Pitocin a Danger in Twin Deliveries?

***Please don't read if you're scared about labor or sensitive about these topics. Sometimes its better not to get your mind going (like mine is now!)***

My dad is a respected OBGYN in my home state, and I do trust his medical judgment above just about anyone else's. However, he's been careful during my pregnancy to remain "dad" and to let my doctor make all the decisions (I'm living several states away from him anyway) and to refrain from comment other than agreement with her decisions and those of my MFM. Up until now...

Yesterday he just couldn't hold back, and he got me kind of worried. I told him that my doctor would induce me at 37 or 38 weeks (babies are vertex), and he was like "induce, or C-Section?" Then he went on to tell me that he thinks that the standard of care today is to offer a choice of cesarean whenever induction is indicated due to a multiple gestation. He said that when your uterus is very stretched and distended (and mine may be moreso than many, I have bigger than average babies and polyhydramnios/high water and am HUGE, and my uterine wall is very thin), pitocin can cause cramps that are so powerful that they can be dangerous. In short, he is worried that if I'm induced with pitocin, it could rupture my uterus.

To be clear: He is not against vaginal delivery of twins, just vaginal delivery of twins with pitcocin.

Now in full disclosure, I have a good friend who delivered triplets vaginally and her uterus ruptured from the stress that was put on it from carrying/delivering 3 (and I am bigger than she was!)...and well, the end result was very bad. I suspect that this experience also colors my father's view and his fears about what is happening with his own kid (me). However, it also makes me terrified that if I don't heed his advice, the same could happen to me.

So I wondered if anyone else has heard this from her OB/MFM? Are many people induced with Pitocin? How common is a ruptured uterus really?

I'm going to talk to my OB about this on Tuesday, if mother nature doesn't do her job on her own before then. But I wanted to go in armed with more than just "my dad says" because I know that will be annoying!

Thanks ladies!

 

I haven't heard of it, but I can imagine, because I was given it with my son after 3 day of 8 minute contractions and no progress. The result had me doubled over and unable to breath.... with the strongest longest contractions with only seconds between. I though my stomach was going to turn into a giant charlie horse, that did it for me, I never want to have "pit" again it did not agree with my body! I fear them putting me on it this time.

 

Wow this is interesting! I haven't heard this before, but then again I haven't looked too far into it. I'm torn between which type of delivery I want to try. I'm 4'11 and all of my doctors (military doctors; so you never get the same one every visit) believe I would be lucky to make it to 34 weeks, however they won't induce me or schedule me for a c-section before week 38. I initially was going to just go with a c-section until I found out that this military hospital will cut your horizontally if it's a scheduled c-section, but if it's an "emergency" c-section they will cut you vertically. Therefore, if I didn't make it to my 38 week scheduled c-section I would be cut vertically any time before that. So that made me go back to wanting to attempt vaginal if it was possible at the time (to avoid a vertical cut if I did have to go early), but now hearing that it may potentially cause problems such as you mentioned, it's yet another thing to think about!

I'm almost 26 weeks and I still can't make up my mind, but thanks for the information because it gives me yet another thing to think about. Let me know if you find out anymore information on this!

 

I found this ... http://www.drspock.com/article/0,1510,5926,00.html.

I was induced with Pitocin, although they had to turn it off since my body took over (I was already 4 1/2 cm when I arrived without going into labor), especially after breaking my water (at 5 1/2 cm).

There were no other risk factors, my babies measured large and were born close to 8lbs a piece, so in that sense I would have been higher risk to uterine rupture.

Me, my uterus and my babies are fine. I would talk to your doctor about it and explain your (and your father's concerns and why you have them).

 

I found this ... http://www.drspock.com/article/0,1510,5926,00.html.

I was induced with Pitocin, although they had to turn it off since my body took over (I was already 4 1/2 cm when I arrived without going into labor), especially after breaking my water (at 5 1/2 cm).

There were no other risk factors, my babies measured large and were born close to 8lbs a piece, so in that sense I would have been higher risk to uterine rupture.

Me, my uterus and my babies are fine. I would talk to your doctor about it and explain your (and your father's concerns and why you have them).

 

A lot of what I have read seems to indicate that there is a HIGH chance of uterine rupture, if you are trying for a VBAC or have had repeat C sections. It is even HIGHER if you have had those + are induced with pitocin.
I could not find any statistics of uterine rupture without those prior things.
I do know I HATE pitocin and am going to try my hardest to resist them at the hospital until the last possible chance. I had the most intense contractions with my daughter. They literally forgot to check on me for like three hours (due to an emergency c section they were handling) and my contractions were like every minute and hurt like HE#$!! I was in tears while trying to breathe.

