The Relationship between Artificial Oxytocin (Pitocin) Use at Birth for Labor Induction or Augmentation and the Psychosocial Functioning of Three-year-olds

SUMMARY OF FINDINGS OF THE STUDY

Claire L. Winstone, Ph.D. 

 

The focus of my dissertation research study was, as you can see by the above title, an exploration of whether there is any relationship between the use of Pitocin (artificial oxytocin) to start or speed up labor, and the way children born with its use function individually and in their relationships when they are three years old. I was interested in Pitocin use because what I read suggested that around two-thirds of inductions are now for non-medical reasons, but there wasn’t a lot of research to tell us whether there were any specific consequences to the child of this use.

 

Before starting this research I first interviewed six therapists who work with babies, children, and adults to resolve issues arising fromchallenging prenatal or birth experiences. All the therapists had worked with clients who had been born with the use of Pitocin. The therapists told me what they had observed and learned about their clients and the role they thought Pitocin played in their functioning. I performed a content analysis on the interview transcripts, and about two years later, had a long list of “items” that eventually became the raw material for a survey to be conducted with mothers of three-year-old children. I sent this list to the six therapists with a voting form, and they helped me select which items best represented the various areas of functioning about which I planned to ask the mothers.

 

Eventually, this list became the survey that participants were invited to complete. Ultimately, I had 498 completed surveys that could be analyzed to see if Pitocin use appeared to be related to a difference in how three-year-olds functioned.  The following is a summary of the findings that were statistically significant.

  

1.      Receiving Pitocin resulted in more negative recollections of labor and delivery, suggesting that mothers who received it had a more challenging experience than those who didn’t. However, there was a similar finding for the use of epidural anesthesia and for pain medication, both of which tend either to precede or follow the use of Pitocin.

 

2.      Mothers who received Pitocin spent less time with their babies in the first hour after delivery, and were less likely to feed their babies exclusively at the breast in the first six months. In other words, babies who were born without Pitocin were more likely to be fed exclusively at the breast in the first six months than those born with Pitocin

  

3.      Two factors distinguished children born with Pitocin from those born without Pitocin.

 

The first was called “Assertiveness”, which describes a socially appropriate way that babies and children communicate their need for help and comfort when they are feeling uncomfortable or unsafe. Typically, crying, using facial expressions and physical gestures, and later, verbalizing their thoughts and feelings, elicits helpful responses from parents, who try to identify and meet the need the baby or child is expressing. However, babies born with Pitocin, whose mothers reported having had a more challenging time during labor and delivery, appear to have a higher need to be assertive because they seem to experience more discomfort, but are apparently less effective in asserting their needs and getting them met when they feel unsafe or uncomfortable.

  

The second factor was called “Need to Control Environment” and this summarizes what seems to be a higher level of discomfort or insecurity, particularly in response to “outside-in” influences (e.g., reacting to food with digestive problems or being picky eaters; problems coping with other people’s timing and structure, refusing help from others) and increased or exaggerated efforts to control their environment, resulting in behaviors that may be more challenging to their mothers/family. There appears to be some continuity of effects between infancy and age three: for example, children who were described as picky eaters, or as having digestive problems at three, were likely to have been colicky, fussy babies. Interestingly, the hormone oxytocin is very involved in the digestive process: it plays a role in the production of digestive enzymes and as we enjoy our meal, in a positive feedback loop, we produce more oxytocin.

  

It may be that a process described as “hormonal imprinting”, identified in a considerable number of animal studies since the 1970s, is the mechanism that accounts for these differences between children exposed to Pitocin and those who were not. Using Pitocin to initiate labor may “flood” the available oxytocin receptors in mother and baby, apparently affecting children’s internal comfort levels and how they interact with others, although how this takes place in the babies has not yet been studied. Since both mother and baby receive Pitocin during labor and delivery, it is as yet unclear to what degree each contributes to challenges in their mutual relationship.  

Santa Barbara Graduate Institute

July 2008 

 Use these links to download a .pdf of the Powerpoint presentation of this material:

Microsoft PowerPoint – APPPAH 2010 Handout Format

 Microsoft PowerPoint – 6 slides per page

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My Son Tells His Birth Story

My Son Tells His Birth Story

Posted using ShareThis

I am posting this link because the story has beautiful elements that clearly pertain to prenatal and perinatal psychology and illustrates eloquently how children remember and communicate their early memories.

Meditations on Smoke and Ashes

It has been a week now since I breathed clean air. A week since I slept with my bedroom window open—something I’ve done all my life. My home in the low desert is in no danger from the “Station Fire” burning in the San Gabriel mountains, nor has it been from any of the previous fires that have raged in and around these parts: the Buckweed fire, a couple of years ago, that devoured the home of a family of four I knew, moving so swiftly across tinder-dry brush from Agua Dulce, driven by raging Santa Ana winds, that they barely had time to grab essential papers and their children, the Day fire, that burned in the vast Los Padres wilderness area near Ojai for about a month turning the skies brown and orange and raining embers and ash—the fires all have names, we hear daily of the numbers of acres engulfed by flames, “structures” destroyed, people injured or killed. Last year a fire swept through a mobile home park, destroying 90% of the homes, leaving a bleak wasteland, displacing hundreds of people whose lives revolved around their community, many of whom had lived there for years.

