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Oxytocin vs. Pitocin

February 2016

In this post, we'll look at the physiologic differences between oxytocin produced within the maternal system and the artificial relative of oxytocin, Pitocin. Both bind to oxytocin receptors in the uterus to produce contractions, but here are the major differences:

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How is it delivered in the body? Pitocin: Continuous IV drip. VS Oxytocin: By 4 to 8 minute pulses.

Beta-endorphins: Pitocin: No effects at releasing beta-endorphins for pain control, which in fact, have been found to be 30% lower at delivery. VS Oxytocin: Natural labor involves the release of this endogenous opioid, produced in the hypothalamus, which rises significantly throughout labor until the time of delivery. Beta-endorphins help block pain and regulate oxytocin release to manage the pace and intensity of labor.

Amounts released: Pitocin: Although protocols regulate the administration of pitocin to match the levels of oxytocin in spontaneous labor, each patient will react differently. Prolonged exposure to IV Pitocin could have an effect on the maternal system's responsiveness, becoming less sensitive over time, necessitating greater doses of Pitocin. VS Oxytocin: Each patient's physiology will dictate the amount of oxytocin needed and released to promote delivery.

Contractions: Pitocin: Creates stronger, more painful, and more frequent contractions with increased uterine resting tone between contractions. Increased need for pain medication, which can have its own negative effects on the infant. Can stress the neonate, making him weaker and more tired, which in turn can affect his ability to feed well. VS Oxytocin: Works with individual physiology of the patient, does not produce the untoward effects as pitocin does.

Uterine rupture: Pitocin: The Institue for Safe Medication Practices lists Pitocin in the High Alert category due to "a greater risk of causing significant patient harm if used improperly", and can increase the potential for uterine rupture. VS Oxytocin: Very rarely causes rupture.

Neurologic effect: Pitocin: Affects the brain differently than natural labor. VS Oxytocin: Has a positive affect on the brain, inducing bonding and attachment. Increases pain threshold. Increases dopamine, serotonin, acetylcholine, noradrenaline, and opiod release. Increases social interactive behaviors. Induces a feeling of wellbeing in both mother and infant. Produces potent anti-inflammatory effects and decreases wound healing time. May increase glucagon release, allowing transport of nutrients to the breast for milk production.

Stress hormones: Pitocin: No increase in beta-endorphins. Increased anxiety and reduction in naturally produced beta-endorphins. Interferes with the hypothalamic-pituitary-adrenal (HPA) axis to delay the onset of full lactation. VS Oxytocin: Inhibits the release of adreocorticotripic hormone which regulates the release of cortisol in response to stress.

Breastfeeding: Pitocin: Evidence suggests that Pitocin affects the body differently than oxytocin, leading to negative effects on the neonate and the mother that can interfere with breastfeeding success. Has antidiuretic effect that can cause increased engorgement, difficulty with infant latch, and premature weaning. VS Oxytocin: Enhances breastfeeding.

Apgar Scores: Pitocin has been associated with lower Apgar scores at birth.

Neonatal Outcomes: Adverse effects have been associated with induction or augmentation of labor with Pitocin, including fetal apoxia, increased cranial molding, asymmetry, and cranial base misalignment, all of which can impact the six cranial involved with sucking and swallowing; jaundice, increased neonatal resuscitation, shoulder dystocia, and abnormal fetal heart rate.

Induction and augmentation of labor may be truly needed when applied to a true medical necessity. However, they are not without their own problems and side-effects for both mother and infant. Each case should be viewed in a "benefits versus risks" manner, and mothers should have true informed consent before having their labor augmented. Elective inductions do not meet the criteria for medical necessity nor for benefit.

Just food for thought...

Kathy



Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA
Course Tutor, Step2 Education

 

 

 

 

 

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