"Pit to Distress": Your Ticket to an "Emergency" Cesarean?
Monday, July 6, 2009 at 9:43PM
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 Pitocin 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.
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.
Follow-up post: “Pit to Distress” 2: Why We Are All Distressed
View Printer Friendly Version
Email Article to Friend
Reader Comments (80)
That is truly disgusting. And then when the woman balks, they berate her for "putting her baby in danger"
Wow, I can't believe I have never heard of this before. It just makes me so mad. Purposely putting your baby in distress so they can wisk you off for a cesarean. This is not right!
Yet another example of how evidence based medicine is not practiced in obstetrics.
Remembering George W. Bush and the Love of OB-GYNs
Posted By Christine C. On January 19, 2009 (11:23 am) In Politics
On the final day of George W. Bush's presidency, we bid farewell not only to eight years of failed policies but to gaffes like this gem:
At a rally of cheering supporters in Poplar Bluff, Missouri, Bush made his usual pitch for limiting "frivolous lawsuits" that he said drive up the cost of health care and run doctors out of business.
But then he added, "We've got an issue in America. Too many good docs are getting out of business. Too many OB-GYNs aren't able to practice their love with women all across this country."
What's your favorite Bushism?
Article taken from Our Bodies Our Blog - http://www.ourbodiesourblog.org
URL to article: http://www.ourbodiesourblog.org/blog/2009/01/remembering-george-w-bush
No offense intended to any GB fans out there.
I am so glad I have a bit of a choice as to where I'm going to have my baby - I plan to have her at a local birth center staffed by midwives. They will whisk me off for a c-section if the baby is breech, but so far, at 37 weeks, she's still head down... Fingers crossed!
I am so appalled by this that I cannot even gather my thoughts enough to express how I really feel. I am a doula and soon to be childbirth educator and my husband is a bit of a birth junkie himself. When I told him about 'pit to distress' his response was 'what do they think pregnant women are?'
i am with you, I would do it at home. I unfortunately had an inverted t incision c section (for a face first presentation) and don't know if VBACing at home is the wisest choice for me but I can guarantee you this, I will NOT be having any unnecessary interventions and I am educated enough to know when it's necessary or not.
Lorien, I agree. Try speaking up and you'll hear why you should leave your and your baby's health decisions to the doctor.
CaroLyn, I didn't know you were so far along! Congrats and fingers crossed for heads down. :)
Wow - crazy stuff! Thanks for letting us know!!
Amy, I am really appalled, too. I guess we all knew it happened but I never knew it had a name, indicating that it's totally deliberate.
Anon, I love that Bushism. It's so funny, yet it shows how clueless people (or at least Bush) are about the reasons for litigation. Is the above VBAC case frivolous? Hardly. That's malpractice.
Oh. My. Lord.
*vomits*
Jill replied: Bonnie, I'll hold your hair back.
I am so thankful to live in this high tech world so this kind of information is available to the masses. Women in the USA are coerced into so many, many procedures, and forced to comply with so many policies - most of those procedures and policies doing more harm than good for them and their babies. WAKE UP AMERICA! Birth is not an illness, and NOTHING we need to be saved from. It is a beautiful, empowering, loving, spirit-filled experience, and we need to TAKE IT BACK!
How ironic--I posted about the exact same thing last night. I wish I had seen your post first, there is so much powerful information to share here. Well done.
Hi kangaroo... I like your blog. I'm linking to the post you mentioned.
Thanks for the comment and for stopping by.
Absolutely right on!
The reality is that there are a lot of rogue doctors (and yes, midwives) that practice to the beat of their own drummer. They give the majority of good doctors a bad name. Doctors are notoriously bad at policing themselves. Most hospitals have protocols on disciplining doctors for practicing outside of standards of practice, yet it has been my experience that all that happens to them is a slap on the wrist. MD's should not be complaining about litigation if they allow their own to use pitocin aggressively, especially with a VBAC. Nurses are the gatekeepers in protecting patients in the hospital. We are the eyes the ears, and in my case, the loud mouths. However our hands are tied in some respects. If we do not agree with the MD orders, let's say "Pit to distess" and we refuse to carry them out, we can be in big trouble. We should go up the change of command, but if the top link says, "do it," we are in a difficult situation. OK this comment is getting to long, so I guess I need to write my own post on the ethics of going against an MD order.
GREAT POST Jill. This will be posted in the break room at work.
