E114: Pitocin 101

Pitocin gets talked about like a simple switch that “makes contractions stronger,” but the real story is more human and more nuanced. We unpack what Pitocin actually is (synthetic oxytocin), why it’s used so often in hospitals, and how its steady IV delivery can create a very different labor experience than the pulsed, feedback-driven oxytocin your brain releases during physiologic birth.

We walk through the three most common moments Pitocin shows up: induction when labor hasn’t started, augmentation when labor stalls, and postpartum care to prevent or treat bleeding. From there, we get specific about what changes when Pitocin enters the picture: why it doesn’t cross the blood-brain barrier in the same way, why that can mean less emotional “warm and safe” support from your own hormones, and why some people feel contractions ramp up faster or hit harder. We also cover how Pitocin is typically titrated, what “dose-dependent” really means, why sensitivity varies so much person to person, and what continuous fetal monitoring is looking for when contractions become longer, stronger, and closer together.

Most importantly, we focus on what you can do with this information. We share practical language for asking about a low starting dose and a slower increase schedule, plus comfort tools that can help bring endorphins and natural oxytocin back into the room: privacy, calm, touch, water, position changes, and steady support from your partner and doula. If you want to feel more prepared, less rattled by interventions, and more empowered in decision-making, this conversation is for you. Subscribe, share with a pregnant friend, and leave a review with the question you want answered next.

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Show Credits

Host: Angie Rosier 
Music: Michael Hicks 
Photographer: Toni Walker
Episode Artwork: Nick Greenwood 
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Transcript

SPEAKER_01 0:10

Welcome to the Ordinary Doula Podcast with Andy Roger, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

