​The discussion about Pitocin use after the birth of your baby is based around Expectant vs Active Management.

Active management means actively participating in the process of birthing your placenta. Many providers routinely administer Pitocin immediately after birth via IV drip or an intramuscular shot.

After the birth of your baby, your uterus will take a brief rest and then continue to contract to help deliver your placenta. On average, this process can take up to an hour after birth. I have found some providers will not, or perhaps do not have the time to patiently wait for a woman’s body to naturally release and deliver the placenta. They will use Pitocin and sometimes additionally use cord traction (light tugging on umbilical cord) to facilitate the birth of the placenta.

Active management means actively participating in the process of birthing your placenta. Many providers routinely administer Pitocin immediately after birth via IV drip or an intramuscular shot.

After the birth of your baby, your uterus will take a brief rest and then continue to contract to help deliver your placenta. On average, this process can take up to an hour after birth. I have found some providers will not, or perhaps do not have the time to patiently wait for a woman’s body to naturally release and deliver the placenta. They will use Pitocin and sometimes additionally use cord traction (light tugging on umbilical cord) to facilitate the birth of the placenta.

However, there are times the placenta will indeed need assistance to be birthed and Pitocin is medically necessary including when bleeding is excessive or when the placenta is being retained by the uterus.

Expectant management would mean belief in your body’s ability to expel your placenta, and so, the provider anticipates you to feel cramping contractions which will release the placenta. Your provider would look for signs such as the umbilical cord becoming limp or a small amount of separation blood and would then instruct you to attempt to push your placenta out of the birth canal.

After the placenta is birthed, it is your uterus’ job to contract and involute – retracting itself to a more pre-baby size. After long labors, it is possible for the uterus to become tired and go on strike! A shot of Pitocin would help your placenta find the motivation to contract, slowing bleeding more quickly.
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Pitocin for labor isn’t always great, but Pitocin after isn’t quite the same. Not every woman will need Pitocin after birth and even if it is the policy of a hospital or provider, it is your right to choose to decline now and still accept at delivery if medically necessary.

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​The “birth community” has a rather unfortunate reputation that precedes us. Some tend to come across as harsh and judgmental toward western medication, not unlike this childbirth educator in the 2008 comedy, Baby Mama.

We rather giggle about this interaction as Amy Poehler’s character makes it very clear where her decision lies. And yet, we all know that, especially when it comes to all aspects of childbirth, the media has a reputation for being woefully inaccurate. This includes the education and support personnel in the field of childbirth, namely birth doulas and childbirth educators.

As a doula who has attended all kinds of births, let’s clear the air about medical birth a bit.

When it comes to birth, women have many medical options. Some of these options are what we call “interventions” because they intervene in the normal birthing process. These can be natural interventions (such as natural induction) or pharmaceutical interventions (such as epidural anesthesia for labor and birth).

There is, fortunately, a lot of readily available information about the risks and benefits of interventions. Women have more knowledge available at their fingertips than ever before in history. It’s true that evidence shows that most of the time, interventions do carry more risks than they do benefits.

That does not make them bad. Or evil. Or unnecessary.

And it doesn’t invalidate the women who choose to have them for their birth. It simply says that there are risks associated with them.

But, there are also benefits.

So let’s talk about some benefits to interventions. The most obvious benefit is that some interventions can be life-saving. Birth is rarely complicated, but when it becomes so, western medicine is very good at handling acute care situations for both mothers and babies.

There are many interventions used in modern obstetric units, but for the sake of simplicity, we’ll stick to 3 of the most well known: Induction, Epidurals and Cesarean section.

Induction is a great benefit for when it’s really necessary. Evidence supports induction in 3 cases. 1: Preeclampsia. 2: When the waters have been broken for 18 hours and labor hasn’t started yet. 3. Being induced past 41 weeks is supported by evidence – not because going past 41 weeks is dangerous, but because induction is likely to be successful at this time.

When induction is successful (meaning that it leads to a vaginal birth), it keeps a mother from having to go through a cesarean. It can save a mother and baby who are headed toward toxemia which can be very dangerous. Waters being broken for extended periods without labor starting can cause infection. The benefits of induction are obvious in these cases.

Epidurals (pain relief that is injected into the dura part of the spine) are being hailed as either Heaven’s gift to women or the devil’s invention itself. Emotions and opinions aside, when is it useful? One of the side effects of an epidural is that it causes a drop in blood pressure. It’s so predictable for this, actually, that nurses are required to give women a bolus of fluid to prevent that drop. However, for a woman with out of control high blood pressure in labor, an epidural’s blood pressure lowering effect may be of tremendous benefit.

What about sexual abuse survivors? Sometimes their bodies can respond in a similar fashion to labor and birth that they did to their abuse: by closing up and pulling away from the situation. This is not helpful in childbirth since a baby needs to come down and out. This reaction can be subconscious and out of an abuse survivor’s control. An epidural’s numbing effect on that region can allow a woman to open her body for birth.

Epidurals are also popular because they are generally a very effective form of pain relief. This can be important to many women for many reasons that go beyond just not wanting to experience pain. The way that epidurals are given today, most women are numbed enough that they feel pain relief, but they are also left with enough sensation to push. Birth doulas as very helpful to mothers that have epidurals as well since they can help explain what is happening, keep the mom comfortable, and help aid in the laboring process to keep the baby moving down.

What about the exhausted mother who has a baby that is perhaps malpositioned and causing labor to go longer than the range of normal? Or the baby that simply caught the birthing mother in a completely exhausted state? An epidural can allow for some much-needed rest from what is surely the biggest physical job a woman will ever have.
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It’s true that cesarean section is nothing to shake a stick at. It is major surgery and a mother should only go into a cesarean if the situation truly warrants it. But it does save lives. And the ones that have been saved by surgical birth are grateful for it.
Interventions are tools and nothing more. They are neither good nor bad. They simply carry risks and benefits. Which risks and benefits are important to a birthing mother are solely up to her. Sometimes the benefits outweigh the risks. In those situations, mothers, doulas, and providers are grateful to have them.

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