QuestionI gave birth to my son about 16 months ago. He was overdue, I was induced several times (cervical gel) and then placed on a pitocin drip. After 39 hours and only dilating to 4cm, I had a C-section (including general anaesthesia). About 5 hours later I started to hemorrhage. It became quite significant and eventually I was ambulanced to a larger center for a D&C. I was also given 4 units of blood. I am wondering two things. 1. Is it possible for a person to adversely respond to pitocin? My contractions were very regular and strong until the drip was started and after that, they would last for minutes and then not come for 20 or 30 minutes, start and stop after 3 seconds, etc. I have wondered if I am overly sensitive to the drug and perhaps my uterus responded poorly leading to the hemorrhage? 2. What are the chances I will hemorrhage this severely again? Are they different depending on whether I attempt a VBAC or scheduled a repeat C-section (I will be meeting with my OB about this also, of course). Thanks for your time and advice.
AnswerMichelle,
It is possible to have an adverse reaction to pitocin, which is most commonly a hyperstimulated uterus for the mother or issues with blood pressure. Babies often do not respond well to pitocin-induced labor, since it makes the contractions unnaturally stronger, longer, and closer together. This limits the oxygen supply to the baby and typically leads to a decreased fetal heart rate or full fetal distress.
You are 4 times as likely to have a c-section if your labor is induced than if you go into labor on your own.
For these reasons, induction should not be attempted unless there are clear complications present or your pregnancy has gone longer than 42 weeks. Being less than 2 weeks overdue isn't a reason by itself to schedule an induction unless clear signs of problems have been noted. The research clearly supports that the risks of being overdue do not rise until the pregnancy is longer than 42 weeks.
The average length of a first pregnancy worldwide is 41 weeks, 1 day. In all countries but the US, 41 weeks is considered full term.
Since your hemorrhage started well after the c-section and you were taken for a D&C, it sounds like some products of birth were not fully removed during your c-section. Otherwise, a D&C wouldn't have been needed.
From what you've said, it sounds like your labor was progressing normally until the pitocin was also given, which could have been too aggressive for your body to handle, especially since your labor pattern became erratic after this point. It sounds like your uterus became hyperstimulated, which means that most likely the level of pitocin given was too high for your body to handle and ultimately led to your emergency c-section.
So, although it sounds like your induction was too aggressive and led to your c-section, it doesn't sound like the induction or pitocin itself was responsible for the hemorrhage.
The chances of such a severe hemorrhage again are pretty slim if no placental anomalies were found, such as placenta accreta, percreta, or increta, which could have caused some of the placenta to remain in the uterus and caused the delayed hemorrhage.
You can limit your chances of hemorrhaging this severely again by refusing an induction (which should never be done if you are having a VBAC) unless it is clearly medically-indicated.
Neither a VBAC nor a repeat c-section will lessen your chances of a hemorrhage if a placental problem was to blame.
Having a VBAC, however, will lower your chances of complications in future pregnancies, whereas the more c-sections you have, the more your risks of complications increase, including uterine rupture, placental anomalies, hemorrhage, adhesions, etc.
So, if you plan on having a large family, I would recommend a VBAC as your risks of complications decrease with every successful VBAC you have.
Best,
Catherine
