Pit of Despair

Author // Stephanie Soderblom

Pitocin has been described as a very useful drug that improved obstetrics and gave us options to induce labor and help women in ways we weren’t able to before. Pitocin has also been described as a seductive drug that changed obstetrics, increasing risks to mothers and babies in ways that are often not even taken into consideration.

Both of these descriptions are accurate. How can that be? There are risks and benefits associated with the decision to induce, which will not be covered in this article. It’s a decision not to be taken lightly, but for now, let’s talk about what goes on after that decision is made.

Pitocin is a drug used to induce or augment labors. It is generally administered by IV, although when used immediately postpartum, it’s often an intramuscular injection. It was created in 1953 and has only been approved for the medical induction and stimulation of labor. When Pitocin is used for the elective induction or stimulation of labor, it constitutes off-label usage of the drug. Mothering magazine reports, “A survey by Robbie Davis- Floyd, a cultural anthropologist at the University of Texas, found that 81 percent of women in U.S. hospitals receive Pitocin either to induce or augment their labors.”

It has been said that only 3 percent of deliveries medically require it.

Pitocin has been nicknamed “Pit,” and I’ve even heard “Vitamin P.” I’ve heard many obstetrics professionals say that Pitocin is just oxytocin, and has the exact same effect on your body. While the oxytocin in Pitocin is chemically designed to mimic the oxytocin your body produces, it has far from the same effect on your body.

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How Pitocin Is Different

While the oxytocin your body produces is chemically similar to the oxytocin contained in Pitocin, the way your body recognizes and responds to the two is very different. The difference has to do with the blood-brain barrier. Simply put, the vast majority of substances that enter our bloodstream cannot pass into the cerebrospinal fluid. The body protects the brain from all but a select few substances going from the blood into the brain (such as oxygen and glucose).

Oxytocin is produced by the brain and has a direct effect on brain function. But when Pitocin is introduced into the bloodstream, it does not affect the brain.

While Wikipedia is not always a reliable source of information, the WikiDoc page on oxytocin ( has enough reputable sources cited that I am very confident of its accuracy. Here’s what is has to say on the difference between natural oxytocin and Pitocin.

“Oxytocin secreted from the pituitary gland cannot re-enter the brain because of the blood-brain barrier. Instead, the behavioral effects of oxytocin are thought to reflect release from centrally projecting oxytocin neurons, different from those that project to the pituitary gland, or which are collaterals from them. Oxytocin receptors are expressed by neurons in many parts of the brain and spinal cord, including the amygdala, ventromedial hypothalamus, septum, nucleus accumbens and brainstem.”

The article goes on to list these effects of natural oxytocin:

Sexual arousal. Oxytocin injected into the cerebrospinal fluid causes spontaneous erections in rats, reflecting actions in the hypothalamus and spinal cord. Centrally administrated oxytocin receptor antagonists can prevent non-contact erections, which is a measure of sexual arousal. Studies using oxytocin antagonists in female rats provide data that oxytocin increases lordosis, indicating an increase in sexual receptivity.

Bonding. In the prairie vole, oxytocin released into the brain of the female during sexual activity is important for forming a monogamous pair bond with her sexual partner. Vasopressin appears to have a similar effect in males. Oxytocin has a role in social behaviors in many species, and so it seems likely that it has similar roles in humans.

Maternal behavior. Rat females given oxytocin antagonists after giving birth do not exhibit typical maternal behavior. By contrast, virgin female sheep show maternal behavior towards foreign lambs upon cerebrospinal fluid infusion of oxytocin, which they would not do otherwise. Oxytocin is involved in the initiation of maternal behavior not its maintenance, for example, it is higher in mothers after they interact with unfamiliar children rather than their own.

According to some studies in animals, oxytocin inhibits the development of tolerance to various addictive drugs (opiates, cocaine, alcohol) and reduces withdrawal symptoms.

