Posted by My OB said WHAT?!?.
Jan
21
Posted by My OB said WHAT?!?.
“Well, I Would Personally Want Pitocin At 4 Hours.”
“Well, I would personally want pitocin at 4 hours.” – OB to mother who was being encouraged to augment her labor after her membranes had ruptured.
There are 20 comments to this post.
If this a male OB, How the F*** can you say something like that without ever experiencing real or, better yet, “augmented” labor? If this a female OB, I’d slap her to hopefully make her come to her senses. I possible would just gawk at what just came out of her mouth and say “No thank you.”
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Heather P had this to say,
Jan 21, 2012 @ 7:39 am (Quote)
That’s nice. You go ahead and hook yourself up. I’ll just wait for MY labor to start on it’s own. Keep your damn fingers out of my vagina too.
For the record, this happened to me too. My water broke 36 hours before labor started on it’s own. My homebirth midwives were comfortable with me waiting. I had an easy 4 hour labor because of that.
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Mama Wrench had this to say,
Jan 21, 2012 @ 8:38 am (Quote)
I actually don’t have a problem with this one, as long as it was followed by “but it’s entirely your call and I’ll support you either way.”
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Laura Reply:
January 21st, 2012 at 9:48 am (Quote)
This is mine. I wish! On the other hand, while she didn’t say that, she DID honor my call when I made it. I felt the exchange (I’ve put the full exchange in the pink link below) was unfortunate, since I was asking about evidence and this was her answer, but honestly she was otherwise an excellent OB – the moment/exchange made me very uncomfortable and defensive (stress: always a good labor device…wait), but it wasn’t representative of her otherwise, thank goodness.
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I hate it when doctors couch things in terms of “want.” If it’s a desire then it’s not a medical necessity. It implies there’s a choice while at the same time throwing the weight of the entire medical profession behind that choice. It’s roping the woman into becoming her own undoing, because most women aren’t going to say, “Well, I’m not you and I don’t want that.” Most women aren’t going to hear the “want” as “there is a choice,” and instead will hear it as “I needed that.”
Most women aren’t really concerned with the things the hospital cherishes: speed, efficiency, full compliance with paperwork, clean lines, everything in order, and a legally defensible paper trail. Most women want a tolerable labor, support, respect and safety.
So when a doctor says “I personally would want the pitocin,” the doctor is coming from a model of “It will make things faster and more intense, and you’ll fit our timetable better.” Whereas the woman hears an implied promise of “It will make things easier and safer.”
What we have here is a failure to communicate, one I’m not entirely sure the doctor is aware of. 
And in most cases, I would suspect the woman isn’t aware of it either.
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Jane Reply:
January 21st, 2012 at 9:40 am (Quote)
Let’s reframe this. You’re at a restaurant. The server comes to your table and hands out menus, then says, “Let me tell you about the specials. If I were the one eating here, I would personally want the grilled chicken salad!”
Now the woman at the table is having her one big meal out for the month. She has a certain amount of money to spend on this meal. She’s really hungry. She is totally looking forward to this meal.
The server has recommended something. The woman may go with that recommendation because it sounds okay, whereas if left on her own she might have ordered the bacon double cheeseburger.
Maybe the server recommended the grilled chicken salad because
1) It’s fairly low-fat, and she likes to eat low-fat
2) She eats at that restaurant every night, and she’s pretty much had it with cream sauce, red meat and salted anything.
3) She’s concerned about money right now, so she likes the fact that it’s cheaper
Maybe all or none of those things are concerns of the patron of the restaurant, who
1) Is totally willing to eat a thousand grams of fat if it makes her happy
2) Has no dietary or health concerns that would lead her toward leaner cuts of meat
3) Isn’t concerned about money because she only goes out once a month
4) Isn’t bored with the richer restaurant fare and therefore doesn’t get sick at the thought of a well-marbled cut of beef.
But the patron is hearing the recommendation from the perspective of her own desires, which is “What meal would be really tasty and enjoyable and a great buy for the money?”
It’s no big deal if you have a lousy meal out. But a birth — that’s a really big deal. There’s not only satisfaction to consider but also safety.
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This one’s mine. And I’m not deeply upset about it, because although she strongly pushed me to use the pitocin, she did accept my refusal to use it on her timetable. And to be fair to her, my Bishop’s score was *very* favorable as of my last OB appointment with her practice (she was on call when I came in), and she would have known that as my case had been discussed (going post-dates with a suspected large baby – meaning, in the vicinity of 10 pounds – meant every doctor in the practice got briefed on me). (And she was later excellent during the actual delivery – I have a Thoughtful Thursday in for her too! Just to confuse things.)
However, in the context of what I was asking her, this wasn’t the most useful answer, and it was followed up with another real gem of a line, too. We were clearly not in her area of comfort on this topic.
The background:
I was 40w5d when there was a tiny trickle of fluid that might have been my waters and might not. It wasn’t much and it wasn’t very noticeable. I monitored for an hour trying to determine if it was coming, well, from there – and then I called them because I thought it was. I had no real noticeable contractions. They told me to monitor for an hour. I explained I had, they told me to monitor for another hour, so I did. It was still there, so we went in, and tests confirmed it was amniotic fluid, so we stayed. (I didn’t want to wait too long to go in. My first was over 11 pounds and labor was 8 hours, from the water breaking in a gush to delivery. And I was very dilated, without active labor, at my last OB appointment. I was concerned about precipitous delivery might be an issue once things got started.)
