It’s Distressing

Part of my “summer busy-ness” included going to the backside of nowhere, with no internet for nearly two weeks. You probably didn’t notice it much if at all, because I was able to set up enough posts to keep active (and I could get online at the library… as long as I could get to the library), but I sure noticed! I am so addicted to the internet! 🙂 In addition to a plethora of emails, I had a huge number of posts from blogs I subscribe to, to catch up on, since coming back. It’s really almost insane — I need to cut back… but I don’t want to miss out! 🙂 So, I missed out on the whole “Pit to Distress” viral blog posts.

I did read N is for Nurse‘s original post which seemed to start it all — in fact, her refusal to “pit to distress” was one of the things I was thinking of when I wrote the post about laboring women having and needing a patient advocate. The remainder are in no particular order, except perhaps the order in which I read them. A few of the links will be to blog posts that have multiple links in them, so I may end up linking to a single post more than once, while inadvertently leaving out another post, thinking I’d already linked to it. So, I’m human. If there is a good post you know about that is not included in these links, feel free to post it/them in the comments!

The first one I read was from Jill at The Unnecessarean, followed by part two (which also includes multiple links). Then, Keyboard Revolutionary has another set of links; with Rixa at Stand and Deliver having two posts — the first has an interesting set of comments after it, because Rixa has a graph of fetal heart-rate with a graph of maternal contractions, and asks L&D nurses who read her blog “what should you do in this instance?” — and gets a multitude of answers, which leaves one commenter saying, “Funny thing about the EFM commentary here. It *perfectly* illustrates how constant EFM is total crap–because nobody can agree on what they are seeing!!” [That may be what Pinky was referring to in this post. And fwiw, here is one post and another post on ACOG’s refining fetal heartrate monitoring guidelines.] The second post has multiple links as well. Jenn from Knitted in the Womb weighs in with her tales of being a doula at some Pitocin-induced/augmented births, as does Sheridan at Enjoy Birth. One of the contributors to our Independent Childbirth educators blog posted this.

From the nurse/midwife side of things: Ciarin at a Midwife’s Tale; Reality Rounds (NICU nurse), on nurses declining to follow a doctor’s order that they disagree with; a triad of posts from L&D nurse Melissa at Nursing Birth — Pit to Distress part 1, part 2, and understanding the pitocin dosage; former L&D nurse now new CNM Rebirth Nurse; and finally, Nicole at It’s Your Birth Right weighs in. In addition to the posts, I’ve read most if not all of the comments on them, which are also very interesting.

Then there is this article — not exactly on “Pit to distress,” but it does tangentially discuss the topic.

This is frustrating, because aggressive dosing of Pitocin, even if not given the term “Pit to distress” (even in jest), can harm mothers and babies. Obviously, contractions that are too strong and/or too close together can distress babies, since it reduces their oxygen supply. But it can also cause a mom’s uterus to rupture, even if she has an unscarred uterus — i.e., no history of C-section or other uterine surgery. Of course, this is not typical — but it can sometimes happen. As one of the posts said (I think it was “Nursing Birth”) — Pitocin, like many other drugs, can have different effects on different people — for some, a tiny amount of a drug will be enough to knock ’em out or make him loopy, while another person can take a bottle of it and barely get drowsy. A tiny amount of Pit may put some babies in distress or hyper-stimulate a uterus, while other women and babies will hardly have any effect from a maximum dose.

Does “Pit to distress” happen? Yes. How often? No clue. Anybody’s guess. It probably varies like every other statistic or factor, like epidural rate, induction rate, C-section rate, etc. In other words, some docs are going to be horrible, and others are not. I remember reading something somebody wrote about birth plans — this nurse or midwife basically said that it was nearly embarrassing to read some birth plans that specified “no pubic shave” or “no enema” or such like because these practices were nonexistent any more. Then several readers chimed in with their own personal stories of them being on the receiving end of these practices which were supposedly “not happening any more.” In my area, I could see stuff like this happening because of what I know of the nearest hospitals’ typical practices in certain things. [My mom was given routine general anesthesia, a pubic shave, and episiotomy — without her consent, and even specifically against her will — for all 4 of her births in the 70s, even though the “natural birth” movement really caught on in the middle of the decade, and many hospitals had modernized their services and practices by the time I was born. A friend of mine only barely escaped being given a routine enema when she gave birth at a different area hospital in 1996. The only way she avoided it was that she had an attack of diarrhea [as part of the normal birth process, not from actual illness] when she was being admitted.) So, some things may not happen in most hospitals — but if it’s even 1% of hospitals, that’s probably 30-60 hospitals where X is still occurring on a routine basis, even if the other 3000+ hospitals aren’t doing it any more. If these hospitals have only 1 birth average per day that’s still 11,000-22,000 women annually who are routinely submitted to these antiquated and archaic procedures. Or to overdosing on Pitocin. I’ve never personally known a woman whose uterus ruptured under any circumstances — but that certainly doesn’t mean it can’t and doesn’t happen! So, even if the majority of “birth people” and nurses say that they’ve never seen it happen at their hospital, doesn’t mean it doesn’t happen anywhere.

