October 16, 2014

Papaya and Pitocin

A few weeks ago, a student quietly pulled me aside after class to talk to me about my recommendation for papaya enzymes to help relieve her heartburn. She said that she asked her doctor about it and her doctor said it was fine. However, after researching online, she came across some information that suggested unripe papaya can stimulate the production of prostaglandin and oxytocin. Synthetic forms of these hormones are utilized in labor induction. The student was concerned that she would prematurely induce labor with the papaya enzymes. I explained that if she’s is not comfortable with taking the enzymes, she should discontinue using them. I also mentioned that I believe over the counter enzymes are from ripe papaya, which is not believed to have adverse affects on pregnancy. Jokingly, she said she’ll save her bottle of papaya enzymes in case she has to induce labor. (If it were only that easy!)

Since the mood was relaxed and the student and I were joking about her stash of papaya enzymes for labor induction, I asked her how she felt if she needed to use pitocin during labor. She said she would rather avoid it, but if her doctor thought it was medically necessary, she would not argue. I later took this question to one of my evening prenatal yoga classes. The response was similar. If their care provider recommended it, then they would not question it or cause a fuss. I also asked how many women were drinking coffee during pregnancy, about 1/2 the class raised their hands. Drinking any alcohol? Many said “a few sips here and there.” Sushi anyone? Many nods with the explanation of it being from reputable places and one student commented that women in Japan likely ate sushi on a regular basis. I asked those who had abstained from coffee, sushi, wine etc, why they chose to do so. The moms-to-be expressed they did not feel it was worth the risk to have coffee, wine, sushi etc.

This conversation was enlightening. When weighing the risks versus benefits of coffee, sushi, wine, or even hair-dye, most students thought the risks outweighed the benefit. Was a piece of sushi really worth it? But, when weighing the risks versus the benefits of pitocin, most felt that pitocin was acceptable if their care provider saw it necessary, and would not question this decision.

One of the biggest concerns I have exists within the above conversation. We have a more casual attitude surrounding labor inductions and interventions that we do regarding our eating and hair dying habits. According to the Listening to Mothers II survey, half of all labors in the U.S. are induced or augmented with Pitocin or other synthetic form of the hormone oxytocin (Declercq et al., 2006)(1) Many women do not know the risks, possible side effects and warnings involved in the use of pitocin during labor. If they did, would it be so accepted? I have no blame for those who unquestionably choose this path or 100% trust their care provider. However, I do wonder if all the information is being fully explained. If it was routinely debriefed, would the use of this popular labor intervention be reduced.

Pitocin fun facts!

This information comes directly from the Pitocin medical label. Please read carefully and take this information into consideration when agreeing to use pitocin in your labor experience.

Pitocin'” (Oxytocin Injection, USP) Synthetic (1)(2)

Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefits-to-risks considerations, oxytocin is not indicated for elective induction of labor.
(For more information on what is deemed medically necessary for induction click here)

2. Oxytocin is indicated for the initiation or improvement of uterine contractions, where this is desirable and considered suitable for reasons of fetal or maternal concern, in order to achieve vaginal delivery. It is indicated for (1) induction of labor in patients with a medical indication for the initiation of labor, such as Rh problems, maternal diabetes, preeclampsia at or near term, when delivery is in the best interests of mother and fetus or when membranes are prematurely ruptured and delivery is indicated; (2) stimulation or reinforcement of labor, as in selected cases of uterine inertia.
Going past one’s due date, convenience for mother and/or care provider or “suspected large baby” do not qualify as medical indications

3. All patients receiving intravenous oxytocin must be under continuous observation by trained personnel who have a thorough knowledge of the drug and are qualified to identify complications. A physician qualified to manage any complications should be immediately available. Electronic fetal monitoring provides the best means for early detection of overdosage. This means that the mother have a lack of movement and need continuous fetal monitoring

4. Even with proper administration and adequate supervision, hypertonic contractions can occur in patients whose uteri are hypersensitive to oxytocin. This fact must be considered by the physician in exercising his judgment regarding patient selection.

5. Maternal deaths due to hypertensive episodes, subarachnoid hemorrhage, rupture of the uterus, and fetal deaths due to various causes have been reported associated with the use of parenteral oxytocic drugs for induction of labor or for augmentation in the first and second stages of labor.

6. Oxytocin has been shown to have an intrinsic antidiuretic effect, acting to increase water reabsorption from the glomerular filtrate. Consideration should, therefore, be given to the possibility of water intoxication, particularly when oxytocin is administered continuously by infusion and the patient is receiving fluids by mouth.

7. When oxytocin is used for induction or reinforcement of already existent labor, patients should be carefully selected. If patients are selected so carefully, why do more the ( %) have pitocin involved in their labor?

8. Carcinogenesis, Mutagenesis, Impairment of Fertility
There are no animal or human studies on the carcinogenicity and mutagenicity of this drug, nor is there any information on its effect on fertility. We do not know there is any association with pitocin leading to cancer, cellular changes or fertility issues for mother or baby

9. The following ADVERSE REACTIONS have been reported in the mother:

*Anaphylactic reaction
*Postpartum hemorrhage
*Cardiac arrhythmia
*Fatal afibrinogenemia (blood disorder in which the blood does not clot normally)
*Oxytocin Injection USP
*Premature ventricular contractions
*Pelvic hematoma
*Subarachnoid hemorrhage (bleeding in the area between the brain and the thin tissues that cover the brain.)
*Hypertensive episodes
*Rupture of the uterus

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.

The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.

Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin induced water intoxication has been reported.

10. The following ADVERSE REACTIONS have been reported in the fetus or neonate:

Due to induced uterine motility:
*Premature ventricular contractions and other arrhythmias
*Permanent CNS or brain damage
*Fetal death
*Neonatal seizures have been reported with the use of oxytocin.
*Due to use of oxytocin in the mother:
*Low Apgar scores at five minutes
*Neonatal jaundice
*Neonatal retinal hemorrhage

We are fortunate enough to live in a time where we have amazing medical support for when it is truly necessary. But we have to look at the statistics that half of the labors in the US are using some form of pitocin for induction or augmentation. Do we fully believe that half the labors really need this drug? This information is scary and can be overwhelming. And my intention with highlighting these risk factors is to open up a dialogue with your care provider to discuss the perimeters in which you are comfortable with the inclusion on this drug in your labor experience. It is important to remove the casual approach and acceptance of such a commonly used labor intervention.

For those who would like more information about induction, please visit Childbirth Connection
1. An Investigation on the Effects of Pitocin for Labor Induction and Augmentation on Breastfeeding Success
1. Pitocin'” (Oxytocin Injection, USP) Synthetic
2. Daily Med : Label: PITOCIN- oxytocin injection
3. ACOG- Study Finds Adverse Effects of Pitocin in Newborns




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