Pitocin is a synthetic version of a hormone called oxytocin. Doctors often administer Pitocin to stimulate uterus contractions and speed up the process of labor and childbirth. When Pitocin is not properly administered or the mother’s response is not closely monitored, it can over-stimulate the uterus and cause serious harm to the baby. Hyperstimulation from the misuse of Pitocin can cause the baby to lose oxygen and suffer permanent brain damage.About Pitocin
When it is time for a baby to be born, the mother’s body starts to release large amounts of a hormone called oxytocin. Oxytocin stimulates the muscles in the mother’s uterus to be contracting which is how the process of labor and childbirth begins. The drug Pitocin is basically a synthetically manufactured copy of the oxytocin hormone. Once absorbed into the bloodstream, Pitocin has the same effect. It causes the uterine muscles to contract.
Delivery room doctors use Pitocin for 2 things: (1) to induce contractions and start the process of labor in a mother who is past her due date; and (2) to accelerate labor that is not progressing fast enough. Pitocin is administered intravenously, either through a drip bag or a machine that automatically dispenses the dosage. Pitocin is the most common method of inducing and accelerating labor today.Dangers of Pitocin
The reason Pitocin is potentially dangerous in the delivery room is that uterus contractions can actually harm the baby if they are strong and if there is not adequate rest time between each contraction. Pitocin makes contractions stronger and more frequent so doctors must be very careful when using it. There are 2 primary dangers that doctors run into with Pitocin: (1) improper dosage; and (2) hyperstimulation.
(1) Improper Dosage
Given the proper dosage of Pitocin is very important because too much can result in harmful contractions. However, getting the dosage right is very difficult because the effects on Pitocin individual women varies widely. Some women are very sensitive to Pitocin and only need a small amount. Others need larger doses to get any response.
For this reason, most hospitals have very strict protocol for administering Pitocin. The dose starts out very small, then increases gradually. Doctors and nurses are supposed to carefully monitor how the mother’s is reacting to the Pitocin before stepping up the dose, but this does not always happen. Too often the hospital delivery team pays little or no attention to how the mother is reacting to the Pitocin, until its too late.
When too much Pitocin is administered, or if a women over-responds it triggers a reaction known as “hyperstimulation” of the uterus. This involves uterus contractions that are much too strong and with not adequate rest time between contractions. Each time a contraction occurs it compresses the placenta and restricts oxygen to the baby. When a hyper stimulated uterus contracts too strongly and too frequently it can result in acute oxygen deprivation. Oxygen deprivation during childbirth can cause permanent damage to the baby’s brain and result in injuries such as cerebral palsy.Recurrent Variable and/or Late Decelerations are Warning Signs
The OB and the nurses monitor accelerations and decelerations in the baby's heart rate during labor. A deceleration is a decrease in the child's heart rate that falls below the fetal baseline heart rate. The baseline fetal heart rate is calculated by looking at the heart rate during a ten minute period rounded to the nearest five beats per minute increment.
There are three basic types of decelerations: early decelerations, late decelerations, and variable decelerations. The type of decelerations is identified by looking at its onset to peak in relation to the mother's contractions.
Different decelerations mean different things. Most Pitocin related birth injury cases involve variable and late decelerations. When the fetal monitor shows late decelerations, it is an often a sign that the baby is in distress because the contractions are preventing oxygen from adequately transferring between the uterus and placenta.
Similarly, variable decelerations mean excessive contractions are causing recurring umbilical cord compression resulting in a lack of oxygen. If you give Pitocin and do not properly monitor the contractions and the fetal heart rate, you are creating a recipe for a potential tragedy.
Often, the worst thing for that child is more Pitocin because continued use of Pitocin promotes hyperstimulation of the uterus during periods of fetal distress. This hyperstimulation is dangerous because uterine contractions under these circumstances increase the likelihood of fetal injury because the baby may have trouble breathing in between contractions.
When confronted with recurring variable and/or late decelerations, the delivery team has to suspect that the contractions are potentially causing a lack of oxygen to the baby. The baby is telling the delivery team that there is a problem. Doctors and nurses often fail to heed baby's warning and discontinue Pitocin, causing the baby oxygen deprivation that leads to organ failure, including brain injuries.Hospital Protocol for Pitocin
The hospital is often responsible for the actions of its doctors or nurses. They can also be independently responsible if they have no or inadequate Pitocin protocols.
Most hospitals have protocols that limit the use of this drug when the mother is dilating, having strong contractions, or the baby has recurrent variable and/or late decelerations.
Often, the nurses and the doctors are following a flawed hospital Pitocin protocol that fails to adequately safeguard against the risks of getting more Pitocin than is safe for the baby. Pitocin increases the risk of excessive uterine activity, precipitous delivery, decreased fetal oxygenation, and a hypoxic-ischemic brain insult that changes the baby's life forever.
The standard of care requires that the hospital protocol mandate continuous and adequate monitoring of contraction frequency and duration and the uterine resting tone.