Of course, Pitocin, like every other drug, should not be used unless necessary or medically beneficial. If a doctor — or midwife! — is using Pitocin to speed up your labor simply so they can get done and get gone, that is *ahem* not a medical reason. Some doctors tend to have the idea that labor should never plateau, go slow, sputter, or even stop. That tends to be not allowed. “The labor curve must be followed, at all costs!” [Only slightly tongue-in-cheek.] Some doctors use Pitocin on all women — a few of the stories in either the blog posts themselves or the ensuing comments mentioned this — one doula said that her client was told sometime towards the end of her pregnancy, before labor even began, that she would be started on Pit when she got to the hospital; another L&D nurse expressed frustration that Pit orders were written up for a woman before she was even admitted and assessed (the doctor did it when s/he called to tell them the patient was on her way).

What can you do about it? First — trust your doctor. Seriously — pick a doctor or midwife you can trust. This will entail more than just picking a name out of the yellow pages, or from your insurance company’s “preferred provider” list, or asking your friends who they went with. You wouldn’t have agreed to marry your husband based solely on someone else’s recommendation, nor picking a name at random from a list of “available men”; you probably wouldn’t buy a car just from a description, without even test-driving it, so why on earth would you choose the birth attendant based on such little information? Ask questions, and look for red-flag answers, including such nebulous answers as “only when necessary.” As some of the posts have showed, some doctors apparently consider a 100% Pitocin rate to be “necessary.” Unfortunately, some care providers merely provide a bait-and-switch — appearing to be one thing during prenatal visits, and morphing into somebody completely unrecognizable during labor and birth. Not much you can do about that, except being aware that it can happen, and trying to make sure it doesn’t happen to you. Of course, another possibility is that your favorite care provider will be unable to attend your birth, leaving you with someone else who may not share his/her philosophy.

Second, make nice with your nurse. She will be the one actually managing your labor (or being hands-off), so having her on your side can make the difference between having your wishes followed and having them brushed aside as unimportant. You don’t have to call it “bribery,” but you’ll catch more flies with honey than with vinegar. Something like candy bars (perhaps Snickers, “packed with peanuts” or some other thing that has protein in it) is quick and easy for you to have in your room, to give to your nurse when she first meets you in your room — greasing the wheels and all that. Of course, if she’s on a diet, that might not be the best; but you could think of something else that might go over well that’s not just a carby, starchy, sweet thing to eat (mixed nuts? shrimp tray? — a little difficult to get if rushing to the hospital, but if you’ve got the time, you’ve got more options). If she’s going to advocate for you, you don’t want her weakening due to an empty stomach! 🙂 [Also, if you’ve got food in your room, it’s easier for you to eat it without appearing obvious, in case your hospital has rules against moms eating while in labor. Just note, that may be their rules, but not necessarily your rules.]

Third, educate yourself — know how Pitocin is administered and what you should be looking for when having it — not just the negative side effects like contractions too close together, but also the desired effect of contraction strength and/or pattern. Ideally, you shouldn’t have to do this, but it wouldn’t hurt to know. Know also that you can ask that Pitocin be stopped and/or turned down — it is not at all unusual for labor to continue on its own and in a good pattern after having been jump-started by Pitocin. If you are contracting at an adequate pace, and/or are dilating sufficiently (although I will stress that dilation is not the only way for labor to progress), but a nurse is continuing to up the Pit, you can ask why and/or request that she stop increasing the Pit and perhaps even reduce it or turn it off. Certainly you should know the symptoms of your uterus being overstimulated, so you can be more effective when requesting or demanding that the Pit be turned down. I’ve read several stories (including some comments on these posts I’ve linked to) of women who were hyperstimming, but didn’t know they could ask that the Pit be turned down — some even thought that their level of pain and/or contractions was normal, since “labor is supposed to hurt.” If your nurse won’t turn it down even though you are clinically contracting too frequently, request a new nurse or to speak to the nurse in charge. Of course, if you’re in labor and particularly if you’re having back-to-back contractions, this won’t be easy for you to do, so this is where a doula or other labor attendant (husband, etc.) comes in.

Hopefully, you will never need this information. But if you do, I want you to know it.


6 Responses

  1. I was wondering why you were so quiet on all the “Pit to Distress” business. (thanks for the link BTW). I hope you enjoyed your vacation (?), if that was what it was.

    You really don’t have to bribe us nurses. A little respect and friendliness is all that is required. Food is ALWAYS accepted however 🙂

    At Your Cervix talks about how to secure a nurse that will fit your birthing needs.

    • Well, we did vacate our house, so it was technically a “vacation” 😉 but I’ve had less stressful times! Will talk more about it later, but it included everybody being sick for at least two days and/or nights. With the laundromat 7 miles away. Through road construction. When we weren’t sick, it was fun. But when the kids were sick… well… let’s just say, there was a lot of laundry to do!

  2. Welcome back! And nice article!

  3. Great chime in and thanks for the link. Time again we have to keep saying it and I hope our readers are hearing it…. 1. pick the right provider, 2. get your nurse on board and on your team and 3. get educated!!

  4. wonderful article. thank you.

  5. […] There is a great follow up post to the whole “Pit to Distress” flurry at Woman to Woman Childbirth.  I definitely encourage my readers to check it […]

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