on back or arm that results in goosebumps-as this actually releases endorphins) and visualization, use lavender etc...

Amanda H · 05-25-2007, 02:55 PM

Thanks, everyone. My client's induction and birth went very smoothly yesterday. She insisted that they start the pit very low in increase slowly. Her doctor allowed her to move freely around the room, on the ball, and the rocking chair, which was critical to her success. Once she was 5 cm, they ruptured her membranes, and the baby was born after two hours of intense but manageable labor and three long, strong pushes.

Thanks for the great suggestions.

Amanda

RosyDoula · 05-25-2007, 04:37 PM

I'm so glad to hear that!

Mile High Doula · 05-25-2007, 07:41 PM

Ummmm...just throwing this out there but I have noticed something with my clients and Pit.

1. If I tell my client prenatally that induction is hard and we want to do everything we can to avoid it, they are SCARED to death of Pitocin and already have a preconceived notion about it. Therefore increasing the pain because they fear it.

2. If I tell my client prenatally that induction should be avoided but if we must go down that path we will work together to get through it and AVOID telling them that Pit makes things worse...they cope soooo much better. In fact, I have had a few inductions lately with Pit where things didn't seem that much different. Could have been the clients and their pain tolerence or it could have been the perception they received from me prenatally.

Bottom line, if we fear something, it's gonna hurt.