Pit to Distress- disturbing trend

Copied from The Unnecesarean Blog:

Jill from Keyboard Revolutionary wrote about a new term that she recently came across— “Pit to distress.”

“Pit to distress.” How have I not heard about this? Apparently it’s quite en vogue in many hospitals these days. Googling the term brings up a number of pages discussing the practice, which entails administering the highest possible dosage of in order to deliberately distress the fetus, so a C-section can be performed.

Yes folks, you read that right. All that Pit is not to coerce mom’s body into birthing ASAP so they can turn that moneymaking bed over, but to purposefully squeeze all the oxygen out of her baby so they can put on a concerned face and say, “Oh dear, looks like we’re heading to the OR!”

The term is found in this 2006 article in this Wall Street Journal article:

Oxytocin is a hormone released during labor that causes contractions of the uterus. The most common brand name is Pitocin, which is a synthetic version. It’s often used to speed or jump-start labor, but if the contractions become too strong and frequent, the uterus becomes “hyperstimulated,” which may cause tearing and slow the supply of blood and oxygen to the fetus. Though there are no precise statistics on its use, IHI says reviews of medical-malpractice claims show oxytocin is involved in more than 50 percent of situations leading to birth trauma.

“Pitocin is used like candy in the OB world, and that’s one of the reasons for medical and legal risk,” says Carla Provost, assistant vice president at Baystate, who notes that in many hospitals it is common practice to “pit to distress” — or use the maximum dose of Pitocin to stimulate contractions.

It’s also used on this AllNurses forum:

I agree, and call aggressive pit protocols the “pit to distress, then cut” routine. Docs who have high c/s rates and like doing them, are the same ones that like the rapid fire knock em down/drag em out pit routines.

“Pit to distress” appears on page 182 of the textbook Labor and Delivery Nursing by Michelle Murray and Gayle Huelsmann. In this example, the onus is on the nurse to defend the patient from the doctor if he or she sees the order “pit to distress” by immediately notifying the supervisor or charge nurse.

Jill asks the questions, “OBs, do you still think women are choosing not to birth at your hospitals because Ricki Lake said homebirths are cool? Do you still think we are only out for a “good experience?”

I imagine that all of us who have openly questioned the practices of obstetricians in the U.S. have been hit with the same backlash. We must be selfish, irrational and motivated by our own personal satisfaction. We’ve been indoctrinated into a subculture of natural birth zealots and want to force pain on other women or just feel mighty and superior. We fetishize vaginal birth and attach magical powers to a so-called natural entrance to the world.

Nah. It’s stuff like “pit to distress” that made me run for the nearest freestanding birth center. If I had to do it all over again, I’d stay home.

Have you heard this term before? What is your experience with “Pit to distress?”

Before you comment here, please go applaud Jill from Keyboard Revolutionary for blogging about this term and enjoy her brilliant and honest commentary.

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Update on Tuesday, July 7, 2009 at 4:35AM by Jill–Unnecesarean

More discussion of “Pit to distress” on the Internet:

The then labor and delivery nurse who blogs at At Your Cervix wrote this in April of 2007:

I see the wide use of cytotec (misoprostil) for inductions. I see what it does to a woman’s uterus and to her baby. Not to mention – it’s not FDA approved for use as a labor induction agent in pregnant women! I see many, many women being induced with a “hospital made” form of prostaglandin gel to induce labor. I also see a HUGE number of pitocin inductions/augmentations, where pitocin is titrated at such high doses, so quickly, that it’s like we’re trying to blow the baby out of the woman’s uterus.

Many of the obsetricians that I work with are eager to “get her delivered” as quickly as possible. There is also the “pit to distress” or “make the baby prove itself” – in other words, keep cranking that pitocin up until the baby crumps into fetal distress and the obstetrician does a stat c-section —- all so the doctor can be done, and get out of the hospital. Why wait 12-14 hours for a natural labor, when you can be done in less than an hour?

Our induction rates are through the roof. The nurses are rarely told the unit statistics, and when we are given them, they seem grossly understated. The L&D nurses know how many patients are induced or augmented, day after day, because we are the ones there, admitting the patient, and running their pitocin. We see them in massive amounts of pain from what is a very unnatural process designed to speed up the labor process, thus leading to increased epidural rates due to the higher levels of pain from synthetic oxytocin versus natural oxytocin.