Preparing fetal neurons for delivery. Crossing the placenta, maternal oxytocin reaches the fetal brain and induces a switch in the action of neurotransmitter GABA from excitatory to inhibitory on fetal cortical neurons. This silences the fetal brain for the period of delivery and reduces its vulnerability to hypoxic damage.

MDMA (ecstasy) may increase feelings of love, empathy and connection to others by stimulating oxytocin activity via activation of serotonin 5-HT1A receptors, if initial studies in animals apply to humans. The anxiolytic Buspar (buspirone) also appears to produce some or all of its effect via 5-HT1A receptor-induced oxytocin stimulation.

In other words, natural oxytocin is produced by the brain and affects the brain before becoming systemic. Pitocin is never seen by the brain, and therefore the brain doesn’t release the complex cocktail of labor/birth hormones that it does during a naturally occurring labor. It has recently been suggested that due to the blood-brain barrier and the hormonal dance that happens during labor—and due to the recent discoveries of the affect of oxytocin in autistic children—Pitocin may be a contributing factor to the epidemic autistic rates we are seeing lately.

Another notable difference between Pitocin and our natural oxytocin is the rate in which it’s administered. In the body, during a normal natural labor, oxytocin is released in spurts, ebbing and flowing, causing contractions, then easing off. Pitocin is administered via a steady infusion with a pump. Its levels in the blood remain constant—that is, until the dosage is turned up (generally every 15–30 minutes).

Side Effects of Pitocin

So many people are given Pitocin without ever hearing a single risk or side effect other than that it might make contractions too strong—always accompanied by an assurance that the levels can be decreased if that happens. The website, which is dedicated to drug descriptions, usage and risks, says the following about Pitocin:

The following adverse reactions have been reported in the mother:

  • Anaphylactic reaction

  • Postpartum hemorrhage

  • Cardiac arrhythmia

  • Fatal afibrinogenemia

  • Premature ventricular contractions

  • Nausea

  • Vomiting

  • Pelvic hematoma

  • Subarachnoid hemorrhage

  • Hypertensive episodes

  • Rupture of the uterus

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction or rupture of the uterus.

The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.

Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocininduced water intoxication has been reported.

The following adverse reactions have been reported in the fetus or neonate:

Due to induced uterine motility:

  • Bradycardia

  • Premature ventricular contractions and other arrhythmias

  • Permanent central nervous system damage

  • Brain damage

  • Neonatal seizures

  • Death

Due to use of oxytocin in the mother:

  • Low Apgar scores at five minutes

  • Neonatal jaundice

  • Neonatal retinal hemorrhage

About Chlorobutanol

Chances are you have never heard about the additive chlorobutanol. Pitocin contains not only a synthetic oxytocin, it also contains 0.5 percent chlorobutanol, a chloroform derivative that acts as a preservative. While the oxytocin in Pitocin has a very short half-life of 1-6 minutes (meaning it diminishes in your system within a matter of minutes), chlorobutanol has a very long halflife (about 10 days!). The result is that chlorobutanol builds up in your system for as long as you are being given this substance, and remains in your body for weeks.

According to the article “Inactive Pharmaceutical Ingredients: Implications for Pregnancy,” published in The Canadian Journal of Clinical Pharmacology, “Chlorobutanol crosses the placenta in animals and produces human embryotoxicity. Based on these limited data, systemic preparations containing chlorobutanol should be used with caution during pregnancy. Repeated administration, in particular, should be avoided due to the long terminal half-life of chlorobutanol (about 10 days) that may lead to accumulation in the fetus.” Chlorobutanol is known to affect both maternal blood pressure and heart muscle.

According to the study “Effects of Chlorobutanol and Bradykinin on Myocardial Excitation,” “…chlorobutanol does have direct effects on myocardial cells, acting on the cell membrane and decreasing isometric tension produced by the heart.”