Molly
36 weeks 2 days

 

the problem with pitocin is that dosing it is more art than science - they have no way of telling in advance how any given woman will react to it. that's why they usually start with a low dose & then gradually increase till the contractions are at a good even rhythm. however, someone women end up with intense contractions coming one on top of the other even with the lowest dose of pitocin - you just never know. those kinds of contractions are also very hard on the baby(ies) because they have no chance to recover between contractions, which can lead to fetal distress, which can lead to an emergency c-section.

i definitely think your best bet is to talk to your OB about your concerns & ask for some hard numbers, and then, trust your gut. GL!

 

I realize this is totally off your topic - but we're expecting 3 and were told from our OBGYN that vaginal delivery is not an option, so I'm surprised that your friend delivered that way.

Maybe this post is better suited in a thread of it's own, but I'm just curious about other people's experiences with 3...?

 

I had pitocin after my water broke. I got up to the maximum dose they wanted to give, but I didn't progress and had a c-section. No ill effects from the pitocin though. If you are induced, pitocin is very common.

And I delivered at an excellent hospital with an excellent doctor.

 

I don't know about pitocin, but I do now my doctor would not induce me with cervadil. I was going on 38 weeks and showing no signs of labor--cervix wasn't ripening, nothing. Given that presentation, they would have had to induce with cervadil, and the doctor said it was contraindicated for multiples. Her argument was that the elevated contractions and the size of my uterus could lead to uterine rupture.

I had a c-section at 38 weeks and a day.

 

That's good to know. They call it oxytocin here (I wonder if it's just terminology and it really is pitocin too). Definitely trust your gut and your dad and talk to your OB about it. I would be interested to hear what their response to you is.

 

My understanding is that oxytocin is the hormone that your body NATURALLY releases to stimulate labor. Pitocin is a chemical version of that hormone...

 

Thanks everyone for your responses. At least I know that this is on other people's radar as well. I will definitely talk with my OB and post again afterward. It was just surprising to hear my father advocating so strongly for a cesarean when he is generally of the mindset that they are used way too often in today's medical practice. Made me really stop and think...and thinking has turned into obsession!

HamiltonDad - My understanding from going through what happened to my friend with her triplets is that it is EXTREMELY uncommon to have a vaginal birth with triplets. It was the subject of a huge med malpractice lawsuit, and my friend won. But please don't let my story, however vague, worry you - it was a strange chain of events and very unlikely to reoccur - and you already know your wife will have a C! And if it helps, my friend has 3 very healthy beautiful babies!

Michelle - I think Pitocin is the synthetic form of oxytocin, Oxy being what your body makes naturally to bring on contractions. I've also heard it referred to as both in our hospital.

Thanks everyone!

 

I had to have pitocin. But the amount they were giving to me did not change anything until they placed a monitor inside my uterus to measure the contractions. Once they figured out how much I needed, they turned up the pitocin and things began to move along.

I delivered 2 healthy BIG boys vaginally at 37w 3d. It is VERY rare for your uterus to tear during delivery for twins. Obiously, if you have more than two in there, you should have a c-section!

Good luck with your decision. I know it is difficult but you have to trust your OB. If you second guess him then you need ot find one that you trust. Plus, once your dad starts to question your OB, you may unintentionally offend your OB.

GL,
Jenn

 

Since we are doing a VBAC I've already talked to my high risk OB about all of this but I thought I might share what I was told....

They will NOT induce a twin pregnancy for VBAC or even just a regular vaginal in my practice. They also will NOT allow you to go past 38 weeks b/c the uterus gets to big and there is a larger risk for bleeding and rupture. In my personal case a "natural"(one that is not induced) VBAC gives me a 3% chance of rupture. That is based on my own personal history. I was told induction could more then double that risk but of course we are talking about a VBAC. I'm not sure how much higher your chance fo rupture is for a normal vaginal delivery with twins when your induced.

Personally I am not a fan of pit. I had it with DD and it was HELL! I went 12hrs of natural no pain med labor with pit and there is a huge difference between regular contractions and pit ones. So I am fine with not being induced. I really dont want a repeat c-section but I rather have a c-section then be induced and I am VERY VERY pro-VBAC but I've known women pregnant with one baby who have ruptured with pit. To me the risk of using a drug that can triple the intensity of your contractions is not worth it.

So if I were you I would listen to your father. I'm sure he knows what he's talking about

 

I agree with the others here and discuss it with your OB and MFM. I was induced with Pitocin with both of my pregnancies, a singleton and twins. I had no problems or complications with it, I progressed normally, labored with no meds (we tried to have the epi, but they evidently don't work on me) and was not in any more or less pain than any other laboring woman I'm guessing. I suppose I was very lucky. Uterine rupture is always a risk, even with a normal,singleton delivery with no induction. However, if my Dad was an OB and he was worried about me being induced with pitocin, I would talk with my OB for sure. There are other means of induction without drugs to attempt to get things moving. If you are dialated, they can strip your membranes and see if that helps or they can also break your water if you are close than the babies are doing well. Chances are, as large as you say you are, you will have plenty of uterine irritability once you get close and it won't take much to get things going. But I am no doctor!

Good luck and do let us know what your doctors say.

Kelly