I hate how this article only paints one side of the situation. There are ligitimate reasons to use pit and yes even though I'm sure it can be overly used by some impatient doctors that is NOT always the case. Articles like this are written and put together by people who have this opinion but do not sure the con's to their own side. aka they're biased had i not had an induction my daughter would be dead. i would have waited until my contractions were 4minutes apart to go the hospital and my daughter would be dead. NOT what I want to hear. my daughter was too big for my body, it just wouldn't have happened. sometimes induction, pit, and such is the right answer for some moms. NOT all and thats fine but it is a legitimate way to go. Its up to the individual.
Class. Action. Lawsuits.
Babies are being compromised. Women are loosing insurance coverage and the human right to use their vaginas in subsequent births. Divorces can be spurred by PPD and PTSD, and these diagnoses are rising. Families are forced to deal with complications of surgery and vaginal trauma. Painkillers increase the risk of SIDS. The rates of autism and ADD/ADHD keep pushing up the scale and we don't know that it's NOT attributed to obstetric drugs.
Show me a consent form which authorizes the attending to use products against manufacturer's directions. Show me a consent form which authorizes an individual or institution to disregard the health and well being of the client in order to provide a social or monetary benefit to the provider. Sheez, show me a consent form that says something other than "The material risks have been explained to me by so and so, and I consent."
The consent forms (elective cesarean/epidural) which have been recently posted on such blogs as NursingBirth contain quite long lists of possible ramifications, but how many women are given the opportunity to sign these forms? Most are self-reporting that they "had to" sign blanket consent forms allowing any procedure in order to be admitted to the hospital, and those forms do not contain the same lists of risks.
Nurses and Hospital Midwives are subject to working in hostile environments in which they either take part in sexual assaults and gross bodily harms, or loose their jobs. The "Nurse's Curse" is evidence enough that these women are also targeted for abuse during their own births. The repeat explanation is that "My hands were tied, she signed the consent form, blah, blah."
Ladies, step up and report provider abuse!
1) Being a survivor feels better than being a victim.
2) It's harder for the abuser to hurt anyone else.
3) You're protecting yourself for the future, UNGRATEFUL PATIENT, or not.
4) Nurses and Hospital Midwives are not reporting violations for you.
5) Things will not change unless clients demand it.
Sure it's hard to go up against these people and their community standing. I wonder sometimes if my own family will be targeted for the report we submitted about the abuses we lived through during our last birth. Now I know that the words I should have used at the time were "I am going to sue you if you don't cease and desist immediately. I will own you. I will own your children." would have been more effective than "No. No. No. I do not consent. I want a second opinion. I refuse to accept treatment from that doc. Let me up. etc. etc."
This is so disgusting but I'm really not surprised. That I'm not surprised just makes me kinda sad.
In reference to stupidness...I'm not sure how inducing with pit would help get your 'too big' baby out. Unless you mean you didn't even go into labor but rather had an earlier induction. In which case there is a 99% chance that your baby was NOT too big for your body. Yes, pelvic disproportion does happen but it is VERY rare; doctors like to make women think that any baby over 8 lbs. is 'huge' and is impossible to get out which very well may be your case.
And in any case, this article wasn't about the use of pitocin, it was specifically about 'pit to distress' so what are you arguing about?
Erin's got a point. In fact, inducing a "big" baby is probably not a good idea anyway, because a big baby's got less room to move, and Pit will very quickly cement him into what could be a bad position to try to be born. There's just not a lot of logic here.
I am really curious how much your baby weighed, stupidness. I was told I could not birth a baby bigger than 6 lbs. I went on to birth my 8 lb. 4 oz. son into my own hands. Unless you have rickets or a 13-lb. baby, it's much more likely for your care provider to be feeding you a nice steaming serving of scare tactics than it is for your baby to actually be "too big for your body."
stupidness,
I hate how this article only paints one side of the situation.
As other commenters have noted, the other side would be to show the positives of “Pit to distress.” I don’t know what positives you anyone would find in upping Pitocin to the point of causing fetal distress, whether deliberate or not.
There are ligitimate reasons to use pit and yes even though I'm sure it can be overly used by some impatient doctors that is NOT always the case.
Agreed.
Articles like this are written and put together by people who have this opinion but do not sure the con's to their own side.
See above.
aka they're biased
In this case, not really because there isn’t really a positive spin on Pit to distress. But I have plenty of biased posts if you want to take a gander. The blog format lends itself to biased writing and I readily own that in the About page.
had i not had an induction my daughter would be dead. i would have waited until my contractions were 4minutes apart to go the hospital and my daughter would be dead.
