The other day, I was at my craniosacral appointment, and chatting with my therapist. She’s into all things natural and crunchy, and used to be a midwife’s apprentice and is a certified doula. She’s pretty familiar with the “birth world.”
She told me something I’d never heard…and could not believe.
It was an order that doctors sometimes gave during a hospital birth. It flies in the face of the Hippocratic oath and everything doctors are supposed to stand for. Not to mention it’s potentially dangerous to both mom and baby. I knew that women need to know about this, so that they can make informed choices and avoid doctors who would use this (because of course, not all would).
The Scary Order Your OB Might Give During Birth
The order is called “pit to distress.”
What that means is, the OB orders that the mom be given the maximum dose of pitocin, knowing that it will cause baby to go into distress, so that s/he can perform an ’emergency’ c-section. The doctor is tired of waiting on mom to labor and wants it to just be over.
That is pretty horrifying.
There is simply no justification for giving a mother such a large dose of pitocin that it will knowingly hyper-stimulate her uterus and cause her baby distress. None.
After having heard this, I looked it up online to verify it. It seems unbelievable. But, the Unnecessarean verified it, even showing an excerpt from a nursing textbook that mentions the order (and advises nurses to report doctors who give it).
Why This Matters
So much of obstetric practice is truly not evidence-based — this certainly isn’t.
Labor can take awhile. Some women labor relatively quickly, in only a few hours. Others take several hours or even a few days. This can be hard on the mother to go through. What she needs in that instance is a solid support team, who does not interfere as long as she and baby are doing well.
Unfortunately, many doctors like to “move things along” in hospitals. They want to keep labor moving in a textbook fashion, of at least 1 cm dilation per hour (some prefer more).
Also unfortunately, some women do not dilate well when they are stressed out or observed. When women are strapped to beds, forced to sit/lie down, and are being poked and prodded, it may hamper the labor process.
Some doctors then become impatient and administer pitocin, in an attempt to get labor to move more quickly. And a few of those doctors, when they get tired of waiting, order “pit to distress” so that they have an excuse to perform an “emergency” c-section (an “emergency” that they caused) just so it will be over with.
High doses of pitocin can cause the baby to get too little oxygen, potentially causing brain damage or cerebral palsy. It can affect the baby’s heart rate, causing it to drop. It increases the risk of jaundice. It can even cause a baby to die in some cases. It hyper-stimulates the mom’s uterus, which increases the risk of uterine rupture (especially if it’s a repeat c-section). This practice has so many risks, and the only “benefit” is that the doctor gets to perform the c-section and go home sooner.
This kind of stuff is why so many women are opting for out-of-hospital births, or are demanding to have birth plans and more natural-minded OBs. They do not want to be subject to practice that is more for the doctor’s convenience than for their or their baby’s safety. Who would?
How to Avoid This
Before hiring a doctor to care for you and your baby, ask for his/her c-section rate. It should, ideally, be 10% or less. Ask for first-time moms specifically if that is your situation; it’s often higher.
In fact, ask all of these questions:
- What is your overall c-section rate?
- What is your c-section rate for first-time moms?
- For what reasons do you perform c-sections?
- Have you ever ordered “pit to distress” for a mother? If so, why?
- Is there a ‘time limit’ on my labor, as long as both baby and I are doing well?
- Will I be free to move around and labor in a way that is comfortable to me?
- How important is ‘informed consent’ to you?
You should get a feel from this conversation how the doctor really feels about c-sections. Acceptable answers to these questions include:
- 10% or less
- 15% or less
- Fetal distress, uterine rupture, placenta previa (also pancreta and increta), transverse presentation, other true emergencies (‘failure to progress,’ ‘big baby,’ ‘breech,’ and non-emergencies are all red flags)
- Very important
If the doctor mentions that there are time limits or tries to justify them, or says length of labor alone is an indicator of a problem; if doctor says you must have continuous monitoring no matter how you and baby are doing; if doctor brushes off informed consent or doesn’t even acknowledge it; if doctor says that his/her medical knowledge is important and outweighs the patient’s choice — RUN!!
Do not hire a paternalistic doctor, who expects you to simply do as you’re told and not ask questions. This kind of attitude is what leads to things like “pit to distress.”
And remember, even when you’re in labor, you have the right to question or refuse any procedure. You can ask, “Why did the doctor order pitocin?” You can say that you don’t want it. If it’s truly necessary, someone should be able to explain to you why, and not by saying “Do it or your baby will die.” A real explanation.
Ultimately, it’s a good idea to be cautious of who you trust and make sure that you are receiving safe, effective, and evidence-based care.