My birth plan specified my desire to avoid pitocin if possible. I wanted to birth him naturally, and I didn’t want to have to fight pitocin contractions, especially since with my first (with whom I eventually had to have an epidural) I was told by my OB, “These contractions are so strong, if you’d had pitocin I’d have them dial it back” – I really didn’t want to know, if I didn’t have to, what my body would do if augmented with pitocin.
My OB had suggested induction if I went to 41w, but by AROM (since my Bishop’s score was so favorable). I’d expressed concern about the timetable that would create, and she told me that the old 24-hour timetable didn’t necessarily apply and maybe up to 48.
The OB-on-call’s part:
At this point she had not done an internal exam, as I’d asked to minimize them (another request that was honored, in fact there was only one and I asked for that one). She said she would recommend pitocin induction if I hadn’t gone into labor on my own at 4 hours past the first observation of my waters being broken. This would also be just two hours past my arrival at the hospital.
I was pretty shocked and a bit on the defensive, which may have been evident in my tone, so she may have been responding to that as well. I asked her what the medical evidence said was reasonably safe.
That’s when she replied, “Well, I would personally want pitocin at 4 hours.”
I asked again about the medical evidence and safety and she said “That’s what I feel is safe, that’s why I would choose it for myself.”
I tried once more, asking what about studies or evidence, and she said, “Well, there aren’t really any studies. Most women take the standard care and get pitocin. To do studies they’d need a lot of women doing that and a lot of women like you.”
At this point I gave up on that topic (which I should have at least one exchange prior, probably), and simply said that I would reconsider the question of induction if I hadn’t gone into labor on my own by the next morning. (I may, uh, also have known that there’d be a different OB on call at 7 am….) She said she didn’t think it would take that long even without pitocin (…in which case why induce?), and that was that.
It was after midnight when I finally started measurable active labor, a bit over 6 hours from my first observation of amniotic fluid, so had I agreed to her timetable I would have had the pitocin by then. From the time active labor was confirmed to delivery was less than an hour, so I’m thinking that the pitocin would’ve been a bit of overkill there.
But I did get the birth I wanted, and in fact this same OB was a big part of it and was wonderful. This particular exchange made me uncomfortable and struck me as a MOSW moment taken in whole (“women like you” was actually a more wince-worthy quote than the four-hour quote, to my mind, though neither seemed like a good answer to my question) – but I do want to be clear the doctor in question was overall very good during my delivery.
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Melissa C Reply:
January 21st, 2012 at 10:03 am (Quote)
Yeah, there’s women who take the standard care, and there’s “women like you” who want evidence-based care. And heavens, no, we don’t want any more of the latter. :eyeroll:
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Tee Reply:
January 21st, 2012 at 11:34 am (Quote)
I’m really glad you came and told us the whole story! Sounds like a great doctor who just had a “duh” moment there! I’m sorry that you had to put up with the stress of arguing with her but very glad you went on to have the birth you wanted!
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Details Reply:
January 22nd, 2012 at 4:09 pm (Quote)
It sounds like this doctor had more experience with women like me who get the pit for 10 hours and then get a c-section because they waited 10 hours to even start the pit. “I” would have rather had the pit at 4 hours, but that is hind sight and I have no idea how much worse it could have been if they had left me on the pit for 16 hours since I ended up hyperstimulated which caused some problems during surgery. It sounds like this doctor forgot about your history of preciptious birth, which is a pretty important detail to omit. Glad you had a good birth! Glad this doctor turned out okay.
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I wonder if people who say this have actually experienced pitocin. I can’t imagine anyone WANTING pitocin. Maybe wanting something to help with labor. Or wanting the effects of pitocin. But actual pitocin? That’s like wanting someone to punch you in the face repeatedly.
When I was in day three of labor my nurse told me to get a “whif of pit” and that I wouldn’t even be able to notice a difference in my contractions (which were intense and made worse by back labor). She lied.
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Rebecca Reply:
January 21st, 2012 at 12:27 pm (Quote)
In truth, I’d prefer comments about wanting pitocin or other augmentation to be limited to either having experienced both (because if you really think unaugmented labor feels the same as unaugmented, you’ll likely say “why not get it over with faster) or real medical reasons. And no, shift change is not a real medical reason.
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4 hours? generous by the standards of the obnoxious OB who delivered DD, who broke my water with consent, but not INFORMED consent.
went to the hospital with “active labor” at 11 pm, after an hour it petered out, they drugged me up and had me sleep, and the should have sent me home or at least discussed it with me, it was my first so i thought they knew something i didn’t know. at 9 am the Dr came in (and they wouldnt give me breakfast damnit!) and said “lets have a baby today, i’m going to break your water” and i’m just damn lucky that i was pretty close to ready. i was dilated to 6 but not in labor. and only after that did he look at the nurse and say “start her on pit in an hour if she’s not contracting well by then” without discussing with me that it was now an induction, not just me going into labor. Luckily with the aid of a sneaky nurse, she “forgot” to hook me up and sent me to walk the halls. i never did get that pit, until after she was delivered, because i did fine on my own with my water broken. but it sucked more than my labor with #2 which was almost completely natural- i did ask them to break my water after being in labor for quite a while, because i knew he’d be here as soon as they did…
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Well, I guess you don’t have day-long labors, then. I do. And Pitocin doesn’t speed them up, speaking from experience. Having had two with (22.5 AND 23.5 hours) and one without ANY intervention (14.5 hours), I now believe it slowed me down!
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If you would personally like it, then feel free to hook it up to YOUR Iv.
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