In reply to Dianne's question about increased jaundice as related to use
of Pitocin, I have had some experience and offer these observations.
Mothers who have Pitocin induction/augmention of labor, given in liters
of IV fluid, usually have edema that persists several days post partum.
Usually they have delayed lactogenesis that lasts until the edema
resolves.  The result in the baby is jaundice because they have so
little intake for several days.
I see this scenario quite often.  I usually tell these mothers to go to
bed to nest with baby and have many, many small feedings around the
clock.  If the intake can be increase, usually the bili level plateaus
or decreases.  Keeping the ped from standing on the panic button and
alarming the parents is often difficult.  Sometimes there is so little
available from mother that small amounts of formula are offered - - I do
mean small---15-20 c.c.'s.  But we work on skin-to-skin, sun bathing,
frequent feeds at breast and monitor the bili as a safety net.  It
usually responds within 24 hours, but watching the bili may go on
several days until edema resolves and the milk supply is adequate. 

I recently had a 37 week gestation baby with a bili of 21 on day 3.  Mom
had a lengthy augmentation of labor and lots of Pitocin and IV  fluid
post partum.  Baby had a cephalohematoma and was so sleepy and hard to
feed; mother did not have much milk until day 6 (she was a multip, too).
Then she got a UTI that made her feel awful, just when the bili had
declined to 16.  It went back up because mother felt too ill for 24
hours to work hard at breastfeeding.  When she got treatment and
responded, then breastfeeding picked up again and the bili began to
decline.  I am accustomed to this process playing out in 3-4 days, but
this took 10 days before the bili was down to stay.  This was a patient
ped, thank goodness!

This was not all due to Pitocin; the pre-term baby with a
cephalohematoma just made a perfect set up for jaundice.  But the
protracted elevation of the bilirubin level I feel was related to the
edema that had resulted from the Pitocin.

Diane Perrone, RNC
Materna Wellborn
Algonquin  IL   USA             Looking hard for spring!

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