Naomi correctly points out that most women in labor are not divested of
their basic human rights (not having been involuntarily committed to a
hospital or declared mentally incompetent by a court of law) and thus have
the right to consent or not to any routine treatment offered them.

Pitocin has a half-life in the bloodstream of less than 3 minutes.  Current
evidence suggests that in hospital births, the routine administration of
pitocin and the active delivery of the placenta reduce total blood loss and
reduces the number of women losing more than 500 ml (which is still the
defined upper limit of 'normal' for blood loss, in modern obstetrics).
There is no evidence about the benefits or disadvantages of the routine
administration of pitocin in third stage in women experiencing physiologic,
undisturbed labor with a skilled attendant.

We do know that in nature, the birth of the young is followed by a steady
rise in oxytocin levels during the immediate post partum period, as the
young stimulate the breast and tissue around it by massage, and it is likely
that the mother's stimulation of her young contributes to this rise as well.
I know that I rarely see a hospital birth where the baby latches on after an
hour or so, and drinks, with audible swallows, for an hour after that, but
it is commonplace at the home births I have attended.

Given the short half-life of pitocin I don't know that I would stake
everything about my labor on a battle over this one routine.  I would be
equally concerned about the other things going on that would decrease my own
release of oxytocin: anesthetics, analgesics, an emotionally unsafe
environment where I am not in control of who enters the room or what they
might suggest doing to me to get my baby born, and there are others, all of
which are likely to have an effect on my ability to take in my baby
afterwards and get BF started.

Where I work we overuse pitocin big time; virtually all primips and most
multips are augmented at some point in labor, and it is routinely
administered in third stage to aid rapid delivery of the placenta.  All CS
mothers get it in connection with the removal of the placenta.  Most of them
still get BF right eventually, and when there are problems I think they are
more caused by the other interventions in an environment where we seem to
need pitocin just to give birth, than by the pitocin itself.

For the record: I would not plan to attend a home birth, or any birth
really, without knowing I had pitocin available to treat a post partum
hemorrhage, but I don't routinely administer it.  I have the skills to
observe and evaluate the need for it, which seems to be in about 5% of
normal labors and that is borne out in my practice.

Rachel Myr (midwife)
Kristiansand, Norway

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