What Pitocin Is Used For

Natural Oxytocin And The Ferguson Reflex

Why Pitocin Feels Different

Dosing And How Providers Increase It

Comfort Tools To Add Endorphins

Monitoring Risks And When It Helps

A Real Birth Story And Tradeoffs

Key Takeaways And Closing Message

SPEAKER_00 0:51

Spend a little time. Maybe you're a birth junkie, maybe you're expecting your first, your sixth. Maybe I don't know. I don't know why people listen to this, but I'm glad you do. Thanks for being here. Today I want to talk about a topic that's really common during childbirth, and that is the use of pitocin and the mechanism of pitocin. So Pitocin, you may have heard about, is very, very commonly used in our modern birth practices. It's an intervention, right? You've probably heard that it like starts labor or gets contractions, what we call longer, stronger, closer together. It's funny, fun little, I have a friend who used to do a chant longer, stronger, closer together to get to active labor, right? So um yeah, Pitocin kind of gets people into longer, stronger, closer together contractions, which is the gold standard of progress during labor. But I want to talk about how it interacts in the body, how it's different from what the body might be doing on its own anyway. So this is not pro-pitocin or antipitocin. I've seen um tons, tons of clients, uh, dozens, dozens, dozens, dozens have um unmedicated labors with pitocin use at some point, right? Um, I've seen people not use any Pitocin at all, of course. So it's it's quite pretty common. I call it my little fun phrase for Pitocin is it's like candy on Halloween in the hospital. They kind of hand it out to everybody. It's a very commonly used medication. Um, some people are wary of it. A lot of the clients I work with are like, oh, I don't want Pitocin. Um I hear contractions are worse with Pitocin. We're going to kind of talk about that and get a little understanding. So you can make um good decisions throughout the process because there are ways to use it judiciously and still keep integrity to your goals and stuff. So, what is pitocin? Pitocin is a lab created, it's a synthetic version of oxytocin, which is a hormone, right? Pitocin is um, you'll see a bag of pitocin, it's about 300 cc's of saline and about 30 to 40 of the well, 30 to 40 cc's of pitocin itself. So it's quite diluted actually when it's administered. Um, it is given through an IV, um, which obviously goes into the arm usually. This can be used to several ways actually to induce labor, which means to just start it, right? Not contracting, we want to start contractions. It is also used to augment labor. So that means we are in contractions, we just want to get them longer, stronger, closer together. If we're stalled out for some reason or contractions are spacing or they're not very strong, um, it might augment labor. And then it's also used afterwards. A lot of people, I think, don't realize this, but it's used afterwards in pretty large amounts, relatively speaking, um, to help prevent and treat postpartum bleeding. So afterwards, people, whether they know it or not, are given quite a lot of pitocin, usually two bags of pitocin. So you're getting anywhere from 60 to 80 um milliunits of pitocin afterwards, where you it they use it quite slowly before and quickly after labor or after birth. So um some things that are different between oxytocin and pitocin that I like people to understand is it's the same type of hormone. It has a very similar effect, and most women's bodies are incredibly responsive to pitocin. Um pitocin has what we call a short half-life, which means it reacts very quickly and it like starts reacting quickly and it stops reacting quickly. So we're gonna see an effect when we start using it fairly soon. And when we turn it off, we're also gonna see that effect go away. Um but it has a very different delivery system, obviously, right? Um, so natural oxytocin, which is the hormone that it's uh we call it the love hormone, right? It's a hormone that's released during orgasm and intercourse and during breastfeeding, and just when you're feeling warm and fuzzy, like it's a happy hormone. Um, and this is released in the brain, right? So in the hypothalamus, um, releases this hormone and it puts it by um into the pituitary gland, and the pituitary gland releases it in pulses. So it's not a constant, steady stream, but it releases it in pulses. Um, it kind of works as a feedback loop. So when the body's feeling good, the you know, not even just the body, like the emotions as well. When you're in a comfortable, um safe space and just again feeling nice and cozy. I don't know, whatever that means to you. Maybe you've got a cup of tea and a Hallmark movie playing in your fuzzy socks are on, or maybe it's a beautiful sunshiny spring day. You can smell flowers outside and hear birds chirping. That, you know, everyone has their own different make me happy scenarios, as well as those in our life that we feel close to and love. This comes from lots of different sources, things that bring joy. You're not gonna feel a lot of oxytocin uh on a regular basis during like something stressful or um, you know, a fight or flight situation, which sometimes labor is. And so we have this interesting balancing hormone there. But when it comes from our own brain, it's kind of pushed out impulses as needed by the body, right? Um, it's called the Ferguson reflex. So um, and things that set this off during labor, right? The labor process again cannot, it's not super um cozy in and of itself. Um, but the labor process of birthing