How to Avoid Pit Pain

What is pit pain?

In my residency 40 years ago, the nurses described the pains from induction with Pitocin as pit pain. The nurses used this term to describe contractions which were painful, but not productive of real labor progress.

The contractions from Pitocin are much stronger than those of natural labor and grow to their strongest very sharply. In natural labor, the contractions, if charted, would look more like a bell curve than like a spike. The natural contractions are more effective than Pitocin-induced contractions and much less painful.

What are the three states of labor?

The hallmark of productive labor is a gradual and steady increase in the intensity and duration of contractions. This is the first stage of labor and is called the acceleration phase. The first stage begins when labor starts and ends when the cervix becomes completely dilated. The second stage is the pushing and delivery of the baby and the third stage is the delivery of the placenta. We have often toyed with the idea of the fourth stage of labor, although it has not officially been called the fourth stage. The fourth stage would be to carefully watch the mother after she gives birth to be sure there is no excessive blood loss.

What is Pitocin?

During labor, when your cervix is dilated about 5 cm, your pituitary glad starts producing natural oxytocin. Pitocin is synthetic oxytocin. Unlike natural oxytocin, Pitocin does not cross the blood-brain barrier and does not provide natural pain-relieving endorphins. Although there are doctors who deny that Pitocin pains are stronger or have a greater need for interventions such as epidurals or c-sections, I believe that Pitocin induction is associated with both.

The other problem with Pitocin induction which has never been addressed is safety. We assume that because the monitor graph looks good, that Pitocin induction offers no long-term risk for the baby. The fact is that although efficacy has been proven, safety for the baby has never been questioned and never been investigated.

What is prodromal labor?

Prodromal labor takes the form of a backache or pain similar to menstrual pain. Prodromal labor refers to the early stages of labor where the cervix is dilating and thinning, the fetal head descends into the birth canal, and the cervix dilates to about 5 cm. This stage of labor is dominated by prostaglandins produced in cell tissue. Prostaglandins prepare the muscle fibers in the uterus to contract strongly enough to dilate the cervix.

What is misoprostol?

Misoprostol (Cytotec) is synthetic prostaglandin and works well in supporting the induction of prodromal labor. Pitocin, if started before the cervix is dilated 5 cm, doesn’t work as well as misoprostol for prodromal labor. Cytotec has been given a very bad, undeserved name because of problems with overdosing in inductions, but the medication is actually quite safe, if used responsibly.

The primary problem with the use of Cytotec is its misunderstood latent phase, that is, the time between when the medication is given and when labor becomes obvious. If providers actually watch for contractions after a 25 microgram dose (very small dose), prodromal labor begins subtly with small, frequent contractions which the laboring mother perceives as menstrual cramps. After two hours of patience and watching, normal appearing labor will ensue without too many contractions.

What does manually rupturing the amniotic sac do to a labor?

Unfortunately, your baby’s amniotic sac is often ruptured by your physician to speed up the progress of Pitocin-induced labor. There have been no studies of the long-term effects of manually rupturing a baby’s amniotic sac.

The amniotic sack protects your baby in the same way an egg protects the developing baby bird. If you apply even pressure to the entire eggshell, the eggshell is hard to break. With a baby’s amniotic sac, pressure is applied evenly all over the baby’s body, providing the baby some protection from the pressure of contractions.

How do you avoid the problems with misoprostol?

Many times women are given multiple doses of misoprostol because the initial dose doesn’t seem to work. In my experience, if a baby is ready to be born, 25 micrograms of misoprostol inserted vaginally will ripen the cervix and the baby will be born about 12 hours later. Limiting the administration of misoprostal to a single done avoids most epidurals required to deal with pit pain.