The term was discussed in this Alexian Brothers Medical Center Employee Newsletter

Back in 2006, our tradition, like most maternity units, was to induce mothers when the fetus reached term gestation which was 37-40 weeks gestation. The medication, oxytocin (Pitocin), was administered to high dose levels to affect delivery. At times, the over-zealous use of oxytocin led to uterine hyperstimulation (terminology changed in September, 2008 to tachysystole), where the contractions were occurring too close together to allow the fetus sufficient time to recover before the next contraction would begin. The notion of “Pit to distress” was commonplace back then.

It was mentioned in this Mothering message board thread about Cytotec:

With a reactive baby (either by NST or auscultation) 25 mcg cytotec can be placed in the back of the vagina for cervical ripening 24 hrs prior to hospital induction and the mom sent home to wait, after observing her and baby for an hour. The vast majority (like 90%) will go into spontaneous labor before coming in for their “scheduled” induction. My biggest problem with cytotec is that we just hit moms with it over and over again, and then , surprise,when it does kick in, there’s too much on board, sorta like “pit to distress”.

Pit to distress was mentioned in the comments of the post My Rant on Pitocin on Knitted in the Womb after the blog’s author, a former chemist and doula, was scolded by an anonymous OB nurse for not understanding the difference between microunits and milliliters when it came to dosing Pitocin.

I’m a trained chemist. I hold a bachelors degree in biochemistry, did some course work towards a masters in chemistry, and worked for 6 years in an R&D lab in the specialty chemicals industry. I probably know WAY more about different units of measure than you do. I used “microunits” and “milliliters” in my discussion appropriately.

I’m not sure why I have to resuscitate a newborn to have “been there,” but since it seems to be very important to you, I’ll talk about it. 90% of the time labor should go just fine, with no need for resuscitation—this according to the World Health Organization. Of the other 10%, not all of them would require newborn resuscitation. If you’ve found that a large percentage of the births you’ve been at have required resuscitation, perhaps you should look at the medical interventions that might be causing that. From my end, the only clients I’ve had who had babies who required resuscitation were cases where there had been “Pit to distress.”

The news just broke yesterday of the largest jury award for a medical malpractice case in Ohio history. Miami Valley Hospital was found liable for $31 million in damages, but the parties agreed to settle, according to this Dayton Daily News blog post.

VBAC is safe. VBAC with induction is not, let alone VBAC with Pit to distress.

The lawsuit also identified Dr. Kedrin E. Van Steenwyk and Contemporary Obstetrics and Gynecology as defendants, but the jury found that neither was liable for what happened to the boy.

The boy’s mother, Renetha, was a VBAC patient, meaning she would deliver the boy vaginally, though she had previously had a Caesarian section. That meant she was at a higher risk for a ruptured uterus during labor, which occurred, Lawrence said.

At that point, the mother’s body stopped providing oxygen through the placenta, though the boy was still inside her. He probably went 18 to 20 minutes without oxygen, Lawrence said.

The hospital staff, which knew Renetha Stanziano was a high-risk patient, erred by failing to monitor the labor properly, by failing to diagnosis the hyper-stimulation of her uterus, by inappropriately using the drug Pitocin and by not telling the attending physician of her “inappropriate contraction pattern,” according to the complaint.

The nurses continued to give her Pitocin, even as her contractions escalated to unsafe levels, and “they blew the uterus apart,” Lawrence said.

The boy, called “Leo,” has severe cerebral palsey [sic]. He uses a feeding tube. He cannot speak, is not ambulatory and has trouble holding anything in his hands,” Lawrence said. Though Leo is badly disabled, he is alert and can recognize family members. When he needs something, he communicates by kicking, Lawrence said.

Leo will never be able to work, and Renetha and her husband Douglas are now “24-7 health-care givers,” Lawrence said. After Leo’s birth, Renetha stopped attending college and quit her job at Wright-Patterson Air Force Base to take care of the boy, Lawrence said.

Crunching numbers

I was finally able to get some figures to try and determine what the cesarean section rate is running with my local hospital.  It’s difficult to get an exact number because of the way they have their figures broken down.  You have to get the actual birth rate from one site for a calendar year and the hospital gives you its cesarean rate for a calendar year, but between the two it looks like we are running around a 50% cesarean rate here.  A surgical nurse told me recently he t hought it might even be higher because he saw so many of them.

