Saturday, July 11, 2009

Response to a resident's comment

I received a comment on this post today:
As a resident physician I'd like to note that your rant on pitocin was pretty uninformed. You were given oxytocin following delivery for uterine atony, to prevent HEMORRHAGE, the cause of much maternal mortality before your god-awful pitocin was synthesized.

Furthermore, take a look at the medical literature concerning fetal death rates before and after the discovery of oxytocin. Placental abruption, cord compression, hypoxia in utero, chorioamnionitis secondary to prolonged labor times...these were all huge killers of newborns, but you'd likely not KNOW it because you know nothing about medicine. If you're going to complain publicly please try and do it in an informed fashion, lest you mislead women and have them make bad decisions at the hospital.
I started a response in the comments section, but decided the exchange was worth its own blogpost. So I'll paste my response here.

Dear Anonymous resident physician:

I think you're referring to this post. I'm curious what parts of the original post were "uninformed."

You, not having been present at my birth nor privy to my medical charts, can't claim to know the circumstances that led to my being administered Pitocin. I don't have a doubt that stopping a postpartum hemorrhage is a valid use of the drug. Postpartum hemorrhage remains one of the leading causes of maternal death to this day. In fact, prolonged use of Pitocin during labor is one of the risk factors for postpartum hemhorrage. A friend of mine bled excessively following a long induced labor.

I never said I shouldn't have been administered Pitocin. Honestly I don't know because I haven't looked at my charts myself, and I was never given the details while in the hospital. It's possible that the hospital where I delivered gives every woman Pitocin following labor as a precaution. Regardless of those details, the fact is that it interfered with our bonding as I suspect it does for many mothers. Drugs, even when needed, are unfortunately not without harmful side effects. You can read the list of Pitocin's side effects (including postpartum hemorrhage) here. I shared my own limited experience with Pitocin merely to illustrate one of the possible harmful side effects of the drug. So far I'm not seeing anything I've said that qualifies as "uninformed."

I never said Pitocin shouldn't be used when necessary. I'm absolutely grateful for the fetal and maternal deaths prevented by Pitocin. As I said in the original post, "Pitocin has its time and place." But I am simultaneously appalled by the injuries often inflicted when Pitocin is unnecessary. You can't debate the fact that Pitocin is being abused when used without medical reason. You can't ignore the voices of those women and babies harmed by the drug either. I don't have a problem with Pitocin when it's necessary, but I definitely have a problem with it being used "like candy in the OB world" and leading to unnecessary suffering.

You're right that I know nothing about medicine, and I never claimed to. But I have spent the last 6 years of my life passionately studying birth--which is a natural process. Birth has little need for medicine most of the time, but I have always acknowledged that I am grateful for modern medicine for those cases when doctors and medicine become necessary. The lives of women and babies I love dearly have been saved by those wonderful modern advancements.

You're right that I like to rant about Pitocin. And I will keep ranting until doctors stop abusing it. If you aren't aware of those abuses, try googling the new birth buzz-words "Pit to distress" for starters.

It is certainly not my intention to mislead women. On the contrary, I'm on a crusade to educate women so they can make truly informed decisions. I would definitely appreciate and welcome any feedback that would help me to better inform women or to correct any misinformation I may be disseminating, but so far I think I've only shared the facts.


missy. said...

Accusing you of being uninformed is insane; on the contrary, I have found that your posts provide careful analysis with thorough documentation, so that readers can check out your sources for themselves. Thanks, Busca, for providing referrals to reliable, evidence-based information that helps women make informed choices about their birth experiences.

meredithryan said...

Wonderfully put! It doesn't help anyone when those in the medical field get defensive because we call in to question seriously suspect practices. Is "anonymous" really trying to suggest that those with no formal medical training have no right and/or no grounds to ask tough questions? Last I checked, it's my body, my baby, and my birth and I have every right and desire to be informed, even if it means making a few medical professionals slightly uncomfortable.

Hilary said...

The fact that pit is given routinely to laboring women is a dangerous practice that the medical world 'excuses' because it makes things more convenient for them and if there's problems, they can always just cut out the baby.
I was given pit to just speed up labor (I also had my water broken). Why? Because the hospital floor was full, and they wanted to 'move things along, and it won't matter, because you have an epidural anyway.'
Because I wasn't as informed as Busca is, I had no idea what was around the corner for me . . . my daughter's heart rate started to wig out and even once they immediately turned off the pit, they were talking about an emergency c-section. The nurse was sitting next to me, explaining what to expect, and how they hoped the busy anesthesiologist would make it in time to turn up the epidural enough, and if not, they'd just put me out for the surgery. I have never been so terrified. I was in complete fear that I would lose my baby. Why? Because my labor wasn't going fast enough for the hospital, and so they needed to 'speed things up.' (I had been there less than an hour, and already dialated another centimeter).
All the recent articles about 'pit to distress' just further prove that cases like mine are shockingly commonplace, and the abuses of what can be a useful drug are serious and plenty.

HollySteffen said...

i only have two things to say:
1. i totalllllllly agree:
"On the contrary, I'm on a crusade to educate women so they can make truly informed decisions"

publichealthdoula said...

Well said. There is a middle ground - what's the matter with asking everyone to look for it?

Cassie said...

Beautifully put!

When doctors speak about birth as this huge medical panic, it's nice to remind them that birth is not a disease and pregnancy is not a disorder. It's a natural process that needs to be left alone, with only interventions being used when absolutely necessary.

I thank God for doctors and OBs and nurses and all the medical professionals that have helped saved lives. However, they can't expect to abuse their power and not be questioned about it.

Cassie said...

(also, the Pit to Distress thing is entirely upsetting. It leads to more C-sections which leads to - again - more maternal deaths)

Liz Johnson said...

I have a question for anonymous resident physician - is he referring to the discovery of oxytocin? Or synthetic oxytocin (pitocin)?

Also, "huge killers" of newborns? Where's your source? I'm genuinely curious.

I agree that pitocin has its time and place, just like drugs like oxycontin and vicodin have their appropriate time and place. But, just like oxycontin and vicodin, pitocin is incredibly abused in today's society. The only difference is that it's being legally abused by people who took an oath to "first do no harm."

Diana J. said...

Very nicely put.

Also, just because he/she disagreed with you doesn't mean he/she has to be a jerk about it!! There's room for civility in all disagreements.

Great points!!

Anonymous said...

Great response. I predict this resident has a "God complex" and will use it to his/her advantage to intimidate women into being degraded in birth.

Sarah H said...

"White coat-God complex" is what my ICAN friend calls this kind of attitude.
At one of the last births I was at, the on call doc told the couple she couldn't wait to till the cord stopped pulsing to cut it, that instead she would have to clamp it right away. The husband said "I understand that's what you normally do, but from what we've researched we believe this is safe, and from what I understand, since it's our birth and our baby, it's our decision to have delayed cord cutting". they bantered back and forth a bit and then the dr. actually told him "I'm the only one in this room who has been to medical school!". We were all flabbergasted. She left the room and pretty much abandoned care, didn't come back for three hours. Thankfully, she left at 7 AM and the couple's regular doctor, who was much more accomodating, was there for the birth.

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