Synthetic IV oxytocin infusion during childbirth – commonly referred to as Pitocin or just Pit  – is one of the most common obstetric interventions. In this post we'll take a look at what oxytocin hormone is and what its role is during birth and what crucial differences are between synthetic oxytocin and the one your body produces. You will also understand  why Pitocin is used so frequently and what its benefits and risks are. In short, we'll summarize everything you should know about Pitocin as your prepare for giving birth! 

First, let's understand oxytocin hormone. It's often called the "love hormone" because it surges when we're in love, hug, or have intimate skin contact. During labor, oxytocin triggers rhythmic uterine contractions that restructure the uterus and open up the cervix. Now, there's a myth that activities like sex or belly rubbing could induce premature labor due to oxytocin, but don't worry, it's just an urban legend without any foundation. While that is true that oxytocin levels do increase slightly during sex, but as long as the uterus is not ready for labor, the elevated oxytocin levels cannot trigger contractions. And why is that? Nature has a very good solution! As long as your body is not yet ready, there are no sufficient receptors on your uterus to catch enough of those oxytocin molecules to trigger contractions!

So, oxytocin is a hormone It's produced by the pituitary gland deep in our brain. As labor progresses, more and more oxytocin is released leading to more frequent, longer, and stronger contractions. The pain feedback and the high oxytocin level eventually trigger the release of an other hormone called endorphin! Endorphins act as natural painkillers, alleviate pain, and lull laboring women into a kind of labor la-la-land, when birthing mothers are turning inwards, close their eyes and behave almost as if drugged…

Now, what about Pitocin? Pitocin is just the synthetic version of oxytocin. Chemically it is 100% identical to natural oxytocin and of course Pitocin also triggers the contraction of the uterus. Therefore, Pitocin is typically used as part of the labor induction protocol or to strengthen contractions, to boost labor. However there are very important differences between the way how natural oxytocin and how Pitocin behaves and as an expectant parent it is really important to know these differences – especially if you aim for an unmedicated, natural birth!

The biggest difference between Pitocin and the oxytocin what your body produces is that Pitocin is directly injected into your blood stream and cannot reach your brain, because of a protective mechanism called the blood -brain barrier. You can think of the blood-brain barrier as a one-way gate…it just blocks certain molecules from entering the brain to protect it from possible harm, so oxytocin molecules cannot pass through this gate towards the brain! Natural oxytocin, on the other hand, is produced right in the brain, where it triggers endorphin production. And since IV Pitocin does not reach the brain, it does not trigger the same endorphin reaction! Therefore, labor with Pitocin is typically more painful…

It is also important to know, that if Pitocin is administered for too long and in too high amounts, uterine receptors may become saturated and become insensitive to the high oxytocin levels and then contractions simply stop! Think of it somewhat like this: you might enjoy eating one or two slices of cake, but if you suddenly have to eat an entire tray of it, you might start feeling nauseous and completely fed up with the otherwise delicious cake! So, after a while – if the uterus is bombarded with too much oxytocin molecules for too long – the uterus also becomes "fed up," contractions stop, Pitocin augmentation does not help anymore and such situations typically end in the operating theater...

What's the third important difference between Pitocin and natural oxytocin? During labor, your pituitary gland releases increasing amounts of oxytocin, so contractions become stronger, longer and closer together. And this progressing process helps you get used to contractions, to tune in physically and mentally, and to develop your own individual strategy for coping with contractions. With intravenous Pitocin, there is hardly any evolution, but  the process jumpstart. Depending on the dose, contractions may become all of a sudden strong, frequent and quite long and it might be very challenging to cope with them.

An other point to consider about Pitocin is that these suddenly intense contractions might be difficult also for your baby to cope with! The baby may respond to Pitocin augmentation with non reassuring heart rate which may require further interventions, potentially even immediate surgical birth! An other risk which is not to be underestimated when it comes to Pitocin is that the effects of Pitocin must be monitored to avoid overstimulation of the uterus and potential harm to the baby. So, both the baby's reactions and the uterine contractions must be closely monitored when labor is augmented with Pitocin, and that is why a continuous electric fetal monitoring is essential. However, continuous monitoring typically requires lying in bed, and lying in bed generally makes contractions even more painful...

But there are typical cases when Pitocin becomes necessary. Very often Pitocin is used as part of the labor induction protocol. Once the cervix is ripe (or has been ripened at first place in the process) and once the membranes are ruptured and if contractions do not start and do not progress within a given time frame, typically the next step in the induction protocol is Pitocin to trigger contractions. However it is good to remember that Pitocin is hardly ever the first resolution to induce labor! Pitocin is also very common with epidurals, especially if epidural anesthesia is placed for a longer period. Often because of the elimination of the pain sensation, the pituitary gland just stops releasing increasing amounts of oxytocin and that is why contractions often slow down or even stop with an epidural. In such cases the typical intervention is Pitocin augmentation to trigger uterine contractions again.

So far, we've been talking about Pitocin augmentation in labor, but synthetic oxytocin is often used to support the birth of the placenta too. This is so common that in many hospitals in the US, it's part of the protocol even if the birth itself was completely natural and unmedicated. However in other countries Pitocin during the third stage is only used if there is a concern about blood loss. And in such cases a single oxytocin injection is given into the muscle immediately after the baby's birth to prevent post partum hemorrhage. That single shot triggers immediate uterine contractions and speeds up the delivery of the placenta. However, in such cases, it's typically just one single shot and although the contractions will likely be quite intense, in certain situations, it can save mothers lives!