If the hospital does have protocols that are ignored by the doctors and nurses, does that mean the doctors will admit responsibility? No. We have seen cases where the protocol required discontinuation of the Pitocin and the nurses doubled the dosage. The doctors will still able to find medical experts to defend doubling Pitocin when the fetus was having late decelerations. The doctors, nurses, and hospitals fight all of these cases tooth and nail. They are always a battle and you need to best lawyers fighting for you to achieve justice.The Nurses Can Often Be Blamed
The standard of care requires a labor and delivery nurse to be familiar with the process of labor induction. They need to know the risks and benefits of labor-inducing drugs that are used to initiate and intensify uterine contractions. Specifically, nurses have a duty to stop Pitocin in response a fetal heart rate that suggests uterine hyperstimulation.
That makes sense, right? Here is what might be less intuitive. The nurse has a duty to go up the chain of command if the obstetrician ignores the nurse and continues to administer these drugs when counterindicated. The failure to do so can be medical malpractice.Frequently Asked Questions
The primary danger of using Pitocin to stimulate labor is that in some women it can cause hyperstimulation of uterine contractions. This means that the Pitocin causes the mother’s uterus contractions to become to strong and/or occur too frequently. Contractions that are overly strong or too frequent can be dangerous for the baby and may disrupt the normal flow of oxygen.
Ultimately, doctors and nurses need to watch both the baby and the mother. If a doctor is going to prescribe Pitocin, it is incumbent upon them to have constant external or internal monitoring of the fetal heart rate and observation of any non-reassuring fetal heart rate patterns, particularly late decelerations.
Too often, you have a situation where the fetal monitor is showing late decelerations or other signs of distress, or contractions are 5 or more in 10 minutes, firm, or last longer than 90 seconds. This is the baby telling the health care providers to stop the Pitocin and take steps to quiet the uterus. Sometimes, the breakdown is that the nurses are asleep at the switch. But, often in these cases, nurses sound the appropriate alarms and the doctor is rolling his eyes because he thinks the nurse if overreacting.
The half-life of Pitocin is about 3.5 minutes. This means Pitocin will cease to have an effect within 10 to 15 minutes and likely even sooner. So if Pitocin is pushing things too far the wrong way, withdrawing the Pitocin can bring it back.
But the key is turning off the Pitocin when the circumstances demand it. Continuing to administer Pitocin despite a persistent, nonreassuring fetal heart pattern in the origin of many birth injury medical malpractice claims.
Most hospitals have Pitocin protocols to be followed by OB/GYNs and labor and delivery nurses. What is maddening is how blithely these doctors will contend during that litigation process that it is okay to ignore these protocols.
The nurse has a bigger role than you would think. The nurse has to be able to read the strips and understand the pharmacokinetics of this drug. But what surprises people is the nurse's independent obligation to do the right thing. The nurse has a duty to follow written protocols and exercise independent judgment by questioning the doctor's orders.
If the doctor will not do what the nurse believes is proper, the nurse has to be a patient advocate and follow the hospital's "chain of command." The “chain of command” is a term that implies that a nurse should move up the medical care hierarchy when the believes another medical provider may cause harm to the patient. This usually requires her to start with her direct supervisor and take it all the way up the chain to the physician head of the department\. The bottom line is that if the nurse does not act as the patient's advocate in this way, the nurse can also be liable in a medical malpractice lawsuit brought by the child or mother.
Pitocin can cause uterine overstimulation of the uterus, causing, or contributing to, placental abruption. You know you have uterine hyperstimulation where there are strong tetanic contractions. These contractors can cause problems with decreased uteroplacental perfusion and can also cause a uterine and placental rupture, cervical lacerations, and amniotic fluid embolus.
Uterine overstimulation can usually be managed quite effectively. But you have to identify the problem and remove Pitocin if you believe it may be causing the problem.
Uteroplacental perfusion is a decreased flow of fluid to and from the placenta. Like placental abruption any compromise in the integrity of the placenta's connection to the child can cause a risk of harm.
Increasing the strength, frequency, and duration of the mother contractions with Pitocin can impede uterine blood flow. This complication certainly does not necessarily mean that Pitocin should never have been given in the first place. But when you see tachycardia, bradycardia, decelerations or other nonreassuring fetal heart rate changes, you have to reconsider whether Pitocin is doing more harm to the child than good.
Placenta profusion can also cause arterial hardening. The result can be hypertension that causes pre-eclampsia which can cause serious injury or death to the baby and the mother.
Placental abruption is when the placenta separates from the wall of the uterus before childbirth. This can deprive the baby of food and oxygen.
If your child has suffered a birth injury as the result of excessive Pitocin or other mistakes during childbirth, our firm has the experience and resources to help you both get the compensation you deserve. We are based in Maryland and most of our cases are here. But we handle serious injury and death cases all over the country.
Call Miller & Zois today and speak to a birth injury medical malpractice attorney at 800-553-8082 or get an online case evaluation.More Malpractice Claim Information
- What to expect in birth injury cases in Maryland?
- Cephalopelvic disproportion misdiagnosis cases often involve the use of Pitocin which is counterindicated
- Uterine rupture malpractice claims that include some settlements and verdicts in Maryland involving the use of Pitocin
- Caput succedaneum malpractice cases