Then it sounds like a mighty good thing you were induced!
NOT what I want to hear.
That some women and their fetuses are abused in childbirth? I agree. It’s not what I ever want to hear, either.
my daughter was too big for my body, it just wouldn't have happened.
I have no reason to doubt that based on the information in this anonymous comment. Of course, we really don’t know in life what would have happened and what wouldn’t have by choosing one road instead of another. But I trust that all commenters have a grasp on their own reality. If it wouldn’t have happened, then it sounds like you’re very pleased with your baby’s birth. That’s wonderful.
sometimes induction, pit, and such is the right answer for some moms. NOT all and thats fine but it is a legitimate way to go. Its up to the individual.
Sure is. I am a fan of the judicious use of medical intervention. I am not a fan of hyperstimulating babies, whether with devious motives or not, to the point of distress.
I went point by point, but not because I want to shoot you down or anything. It was just easier and clearer. This post had nothing to do with the appropriate use of Pitocin; rather, it shows different perspectives on the abuse of Pitocin. Since it's obvious that Pitocin is something very dear to you because, as you said, it brought your daughter to you, maybe you feel inclined to speak out against the abuse of a drug that brought you so much joy. I'm not sure how long ago your birth was but congratulations.
Reality Rounds, I thought of you when I posted it. I almost e-mailed you first to hear your experience (although it sounds like your hospital is pretty exemplary) but figured you would comment. Which you have. All a part of my psychic mind games.
I look forward to reading what you have to say. When I read the nursing text, I couldn't help but think what you and Anon said. Can you REALLY go to the supervisor or charge nurse and STILL have a job or respect from docs on the job? It probably depends on the environment, politics and culture of the hospital.
Anon, I hope you will submit your birth story someday. How can I tempt you to write it up and let me post it?
They tried to do that to me when I transferred to the hospital from the birth center with my first birth. And they kept cranking, and cranking, and cranking... and I will forever bless Nurse N, who "accidentally" unhooked the tube from my IV, and let that evil crap just drip onto the floor, instead of into me.
Laureen, that is the best birth "accident" story ever. Thank you for reading and commenting!
-Jill
Women and children are subjected to horrendous abuse by the patriarchal medical profession, as outlined in Dr. R. S. Mendelsohn's book 'Mal(e)practice'. Women are mostly, but not exclusively, subjected to abuse during childbirth, while babies and children have child abuse in the form of vaccinations inflicted on them throughout childhood. Medical practice, if not humanity in general, appears to be in the grip of what can only be called insanity.
I love Malepractice. It's one of my favorites. I wrote about Mendelsohn's take on unnecessary hysterectomies here.
Thanks for your comment.
-Jill
How have I not heard of this before?! How?!?
Having had a cytotec-to-distress baby a mere 2 weeks ago, I am seriously considering sending this post to my client's husband (who is a lawyer). They are still so happy about their decision, that the doctor saved the baby!, I just don't know how much they want to hear yet. What would I have done if I had known the doc said to put that second dose in even though she already had a great/huge contraction pattern? I am so, so, so upset about this, I really don't have as many words at my disposal as I want/need. I just don't know what to do.
*shaking head and wiping tears*
@stupidness: No one here - or anywhere - can logically argue that medicine isn't amazing and sometimes needed. However, there is never EVER EVER (I can state that clearly right here) a benefit to "pit to distress." Period. A necessary induction that unfortunately leads to distress? Okay. But that's not what is being talked about here. Also, as an induced mother of a "too big" child - who was born too early - I don't know that I believe that argument anymore. My son was 8 lbs 7 oz and I was told just barely small enough. Six years later, I birthed my daughter, at home into my own hands, about a pound bigger and on her own time - and in a labor under an hour. Too big indeed.
@NGM: Oh my lord! Have you even just shown them information about cytotec itself, much less to distress? How horrid! I hope the baby and mother are okay?
@CaroLyn
Breech is not reason for a c-section. Footling breech is, but the other breech positions are just as safe to have vaginally as to have via c. If not safer because of the future risks of c.
Of course I feel terrible for the uninformed, trusting women who get caught up in this system, but at this point I'm feeling more sad that this term does not come as a surprise to me.
The term I have heard of previously is "Pit to D or D." The first D is deliver, the second D is distress. The L&D nurse who told me this said that as soon as there is distress, they recommend c/s.
Seems that doctors who practice this are missing the part of their heart where anything but self-interest lies.