Induced Labor Malpractice

Pitocin and Oxytocin Complications

More than a hundred years ago, scientists discovered that a particular hormone could cause more contractions in birth, so they named it “oxytocin,” which is Greek for “quick birth.” The drug Pitocin is just a synthetic form of the hormone oxytocin. Pitocin is the most common drug given to induce labor.(1)

Pitocin might be based on a natural hormone, but it has a powerful effect on the body. In fact, it’s so powerful that it has an effect on the way people think, and so researchers are looking at oxytocin as a possible treatment for autism.(2) When it comes to labor, delivery, and birth, Pitocin has to be used carefully because of how quickly conditions can change for the baby.

The Institute for Safe Medication Practices has described intravenous oxytocin (which is Pitocin) as a “high-alert medication,” which means it’s a medication that has a higher risk of causing “significant patient harm when it is used in error.”(3) A study in 2013 found that the use of Pitocin made it more likely that a newborn would have lower Apgar scores and more likely the newborn would be admitted to the NICU.(4)

Unlike most “high-alert medications,” however, with Pitocin, there is no universal guideline for its use. That means there is an even higher risk for medical error, because many labor and delivery nurses, and many obstetricians, don’t have a good sense of when it should be used, when it definitely should not be used, what dosages they should use, and what they should monitor when they use it.(5)

But that’s no excuse for malpractice. Almost a decade ago, the American Journal of Obstetricians and Gynecologists published guidelines for a checklist that hospitals, doctors, and nurses should follow when they use Pitocin.(6)

The three biggest problems with Pitocin are:

First, Pitocin is often given simply to “speed up” normal labor. This is inappropriate: given the known dangers of Pitocin to the mother and the baby, it should not be used to make normal labor quicker, but rather should only be used where it becomes necessary to induce labor or to make it proceed faster.

Second, nurses and doctors often use too much Pitocin. A systematic review in 2014 proved that high-dose oxytocin does not increase the likelihood of vaginal delivery within 24 hours, but it does increase the likelihood of uterine hyperstimulation, a dangerous condition for the baby where the uterus contracts too frequently and with too much force.(7) If a hospital is going to use Pitocin, it should use a low-dose method with 0.5 to 1 milliunit per minute, increased every 30 to 40 minutes at most. Yet, many hospitals use six times as much, and increase it twice as fast.

Third, labor and delivery wards don’t monitor closely women on Pitocin. Once a mother in labor has been given Pitocin, the nurses and doctors can’t just check on her every now and then. Rather, they need to keep a close watch on the contractions, on the baby’s heart rate (and the fetal heart strips), and on the mother’s temperature.

Citations:

(1) “Intravenous oxytocin alone for cervical ripening and induction of labour” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164045/

(2) “Neuroscience: The hard science of oxytocin” http://www.nature.com/news/neuroscience-the-hard-science-of-oxytocin-1.17813

(3) “Results Of ISMP Survey On High-Alert Medications: Differences Between Nursing, Pharmacy, And Risk/Quality/Safety Perspectives” https://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=15

(4) “Study Finds Adverse Effects of Pitocin in Newborns” http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Study-Finds-Adverse-Effects-of-Pitocin-in-Newborns

(5) Oxytocin: new perspectives on an old drug. http://www.ncbi.nlm.nih.gov/pubmed?term=18667171 Oxytocin, excessive uterine activity, and patient safety: time for a collaborative approach. http://www.ncbi.nlm.nih.gov/pubmed?term=19209060

(6) “Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes” http://www.ajog.org/article/S0002-9378(07)00992-1/pdfSummary

(7) “High-dose versus low-dose oxytocin infusion regimens for induction of labour at term.” http://www.ncbi.nlm.nih.gov/pubmed?term=25300173

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