Another paper, “The Effect of Oxytocin on the Contractile Force of Human Atrial Trabeculae,” states, “Chlorobutanol decreased the ability of the heart to contract, while as pure oxytocin had no effect. This explains why maternal blood pressure may decrease and provides impetus to produce oxytocin with another, safer preservative.”

And finally, from the article “Prescribing Methadone, a Unique Analgesic” in the journal Supportive Oncology, “Chlorobutanol or chlorobutanol plus methadone, rather than methadone alone, may be the cause of cardiac toxicity in patients treated with IV methadone. Chlorobutanol has a very long half-life, extending beyond 10 days, and one report showed a serum concentration of 85 mg/mL (0.480 mM) of chlorobutanol in a patient receiving IV morphine preserved with 0.5% chlorobutanol. Furthermore, in a controlled clinical trial that led to the discontinuation of chlorobutanol from heparin, chlorobutanol was found to decrease blood pressure in patients. Chlorobutanol also causes significant negative inotropic effects on human atrial tissue, and this was the postulated cause of the hypotension seen in patients receiving oxytocin preserved with chlorobutanol.”

The call to find a safer alternative to chlorobutanol was first made in 1998. This problem has been known and documented for at least 12 years. Why is this not big news, and why have we not explored other safer preservatives for Pitocin? My guess is this: money. I wonder how many of the 81 percent of mothers who have received Pitocin, having incurred a greater sum of medical expenses in the birthing room, have ever heard of chlorobutanol?

Other Interventions, Other Risks

Hopefully by now you understand that using Pitocin is far from the same as going into labor on your own. It affects the body differently, and there are definite risks to the mother and baby associated with both Pitocin and its preservative, chlorobutanol. Now, let’s talk about some of the interventions that are likely to come along with the administration of Pitocin.

Think about this:

Because the oxytocin in Pitocin doesn’t affect the brain the same way your natural oxytocin does, you are likely to experience much more intense contractions without the good oxytocin feelings that the brain experiences during a natural labor. Therefore, those contractions are interpreted much more negatively by your body. The result is that it makes women far more likely to request epidural anesthesia. Epidural anesthesia is notorious for lowering blood pressure. With this in mind, the medical response is to pump enough fluids into your blood in attempt to keep your blood pressure stable. Pitocin is diluted into IV fluid, commonly mixed at a 3:1 or 6:1 ratio in the IV bag. The problem is that chlorobutanol is an anti-diuretic, meaning it makes you retain water.

Recall that one of Pitocin’s side effects is “severe water intoxication with convulsion and coma.” Are you beginning to sense a problem here?

We haven’t even touched on the fact that chlorobutanol easily crosses the placental barrier and can affect the baby for weeks. There is also a much higher likelihood of a cesarean birth when Pitocin is administered, due in part to the continuous electronic fetal monitoring that goes along with it, and its 90 percent false positive rate for detection of fetal distress.

It is a complex game of Russian roulette we are playing. This is not to say we shouldn’t be thankful for Pitocin at times, since it has saved moms and babies from undergoing cesareans and from experiencing other complications, such as postpartum hemorrhage. But the risks should be discussed and taken seriously by doctors and patients alike. Rather than addressing the problem of stalled labor with off-label usage of Pitocin, we should show greater respect for the relationship between the mind, body and baby, allowing everything to work with its natural balance.

My solution? Start by recognizing that our bodies are much more complex and effective than anyone is giving them credit for. Recognize that labor and birth is a whole-body experience, not just a uterine experience. Treat the cause of the stalled labor, not just the uterus, and give this mom and baby ample time to both start and complete this process. Making her feel safe, nurtured, secure—and able to be open, relaxed and free—carries far fewer risks than Pitocin.

About the Author:

Stephanie Soderblom is a licensed midwife in Mesa, Arizona. She is the proud wife and mother of five children and the founder of Nurturing Hearts Birth Services— catering to all of the needs of pregnancy and postpartum families. Visit her at

Pathways Issue 29 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #29.

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