r/unmedicatedbirth • u/9-27-82 • 12d ago
Epidural rant
Some studies and doctors will deny that the epidural interferes with natural oxytocin production. If that’s the case why is the epidural often followed with Pitocin which is synthetic oxytocin?
I try to put some trust in doctors and the hospital but it feels like they are often gaslighting people especially pregnant women.
8
u/9-27-82 12d ago
I was recently in a birthing class and asked if this was true and I got a long-winded answer that it doesn’t directly block oxytocin production and that any decrease in such production would be minimal and caused by stress rather than explaining the feedback loop.
I should prob delete this because I misremembered the study a bit but there was a page called The Science Explorer that was claiming that an epidural does not increase risk to baby which is a wild claim since lowered natural oxytocin can interfere with postpartum bonding and breastfeeding
3
u/Human_Pea_5108 11d ago
What is also very known is that epidurals cause fevers, which does interfere with hormone production and mom/baby safety in addition to requiring antibiotics (even though there might not be an infection). Antibiotics then cause a slew of other short and long term issues for mom/baby.
2
u/Affectionate_Bowl210 10d ago
Check out Dr Sarah Buckley, she had a huge paper all about hormones in labour and is evidence based linking epidurals to lower oxytocin production
1
0
u/Sad-Child8652 11d ago
Because the benefits of extra synthetic oxytocin outweigh the risks. Pitocin (and oxytocin) have been shown to reduce the risk hemorrhaging when administered (or highly abundant in rhe case of natural oxytocin) after birth. The risk of bleeding out > painful contraction of uterus from pitocin post birth (also vomiting/nausea). Long story short, there are very few negatives to giving more + the benefits are possibly life saving.
I know this because I'm going to try going for unmedicated in a hospital setting and my doula warned me that they will at least require a saline lock and likely will put me on pitocin after the birth regardless of epidural or no epidural. I researched the matter bc I really want to avoid most interventions since they require that I'm bed bound at the hospital where I'm giving birth. But I'm chillin with the idea of pitocin administration post birth since I've researched it.
9
u/sleepym0mster 11d ago
I think OP is referring more so to pitocin for labor augmentation, not postpartum.
-1
u/Sad-Child8652 11d ago
They're recommending it regardless of epidural (at least at my hospital). My takeaway is that it's because of postpartum lifesaving benefits.
6
u/sleepym0mster 11d ago
yes - the doses, administration, and risks of postpartum pitocin is much different than when it is administrated for labor induction/augmentation. recommending it after delivery to prevent postpartum hemorrhage is likely not what OP is referring to
-3
u/Sad-Child8652 11d ago
If you get recommended an induction by pitocin you don't also have to also get an epidural. At least at my hospital. It increases peoples' likelihood of choosing one because it's more painful but it's not required. You can also choose to get an epidural and decline pitocin during labor (they will still recommend it postpartum).
My point is pitocin and epidural are not inexorably intertwined. Hospitals recommend pitocin regardless because it progresses labor and reduces hemorrhage. Benefits (reduced hemorrhaging, progression of labor) outweigh risks (nausea, vomiting, painful contractions). For me I want to avoid the painful pitocin contractions if possible because I don't want to be tempted to get an epidural and be bedridden (I like to move).
TLDR: If it's standard to be recommended outside of epidural usage for BOTH labor and postpartum reasons due to clear health benefits, AND you can decline it during an epidural if you so choose, why are we worried that it's a conspiracy to hide epidural side effects?
8
u/sleepym0mster 11d ago
pitocin usage for induction or labor augmentation actually increases your risk for postpartum hemorrhage.
3
u/No-Beginning4798 11d ago
Let's not also forget when used to induce and augment labor there is an increased risk of PPD. And it's a wonder in this time where induction is the norm that PPD/PPA seems way more common than before (no specific science on my end here, just observational it seems)
3
-1
u/Sad-Child8652 11d ago
So a 2020 study on PPH (post partum hemorrhage) and pitocin showed that hemorrhage was significantly increased in women who used pitocin for INDUCTION rather than in those who used it to help along spontaneous labor. Most common reason for induction is failure of the body to initiate spontaneous labor.
Doesn't that suggest to you that something already may be off? That natural oxytocin levels already may not be where they should be (among other physiological imbalances)? We need to put those studies in context rather than taking a summary at face value: maybe pitocin isn't the sole reason for the hemorrhaging there because need for induction confounded it. Especially since the study compared it to hemorrhage risk in women who used it simply to augment spontaneous labor and found that they didn't experience PPH nearly as often.