Either way….that is criminal.  HALF of the women in this area are not allowed to birth their babies vaginally?  High intervention rates, high induction rates, high epidural rates, and across the board denial of VBACs have resulted in this soaring rate.

My childbirth classes are geared to those intending to have a hospital birth.  I try to teach them how to avoid an unnecessary cesarean birth, coping techniques for a natural birth and the many advantages of natural birth.  If I can save a few women from the trauma, recovery from major surgery and psychological scarring of surgical birth, it’s worth my time.  Some of them learn too late the consequences of their choices in birth.

I recently tried to help an expectant mom achieve a vaginal birth after a cesarean birth for her first child.  I’ve never seen a mom want something so much and work so hard to attain it.  She was a warrior and as long as she and the baby were both fine, I continued to fight with her for her goal.  But ruptured membranes for too many hours, a posterior baby that wouldn’t turn anterior, a large baby and a marginal pelvis combined with a dysfunctional labor were more odds against us than we could fight.  She ended up in a transfer with her uterus still intact and baby still in good shape.  But she had another cesarean.  It was hard emotionally on us both.  I knew she had done everything she could possibly do and I knew I had also, but it just wasn’t going to happen.  I know that the cesarean was necessary and I’m glad that eventually she will know it was the only way to safely deliver her child.

When she and her family arrived at the hospital they were treated as criminals for having attempted a VBAC.  Every person they encountered was rude and misinformed about the statistics concerning VBAC safety (a nurse told them there was a 99% rupture rate!).  The OB on call lied to her and said her uterus was ruptured and that’s what you get when you use an illegal midwife.  When she was finally able to get her actual surgical records, she discovered there was no rupture at all.  This same OB told another VBAC homebirth transfer several years previous to this that he had done a vertical incision just so she would never try something that stupid again.  Again, she was smart enough to request her actual surgical records and discovered only the external incision was vertical, the actual uterine incision was transverse.  This same hospital was doing VBACs themselves until just a year and a half ago, when pressure was put on them by other hospitals in the region, and insurance companies. It had nothing to do with good science or the vast body of medical studies that have shown us there is only a 0.05% chance of rupture, meaning there is a 99.05% chance of NOT rupturing!  It had everything to do with community standards, which are frequently not based on medical evidence.

Is it any wonder some women want to run away?

Experience a cesarean and lose insurance coverage?

Original article here

This article, featured in the New York Times, June 1, 2008 online edition, tells of the latest frustration with our county’s rising and epidemic cesarean rates.  Women who have experienced a cesarean birth may either be turned down for health care coverage or their current coverage may raise their premiums and consider them to be high risk.

Add this to the decision of more hospitals deciding (contrary to all the evidence-based medicine) they won’t continue to offer women the choice of a VBAC (vaginal birth after cesarean), and our country’s 31% cesarean rate (MUCH higher in many areas of the country) and you have another simmering healthcare crisis.

So what is a woman to do?  She has become another cesarean statistic, her hospital has quit offering VBACs and now her insurance coverage is in jeopardy.

One thing every pregnancy woman can do is educate herself with her very first pregnancy so she won’t become a victim of an “unneccesarean” (an unnecessary cesarean).  Working in the field of births for many years, I can honestly say that when a cesarean is truly needed, you are very grateful they are available.  They save lives and that’s the truth.  But one-third (or more) of this generation’s women are not “broken” and unable to give birth vaginally.  Not that many emergencies happen.  Something has gone very wrong with the system, not women’s bodies.

Here are a few suggestions that have been shown to lower your statistical risk of delivering by cesarean:

  • Don’t allow an induction for any reason other than an immediate crisis for mother or baby.  These do NOT include caretaker going on vacation, you want the baby born on someone’s birthday, you are uncomfortable and ready to get this over with, or baby seems to be getting a ‘little large’.  Especially in first-time moms, you will considerably raise your risk of a cesarean outcome.
  • Avoid pain management that interferes with your mobility.  Staying upright and mobile not only assists greatly with the management of discomforts during labor, it can make all the difference in getting a baby to maneuver more easily through the contours of your pelvis.  Once you choose an epidural, you are confined to the bed and usually to laying on your back in order for them to provide good coverage and to work well.
  • Research the use of electronic fetal monitoring.  Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.  It can be used as a screen, but should not be considered a diagnostic tool without errors.  Request intermittent monitoring instead.
  • Avoid pitocin augmentation for a slow labor.  It can cause fetal distress which would lead to a cesarean.
  • If your baby approaches your upcoming delivery with a less-than-optimal position for birth, check out Spinning Babies website.  Lots of information there on encouraging a better position for baby, which could not only spare you a cesarean, but make for an easier, less painful vaginal birth!
  • If you have already experienced a cesarean birth, see my previous entry on “Protesting a VBAC denial“.  Join ICAN (International Cesarean Awareness Network) and visit their website for lots of information about cesarean prevention and VBAC safety.
  • Interview different care providers.  Find out their philosophy of normal birth, induction rate, interventions used,  and cesarean rate.  Find out how long they will usually allow the second stage of labor to occur without interventions or cesarean if baby is coping well.
  • Hire a professional support person (doula).  Studies have shown having a support person reduces cesarean rates.
  • Educate yourself with more than your typical hospital childbirth classes.  Read, ask questions, research, learn.  Most people put more time and effort into choosing a new computer or car than they do the birth of their child.  Learn what your rights are as a pregnant patient, both informed consent and informed refusal.

Here are some great places to check out:

Coalition for Improving Maternity Services


Childbirth Connection

Mothers Naturally

Citizens for Midwifery

Informed Choices in Childbirth

Lamaze Institute for Normal Birth

VBAC.com

The Top 5 Underreported Birth Stories for 2007

Top 5 Most Underreported Birth Stories of 2007

A year-end review brought to you by http://www.nowombpods.blogspot.com

5. An Orlando mother goes into hospital to give birth and leaves without her arms or legs.

(http://www.wftv.com/news/6253589/detail.html)

The birth for this mother was smooth. It’s what happened afterwards that left her unable to hold or care for her newborn. Claudia Mejia went into a hospital to give birth but when she left the hospital, her arms and legs stayed behind. She is now a quadruple amputee and the hospital refuses to tell her why. She was told she had streptococcus and toxic shock syndrome but the hospital will not tell her how she contracted them. It is unlikely Ms. Mejia would have contracted the illnesses had her baby been born at home.

4. A Florida woman dies following induction of labor.

(http://www.sptimes.com/2007/05/19/news_pf/Tampabay/Why_she_died_a_puzzle.shtml)

Caroline Wiren was a young, healthy mother who was excited by the upcoming birth of her child. She touched his head, told her mother to tell the baby that she loved him, and then she was gone. Mrs. Wiren had her labor induced just seven days past her baby’s due date, even though it is common for a woman’s first child to be born as much as two weeks after the given due date.

According to http://www.medpagetoday.com/OBGYN/Pregnancy/dh/4334, one possible complication of induction of labor is amniotic-fluid embolism, which can lead to death.

3. 3. Two New Jersey women die just days apart following their cesarean surgeries.

http://www.nownj.org/njnews/2007/0518%20Moms%20decry%20high%20N.J.%20C-section%20rate.htm

Two young, healthy mothers entered a hospital in New Jersey to give birth to their babies. Both had cesareans and both were dead within days. The mothers leave behind two beautiful, absolutely healthy baby girls. This raises the question: then why the surgery?

2. The most updated birth data from the CDC shows that the cesarean rate in the United States has risen to 31.1%.

(http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf)

This latest number (from 2006) represents a 10.4% increase from ten years ago, and a 3% increase from the previous year. The report also indicates that the percentage of low birthweight babies and preterm babies is on the rise. Consumer Reports names the cesarean as one of the 10 most overused tests and treatments (http://www.consumerreports.org/cro/health-fitness/health-care/medical-ripoffs-11-07/10-overused-tests-and-treatments/medical-ripoffs-ten-over_1.htm).

For more information on cesarean awareness and prevention, please visit http://www.ican-online.org

1. United States ranks among lowest of developed nations in terms of newborn death rates. (http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html)

According to Save the Children researchers, infants in the United States are more than three times as likely to die within their first 24 hours as infants in born in Japan. The United States has the second highest IMR (infant mortality rate) in the developed world. Latvia is the only developed country with a higher IMR than the U.S.