a baby puts off these the fergicasin reflex, which pushes pitocin out of the patriarchy gland in little pulses. Um, so it's not constant and steady. So one of these things could be the baby's head pushing pressure on the cervix. That's gonna pop out oxytocin, right? Um, the brain's gonna release oxytocin, which increases contractions, and the baby's head is pressing on the cervix, which increases contractions. So that more pressure is more oxytocin. It's kind of this feedback loop, right? Um, and what's kind of cool about that is oxytocin is often tied to, even during labor, safety, privacy, an emotional state that is positive. So that's all kind of cool, and it's really neat how it works in our bodies. Now, pitocin works a little bit differently. Um this is a continuous intravenous drip, right? So not even a drip, just a flow. So it's a continuous versus pulsatile or pulsating, right? When it's just pushing out in in uh as needed and as prompted by the body. So pitocin is dev delivered in a steady drip. Um, it's not also not responsive to the body feedback. We get we miss that Ferguson um reflex where we have that feedback where it should it, you know, pressure means more pitocin, which like that positive pressure or that positive cycle in our bodies. So it doesn't react the same way in real time anyway, but we can keep it pretty steady for good or bad. Um, it does not cross the blood or the brain in the same way. Sorry, it doesn't cross the brain in the same way, which we call the blood brain barrier. Um, so it doesn't affect the emotions, it just affects the uterus, the muscle of the uterus to make it contract. So we don't create that same emotional response that is related to safety, privacy, a positive emotional state. Like you, like we said, your Hallmark moving, your fuzzy sucks. Like we're not gonna get that kind of a buy-in when we're getting from the brain when we're getting um pitocin in a drip. So the endorphins, and if endorphins are a chemical in your brain that kind of takes pain down, honestly. Like um if you, you know, exercise or go running or something, you're gonna have these fun, happy chemicals in your brain rushing around that make that easier to do, and they can last in your brain for quite a while. When your body is getting oxytocin, the endorphin response is matching what the uterus is accomplishing. Um, but we don't get that same brain response from oxygen or sorry, from pitocin, synthetic oxytocin, which is pitocin. So that is sometimes what's challenging because our brain is like, oh, I'm not filling warm fuzzy socks here. Um, I'm like just have a really contracting uterus, is what I have from from uh pitocin. So contraction patterns. If we were to, I don't know, if we had some way to compare, if we could, it's hard to compare situations, but if we could have a woman in labor without Pitocin, but just with the use of oxytocin from her own body, and then her twin sister next to her, I don't know, her her exact same self having um pitocin contractions, those might look a little different on the monitor. They might, they're definitely gonna probably feel a little bit different inside the person's head, um, but closer, you know, stronger, longer, closer together is what we're going for with pitocin. And often the body will get there as well. Um, but sometimes there are times that we do need um to prompt things along and get them stronger, longer, closer together. So this is dose-dependent. Um, pitocin is often what we call titrated or really um cautiously um used uh in a really careful, accurate manner. Um, it's increased gradually. Like we don't blast people with pitocin. We're not gonna start it at like 20 milliunits or anything. It's usually started very low at two millionits, four millionits, and it's dose-dependent. It's increased gradually. And so kind of the whole point of it is getting um people into this active labor pattern, which means contractions are closer, um, stronger, closer, longer, stronger, closer together is that fun chant. Longer, stronger, closer together. Um, and more Pitocin does usually mean more uterine stimulation. Now, some people are really sensitive to Pitocin and at two, three, four milliunits might be having a fabulously strong contraction pattern, where other people, it gets upwards of 15, 16, 20 before they start feeling anything going on. There's no right or wrong, it's just how your body responds. Um, 20 is kind of the max they'll go to without a really good assessment from a provider to see if they could or should um go higher than that. I have seen it go up to 30 and 40 several times, but that is pretty rare. Um, and that assessment is it gonna include using an IUPC to determine the strength, the actual strength of the uterine contractions to see if it's safe to go stronger. Um and it does require, you know, breaking the bag of waters to do that. So um it can go quite high, but most people don't need that. Um, so how this feels in labor, this is what I often hear people are worried about. They're like, oh, I don't want contractions to be harder. Like, don't, you know, I don't want to bring on any more. Um, so I kind of want you to connect physiology to experience, right? So contractions may with Pitocin feel more intense, they may build up more quickly, like they just like would just zero to 60, 0 to 100, maybe in very quickly. So usually a contraction is this nice wave-looking thing, right? It goes up gradually, it peaks, and it comes down gradually. Sometimes with Pitocin, we jump to that peak a little bit higher, but not always, for sure, not