Pitocin Safety

What is Pitocin?

Pitocin is a synthetic version of the natural occurring hormone, Oxytocin. The female body produces its own oxytocin. When released by the pituitary gland, oxytocin causes uterine contractions. When labor starts, oxytocin continues to be released by the pituitary gland and this release of oxytocin drives the labor pattern.

If the body makes its own oxytocin, why would synthetic Pitocin need to be administered?

Synthetic Pitocin is administered for a couple of different reasons:

1. To start or induce labor. If labor has not started on its own, sometimes a physician will decide to use synthetic Pitocin to help the body get labor started.

2. To augment labor. Once labor has started, sometimes physicians will administer synthetic Pitocin to speed things along or to increase the strength of the contractions that are occurring.

Are there risks associated with the use of Pitocin?

Absolutely. In fact, Pitocin is what is known as a high alert medication. This means that Pitocin has an increased risk of causing significant harm if used incorrectly.

What are the risks of Pitocin Use?

Pitocin has several specific risks associated with its use. A couple of these are especially important to understand.

1. Risk of causing contractions that are too strong or intense. This can cause damage to the uterus and even cause it to rupture or tear or the placenta to separate from the uterine wall too soon. These intensely strong contractions can also interfere with the flow of oxygen to the baby. This happens because the umbilical cord, which is the baby’s lifeline and only source of oxygen, gets compressed during contractions. If these contractions are too intense that compression can disrupt the flow of oxygen to the baby

2. Risk of causing contractions that are too close together. If contractions are too close together this means that there is not enough rest time in between contractions. Rest intervals are critical for the health of the baby because this is when the baby gets a chance to recover from the time when the contraction is squeezing and limiting the flow of oxygen to the baby’s brain. If there are inadequate rest intervals, the baby will use up his oxygen reserves and this can result in brain damage to the baby.

If Pitocin is mismanaged during labor, it can cause severe injury to the baby. A certain type of brain injury called hypoxic ischemic encephalopathy (HIE) is typically the result when Pitocin leads to hypoxia during labor. HIE will often lead to a diagnosis of Cerebral Palsy. Studies have shown that between 45% and 71% of HIE malpractice cases involved the excessive, incautious use of Pitocin. It is a dangerous drug and should be administered with extreme caution and care.

What are the Responsibilities of Health Care Providers and Facilities When Administering Pitocin?

Because Pitocin is such a high-risk drug, health care providers must exercise extreme caution and carefully monitor patients who are receiving Pitocin. This means that the hospital, the doctor, and the nurses all have responsibility for ensuring that Pitocin is safely administered for both the baby and the mother.

Responsibility of the Hospital or Healthcare Facility:

The hospital has the responsibility to ensure that their labor and delivery staff, doctors and nurses included, are properly trained. This means that they are competent to interpret fetal heart monitoring strips correctly, know what kinds of interventions to use if the strips look concerning and know when FHR strips are showing signs of a fetus in distress that needs to be delivered emergently with a c-section.

The hospital also has a responsibility to ensure that there are policies and protocols in place which govern the safe administration of Pitocin. Policies and protocols should be written to protect the patients from harm and should follow FDA recommendations, ACOG guidelines and AWOHNN guidelines.

Pitocin protocols need to provide clear instructions to the nursing staff advising them of when the physician should be contacted and how to titrate the Pitocin according to each patient’s individual response to the medication. Protocols should not be written in a way that provides not a cookie cutter approach to dosing of high-risk Pitocin but rather, customizes the dosing to the patient’s individual response to the medication.

Responsibility of the Physician:

Physicians have the responsibility to write orders that properly dose Pitocin according to the individual patient.

They have the responsibility to ensure that there is a valid reason to give Pitocin in the first place. Just wanting to schedule an induction for convenience or to speed labor along without a valid indication or reason is beneath he standard of care.

Pitocin dosing orders need to include very clear language from the physician as to when he/she wants to be called when not physically present during labor.

Safe Pitocin orders should be written to explain that the goal of Pitocin dosing is to achieve an adequate labor pattern and details should be provided as to what constitutes an adequate labor pattern. Once this goal is achieved, the Pitocin orders need to specify that the dose can be lowered or turned off, allowing labor to progress on its own under the drive of the naturally occurring oxytocin.

While their patient is receiving Pitocin, physicians also have a responsibility to respond to any concerns from the labor and delivery nurses. If the nurse is seeing something concerning on the FHR monitor, the physician has a responsibility to personally evaluate the strips and the patient and intervene when needed.

One of the most important responsibilities for the physician while a patient is receiving Pitocin is to be ready and willing to perform an urgent or emergent c-section at any time should the FHR tracing show ominous signs. There are certain things that a FHR strip can show that tell the physician that this baby is in serious trouble and needs delivered now. They have a responsibility to be ready to do that. Industry standard is that there should be 30 minutes or less between the decision to perform a c-section and the incision time.

Responsibility of the Labor and Delivery Nurse:

Because typically the nurses are the ones who spend the most time with the laboring mom, there is a lot of responsibility on them to ensure this high risk medication is delivered safely. Because Pitocin is a high alert medication, nursing staff must do what is called a dual verification before administering the medication. This means that another RN must read the physician order and compare it to the Pitocin being given to make sure that the dose is correct.

One of the most important responsibilities for the Labor and Delivery nurse is to provide constant close monitoring of the FHR strips the entire time the patient is being given Pitocin.

It is the responsibility of the L&D nurse to ensure that the Pitocin is being managed in a way that makes sure the baby is always getting adequate oxygen. The FHR strip is the way the baby can communicate and say “I need help”. The nurse must be well trained to recognize those calls for help and step in BEFORE it is an emergency with proper interventions like turning the Pitocin down or off for a period of time.

The labor nurse must communicate to the physician any of these calls for help she is seeing on the FHR strip. If the physician does not respond appropriately and safely, the nurse has an absolute duty and responsibility to advocate for her patients by utilizing what is known as the chain of command. This means that the nurse goes to the next level after the physician to get help and keeps going up that chain of command until she gets a result that will rescue the baby from harm.

While a high-risk drug, Pitocin can be administered safely but it requires care, attention, and proper training of all involved. The healthcare providers entrusted with the health and safety of both mother and baby owe an absolute duty to their patients to be sure they are always practicing within the standard of care when administering a drug like Pitocin.

If you are a malpractice attorney plaintiff or defense and have a case you believe involves Pitocin we can help you with a complete review of all aspects of the medical records involving Pitocin administration and will ensure that you are aware of all potential standard of care deviations.

If you are a healthcare facility, we can audit your Pitocin policies, procedures and protocols to ensure they are written to protect your staff and facility from litigation. We can assist with the creation and use of a Pitocin Safety Checklist.

Contact Veritas Med-Law to see how we can help