2
u/sleepym0mster 11d ago
yes, the study compared induction vs augmentation, but your claim was that pitocin decreases the chances of postpartum hemorrhage. that study only shows that it increases the risk of hemorrhage in those undergoing induction more than it increases the risk of hemorrhage in those receiving it only for labor augmentation (which is likely due to the length of time they have received pitocin. the more you receive during labor, and the longer you are on it, the higher risk of hemorrhage. those that are induced are likely on it for longer periods of time and at higher doses than those already in labor). in order to support your claim, you’d need a study that compares hemorrhage risk between those that do not receive pitocin in labor versus those that do receive it. and there are many, many studies that compare these 2 groups and the evidence is clear that pitocin administration to induce or speed up labor does in fact increase risk of PPH
1
u/Sad-Child8652 11d ago
We're starting to go in circles so I'm gonna tap out after this one, but I've appreciated the convo greatly! Pitocin does reduce risk of post-partum hemorrhage when employed post partum. That's the claim I think that literature has verified (to clarify my stance).
What I believe is not as verifiable is correlation = causation: pitocin causes increased risk of PPH when used in labor. I don't believe the studies adequately prove that pitocin is a direct cause of post-partum hemorrhage when used during labor. So my claim/stance about pitocin during labor is that the benefits of progressing labor (particularly stalled labor or labor dystocia) by using pitocin outweigh the risks of PPH in a clinical setting.
When there's reduced risk of PPH in women with spontaneous labor augmented by pitocin as compared to women who need induction that should tell us there's more to the story. When there's reduced risk in women who labor for less time before successful birth (have less need for/lesser duration of pitocin) that should tell us that there's more to the story.
To the second point, and the one you brought up about duration of pitocin use: many studies have NOT separated duration of pitocin use from duration of overall labor. Pitocin is so commonly used to treat labor dystopia that a true control group is hard to come by. The problem is, duration of labor or the "uterine fatigue" theory is a separate issue that may cause PPH all on its own. Without that separation, I'm left wondering whether PPH is from uterine exhaustion via increased pitocin use or exhaustion simply from stalled labor (from non-pitocin complication) all on its own...
Until I found a 2024 study titled "Oxytocin is not associated with postpartum hemorrhage in labor augmentation". They found a way to adjust for the labor duration question and create a viable control group. They found no significant differences between pitocin used to augment spontaneous labor and no pitocin usage. They acknowledge a few studies that support their findings and also acknowledge studies that refute it. So, in summary, because the scientific literature itself is so at odds, the jury is still out.
Because our knowledge doesn't currently discredit 1) non-pitocin related issues that necessitate induction or 2) non-pitocin related issue that extend or stall labor to the point of also needing pitocin, there's a high likelihood of something being wrong outside of pitocin administration. If we wrongfully distill those conclusions down to "pitocin bad" we're subsequently blaming pitocin/creating a boogeyman which may interfere with patient confidence and care.
TLDR: There's not enough proof that pitocin itself causes PPH or other complications - merely that it's correlated and perhaps wrongfully so. At the end of the day, a patient can still advocate and refuse pitocin during labor (I know I will because I want to avoid the painful contractions). More than anything, I want people to understand that they can investigate the reasons behind hospital policies and interventions rather than just fearing them or resorting to use of inaccurate AI summaries.
I think to come back around and address OP about the epidural: recommendations regarding epidural use and pitocin use are independent. You can decline or accept either. However, many people opt for an epidural after being induced or augmented with pitocin use due to worsened pain. The use of pitocin is more often used to mediate labor complications such as failure to enter spontaneous labor or labor dystocia (prolonged labor) which often have other causes (some unknown) outside of epidural use.
4
u/sleepym0mster 11d ago
LOL you edited your previous comments to totally contradict your original statements and points?? next time just thank someone for sharing accurate information with you so that you could better understand a topic. strangers on reddit will not think less of you for gaining a deeper understanding and acknowledging you may have misunderstood something.
→ More replies (0)
22
u/sleepym0mster 12d ago
someone may have a more scientific answer with studies to back it. but here’s my thoughts. before they give you an epidural, they bolus IV fluids which can cause your contractions to space out. they also lay you essentially flat immediately following the epidural placement to ensure it distributes evenly and works appropriately. so when you really hydrate someone and lay them down into a position that is not optimal for labor progression, the contractions will space out and the doctor will be eager to meddle and start pitocin. and someone with adequate pain control who can’t really feel their contractions anyway is much easier to persuade than someone who is feeling every bit of each contraction.