always. Um, so the laboring person may fatigue more quickly. Um, they may request some kind of pain relief or analgesic or something where they didn't want to, or may request it sooner. However, um, there are a lot of other things we can do to create comfort around Pitocin, right? So if Pitocin is needed in whatever situation, um, we can create some endorphin use in other ways, right? So that could be being in that safe place, being comfortable, being feeling private, feeling supported, adding comfort tools to that. Maybe that's caressing the back. Um, and we can release oxytocin from the brain and um the endorphins that follow it with other ways. So maybe that's being in the water or in the shower. Um, maybe that's um having some time with your partner. I we have many a time with my mentor, she would send people into the bathroom. She's like, go use some oxytocin, go get it going on in the bathroom and uh or whatever, we'd leave the room too. Um, and so I have seen that work really well too. So if we are using, if we feel compelled or in whatever situation have to use Pitocin, which is quite common, we can also call upon those endorphins in different ways and add more support, more quality coping tools around that so that it is easier to cope with. Now, um, I will say that people can still, like I've seen I've like I said, I've seen it so many times, they still do a totally unmedicated birth with the use of pitocin. Whether it's later during labor, pitocin's used a little bit, sometimes we see it a pushing. If the contractions kind of space out and the mom's super tired, we might use a little boost of pitocin at that point. But you can ask your nurse, talk to your nurse, share what your goals are with her, whether you want a delayed epidural, whether you don't want an epidural, whether you're nervous about pitocin. And so, so often, I don't think I've ever, maybe for a long time anyway, not seen this work where I just request, can we just start it really low, like the lowest possible dose and raise it gradually, right? Um, and see how you respond to it, right? Sometimes a nurse will come in and a lot, actually. We'll start at four, raise it to eight milliunits 30 minutes later, and then 12, 30 minutes later, 16, 20. So we get to the max pretty quickly within a couple, two or three hours. But also very, very easy to request in my experience. Like, can we start at two and raise it really gradually? So maybe we're starting, we're erasing every 45 or 60 minutes and see how the body responds. So that's kind of being more intentional about it and having a nice, easy, gradual buildup to what we want to be longer, stronger, closer to the other contractions. So pitocin is not the end of your desires for sure. Some people I had a I taught a birth class um this week, and one of the moms said, When do we get Pitocin? Um, she was super excited for it. It was like a rite of passage. So I'm like, Well, you might not. Um, but it was it was interesting. I'm like, yeah, it's that common that she's like, all right, when does that start? Um, which may or may not, right? Now, use of Pitocin does come with continual fetal monitoring. A lot of people are getting that anyway in different situations. So we're gonna be continuously checking in and seeing how the baby's doing with this because um we make these, we're making these contractions longer, stronger, closer together. So I want to make sure the baby's doing okay with that. These are it's a synthetic hormone kind of creating contractions that the body might not necessarily be giving or be giving yet. So the contractions might be pretty frequent, they might be pretty strong. Now, if some people have frequent and strong contractions all on their own without Pitocin, right? When your body's giving it to your body, it's safe for the baby, right? Um, but when pitocin's involved, it's kind of an extra little oomp for a little bit of strength that we got to be cautious with. So we taught we really monitor baby's tolerance of that of labor and of uterine activity, because uteruses can get tired from a lot of pitocin, too, because it's just like a we the pitocin doesn't let the uterus tire out, right? It's just like we we're stimulating it, stimulating it, stimulating it. If it's gonna get tired and wants to take a break, we're just gonna keep stimulating it. So this can, the use of pitocin can lead to more hemorrhaging afterwards. Kind of the way we manage labor during labor can um influence how the uterus behaves after labor. If it's exhausted or tired or done contracting, which we really needed to contract afterwards, um that might be something that we're more cognizant of if we're using pitocin. So this happens not because pitocin is bad, but because it works, right? Because it's it can be a powerful tool in cases where it's needed. So we got to kind of watch the consequence of using that tool. So bringing all things into balance when Pitocin is helpful sometimes. There are some cases where I'm like, let's please get some pitocin started. Um, and some of my clients are resistant, totally get it. I would be too. If I was having a baby, I'd say no, thank you. Um, but in some cases, as time, time, time, time goes on, the hours are ticking by and we're not doing a whole lot. Um, and and we finally say agree to a tiny bit of pitocin, maybe we get it up to four milliunits, and then boom, we have this beautiful contraction pattern that's making progress. Um, we like to do that strategically before people get too wiped out, right? Sometimes, you know, we can use pitocin in post-date