Why is pitocin used after birth

Active management involves administration of uterotonic medication after the delivery of the baby, early cord clamping and cutting, and controlled traction of the umbilical cord while awaiting placental separation and delivery. Good evidence shows that active management of the third stage of labor provides a better balance of benefits and harms and should be practiced routinely to decrease the risk of postpartum hemorrhage. Oxytocin, ergot alkaloids, and prostaglandins have been compared, as have timing and route of administration of these uterotonic medications.

Oxytocin is the uterotonic agent of choice; it can be administered as 10 units intramuscularly or as 20 units diluted in mL normal saline as an intravenous bolus, and can safely and effectively be given to the mother with the delivery of the baby or after the delivery of the placenta.

The third stage of labor is the time from the delivery of the infant until delivery of the maternal placenta. Volume of blood loss depends on how long it takes the placenta to separate from the uterine wall and how effectively the uterine muscle contracts in the immediate postpartum period. Practice active management of the third stage of labor during obstetrical delivery to prevent postpartum hemorrhage.

Active management includes prophylactic administration of uterotonic agent with the delivery of the baby, early clamping and cutting of the umbilical cord, and constant controlled cord traction.

For the prevention of postpartum hemorrhage, and in conjunction with the other components of active management of the third stage of labor, oxytocin can be administered with the delivery of the anterior shoulder or after the delivery of the placenta. The recommended dose is oxytocin 10 units intramuscularly or 20 units diluted in mL normal saline intravenously to prevent postpartum hemorrhage in the third stage of labor.

Oral prostaglandins should not be used for the prophylaxis of postpartum hemorrhage. Postpartum hemorrhage occurs in approximately 4 percent of vaginal deliveries, and estimates are that it causes significant morbidity and 25 percent of all maternal childbirth-related deaths. Maternal risk factors for postpartum hemorrhage are summarized in Table 1. Uterine atony is the most common cause of postpartum hemorrhage. Uterotonic medications e. Factors associated with postpartum hemorrhage with vaginal birth.

Obstet Gynecol ; Attempts to prevent postpartum hemorrhage have focused on the prophylactic use of uterotonic agents and the active clinical management of the third stage of labor.

This article reviews the evidence supporting these approaches in the prevention of postpartum hemorrhage. Key terms are defined in Table 2. Uterotonic medication administered after the delivery of baby; early clamping and cutting of umbilical cord; and controlled umbilical cord traction until separation and delivery of the placenta.

No uterotonic medication administered; umbilical cord not cut or clamped until after cessation of pulsating; separation of the placenta without intervention; and placenta delivered by gravity or spontaneously by maternal expulsion. Information from references 1 , 2 , and 6.

The umbilical cord is not clamped or cut until cessation of pulsating; separation of the placenta occurs without intervention; and the placenta is delivered spontaneously or aided by gravity. Active management of labor incorporates three main interventions: administration of a uterotonic medication after delivery of the baby; early cord clamping and cutting; and controlled traction on the umbilical cord while awaiting placental separation and delivery.

A Cochrane systematic review 6 identified five randomized controlled trials RCTs comparing active and expectant management that included more than 6, women. There were no advantages or disadvantages for the baby with either approach. The uterotonic agents and the route of administration varied, but the outcomes of active and expectant management of the third stage of labor were similar among the five trials.

In one trial, 6 manual removal of the placenta was more common after active management. This trial 6 was the only one that used an intravenous ergot alkaloid as the uterotonic agent. Ergot alkaloids are thought to promote contraction of the lower uterine segment and may thereby increase the risk of an entrapped placenta and the subsequent need for manual removal of the placenta.

A second analysis 9 of these data, excluding the trial using intravenous ergonovine and a trial of lesser quality, demonstrated the benefits of active management in preventing postpartum hemorrhage while finding no increased risk of retained placenta or maternal side effects. Together, these two systematic reviews 6 , 9 provide evidence that active management with uterotonic agents other than an intravenous ergot alkaloid confers important benefits without significant side effects.

The evaluation of individual components of the active management of the third stage of labor has focused on the uterotonic medications. A Cochrane systematic review 10 evaluated oxytocin as the prophylactic uterotonic agent in the third stage of labor. The trials varied in dose of oxytocin administered, route of administration, and general management active versus expectant of the third stage of labor. In the studies using prophylactic oxytocin without the other components of active management early cord clamping and cutting, controlled cord traction , there was a nonsignificant trend toward increased manual removal of the placenta 4.

The Cochrane review 10 also evaluated six trials that compared the prophylactic use of ergot alkaloids with the use of oxytocin in women in the third stage of labor. The use of intramuscular ergometrine-oxytocin has been studied in a systematic review including six trials totalling more than 9, women.

Overall, the prophylactic use of oxytocin reduces postpartum hemorrhage and the need for therapeutic uterotonics. The ideal dose of oxytocin has not been directly studied. From the available data, the most effective dose appears to be 10 units administered intramuscularly or 20 units diluted in mL of normal saline and given as an intravenous bolus.

There seems to be no significant benefit to the prophylactic use of ergot alkaloids alone when compared with oxytocin alone or with the combination of oxytocin and ergometrine-oxytocin. Carbetocin not available in the United States is a synthetic oxytocin analogue with a half-life four to 10 times longer than oxytocin.

It can be administered intramuscularly or intravenously as a single injection. An RCT 12 compared mcg of intramuscular carbetocin with 10 units of intravenous oxytocin and found no difference in the number of women requiring additional uterotonic medication.

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Monet Nicole. Find out more about this common way to give labor a nudge. Back to Top. In This Article. Continue Reading Below. Read This Next. Signs of Labor. What Is Cord Blood Banking? Natural Ways to Induce Labor.

No induction will start with Pitocin unless your cervix is favorable. What does that mean? As your body preps for labor, your cervix softens and opens. Anything less than a six means the cervix may not be ready for labor. Other benefits include:. Simply put: Inductions are medically necessary in cases when the risk of the baby staying in utero exceeds the risk of the induction. As with many medical procedures and interventions, there are risks with a Pitocin induction.

These include:. Starting an induction is usually the start of a long process, so your doctor will likely proceed with caution and with your input. After that, Pitocin could be the next step. Once you are on Pitocin, you must be strictly monitored and remain in bed. Contractions typically start about 30 minutes after starting Pitocin. This is because of the risk of aspiration in the event that you need an emergency cesarean delivery. Pitocin-induced contractions might interfere with rest, too, so both you and the baby can get tired out.

Mental and emotional frustration can have an impact on labor, too. We know an induction can sound scary, and understanding exactly what it involves is key.