pregnancies to help labor to begin if we need it. Let's say the water's been released and then we're not having labor contractions. We can kind of prompt them with, again, negotiate a low dose, slow and slow and slow to get contractions going. Maybe labor has slowed down or stalled out at a certain point. It can be a good tool to kind of bring it back into focus. Um, and then, like I said, most people are going to get two bags of Pitocin afterwards to prevent postpartum hemorrhaging. I was at a birth this week that was perfect and beautiful. It was a V back. Um, this mom had a cesarean for a breach uh a few years ago and wanted to go and medicated then, but was not able to because the baby was breached. And this time um had a beautiful, she looked like so peaceful, it was wild all through labor. Um, pushed her baby out. It was a short labor, very minimal bleeding. I think it was 200 cc's. And her doctor said, Okay, can we start Pitocin? And she said, actually, can we wait a little bit and see how things are going? The doctor gave her the information. She said it does prevent postpartum hemorrhaging, but yeah, let's see in your case that you look like a good candidate not to use it. Um, and so we didn't use it. They were obviously checking her fundus, making sure it was firm and nice and centered. And um, she did not get use of pitocin, but of course she was offered it um for the afterwards. So there are some trade-offs, there's some things to consider. Um, I just like people to know that um it's a tool, it's one of many, many tools that can be available. Um, and we can use that tool a tiny, tiny little bit, can make a difference sometimes. There is, we know, this is the trade-off, there's a little bit less of a physiologic feedback loop, but we can make up for that with using other comfort measures and coping mechanisms. Um, it may increase intensity, but it may help labor to move along and to get done so we're not exhausted, right? Um, sometimes we have people are worried about a cascade of interventions coming after that, and it may cause stronger contractions than the baby likes, right? Um, or then the uterus likes, or then the mom who's experiencing it like so that might lead to um pain relief, um, which you know is a tool that is in that is available anyway. Um, but I just wanted folks to stay grounded if the if the use of pitocin is approached. Um doulas can obviously support you during this, your partner, other family members can, and you can just kind of go into this in a really practical sense and still be empowered with education information and then continued tools that you're gonna use, right? So continued position changes, continued and increased use of breathing and relaxation tools, um, rest and support for rest between contractions, maintaining a calm environment, um, getting endorphins in other ways, whether that's through massage, um, efflorage, scents, the tub, a shower, whatever that might be. So you can still have a very supported, connected birth unmedicated if you desire, in lots of cases, with the use of Pitocin. Um, and I, you know, I jokingly do. I call it candy on Halloween. It's not my favorite, how much we use it because it takes away um I as a doula. I mean, I just this is where my head is. Like physiologic birth generally works. Um, and we like to, just because we can, we do it. So we will interrupt it quite frequently. Sometimes it's super great, you know, we're really grateful for interventions. Sometimes we're like, uh, maybe we don't have to do that just habitually, right? Um, so kind of to wrap things up, pitocin isn't all about just being fearful of stronger contractions, right? It is a different hormonal experience in your mind. Um, so like people to be prepared and ask the questions. Um, ask for a little bit of wiggle room on the dose and the speed of of increase, um, so you can feel more grounded and more involved in your choices, right? Um, so I always encourage encourage people to be curious about things. Like don't be scared of it right away, um, but kind of just be curious and learn. Ask the questions so that you can learn and kind of know what all of your options are. Like I said, I've seen so many people have really great um unmedicated labors with Pitocin. Not the end of the world. And who doesn't like candy on Halloween, I guess? Um, so hopefully that helps you get a little bit of understanding of why and how Pitocin's different than when we don't use Pitocin and how we can make up for that in a couple of different ways by asking for a low, slow dose and creating endorphins, that chemical feedback loop um that will create kind of chemical coping mechanisms naturally in your body by doing other things. So that's my little take on Pitocin. It's a great tool in some cases. Is it overused? Absolutely. Um, but are we grateful for it? Yeah, in a lot of cases we are. Hopefully that helps you a little bit as you plan for, prepare for bare birth and labor. I wish you the very best. I hope everyone um I just love it when people have a good positive birth experience. That's so important to me. So I hope that you do. And as we wrap up tonight, um, I just want to encourage you to reach out to someone, make a human connection with someone. That is so important. We need each other. So please reach out to someone and let them know they're important to you. Hope you have a great day, and we'll see you next time here on the Ordinary Doula Podcast.

SPEAKER_01 23:28

Episode credits will be in the show notes. Tune in next time as we continue to explore the many aspects of giving birth.