I wondered if I had an overly morbid fascination with fires. I keep the television on, listen to the radio in my car, check the web for updates, and search for interactive maps that show the movement of flames and the growth of the area involved. Then I realized that, really, it’s my weak attempt to control the uncontrollable—defaulting to my left brain as I usually do when overwhelmed, I feel less helpless, less awed by the terrible power of wildfires, when I have facts and figures: the location of the fire’s edges, the percentage of containment— 154,000 acres burned, 78 structures lost, 2 firefighters killed, 3 injured—natural causes or arson? (apparently, 90% are the latter—although Buckweed was started accidentally by a child playing with matches while the Santa Anas were blowing).

Ironic that, when talking and writing about birth, I am all for allowing Mother Nature to prevail, to trust that, when protected and undisturbed, mothers and babies know how to do this thing called birth with very few problematic outcomes. In birth, “civilization” has taken too much control and outcomes have worsened proportionately. Yet with these terrifying wildfires I want more control. I want Mother Nature tamed and safe. And even then, perhaps fewer homes would be endangered by fire if we paid more attention in selecting where to build: they are tucked into steep, wooded canyons, clustered in the foothills of forested mountains—places that are rich in fuel in this hot, dry climate—beautiful, but potentially deadly. I’m grateful that there has been no significant wind during this fire—it would have spread so much faster and done so much more damage, but the lack of wind also kept the haze from dispersing. *Click*–another shot of pink sun seen through brown smoke.

Physically safe though I may be, the fire preoccupies me every day. Periodically, I try to plan what to pack if I had to evacuate and feel rising panic as I realize what might be considered non-essentials in a hurried departure: my books—a sizeable collection since I completed my Ph.D. and continue to collect publications whose contents fascinate me and/or whose information I hope to use in future scholarly articles or a book, computer, jewelry, boxes of photographs, as well as more accepted essentials: personal documents (insurance policies, passports, birth certificate, etc.), clothes, shoes, medications . . . how would I ever find and pack everything in the urgency of an immediate evacuation?!

I notice ashes on my car in the morning. A colleague posts on Facebook “I’m scared! May have to evacuate!” I stop outside my hairdresser’s to photograph helicopters flying above flames. I drive to work watching for the columns of smoke noting the direction of movement of the fire.

*Click*–a shot of the haze over the desert. *Click*–a photograph of the amazingly white cumulonimbus clouds formed by the heat of the smoke and flames.

I breathe smoke going from car to buildings, I watch and take more pictures of the colors of the sky: pink, brown, grey, orange—anything but the usual intense Southern California blue.

I wonder if I will ever again relax by a fireplace and truly enjoy the crackle and smell of burning wood. I complain with my colleagues about the bad air and the triple-digit temperatures. I cough and rub my stinging eyes, and fall asleep to dream of green places: tall trees in forests, rivers and lakes, the fragrance of pine and juniper, wild ocean waves, rain . . .

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Postscript: We have learned that this fire was the result of arson.

Bumpers!

Nothing whatsoever to do with birth and babies but I have something to say for which a blog is the perfect place!

Bumpers!

Yes, those invisibly color-coordinated bits of cars back and front that are expected to protect passengers (and cars) in rear- and front-end crashes.

What the hell happened?!!!

When I learned to drive, umpteen decades ago, bumpers were big, black, rubbery-looking things that could withstand a fair amount of impact without damage to the car. On a visit back home to England I remember my cousin and her daughter laughing as they squeezed the car into a tight spot, tapping the bumper behind them in the act. Immediately, cousin and daughter laughed and announced in unison “Bumpers are for bumping!”

Today, lightly tapping the part of a car laughably called a bumper will cost you at the very least a couple of hundred to fix the paint, likely points on your record, and possibly, if the tap was less than light, a couple thou to fix the dent. Dent? What happened to “bumper”?!!! Oh, and not to mention the possibility of an additional claim for whiplash! So much for protecting car and passengers!

My previous car, the Mazda 323 I owned for 15 of its 16 years, had solid-looking black bumpers. They had survived one being knocked off kilter by a car skidding across black ice on a Vancouver corner (just had to pop it back on to its mounts—no harm done), countless minor bumps and scrapes over years of driving and parking–mine and others, protected me from possible whiplash injuries in a couple of fender-benders—and never once required dent removal or painting. Actually, I thought they made my little car look sturdy, a little more macho, and trustworthy, living up to the AAA inspector’s description of the car as “bullet-proof”—figuratively speaking, of course.

So what happened to bumpers that work—that do the job they were originally designed to do? Was it just valuing cosmetic appeal over safety that made them disappear? Another way to make money off the hapless consumer? Despite the matching paint, do they do as good a job of protecting car and passengers? Did they make the rules more lax and begin to rely instead on airbags?

I simply don’t understand. All the slick, uniformly painted cars on the road today (mine included) just don’t compare to a car with great, chunky, reassuringly black bumpers. Who do I have to talk to to bring them back?

Reducing Infant Mortality: A free film

From Debby Takikawa, the Director of “What Babies Want,” comes a new 17-minute film free for downloading, with permissions to burn it to DVD, send the link to anyone, and show it anywhere, with the only requirement being to keep the film intact. For more information, see

www.reducinginfantmortality.com

For a country that spends so much money on pregnancy and childbirth, our infant mortality rates are appalling. Listen to obstetricians, doulas, neonatologists, midwives, psychologists, pediatricians, and other physicians explain how our health care system is failing babies and mothers and what we can do about it.

Please view the film, then share it with your colleagues and friends, show it in your community, and send it to your legislators. Our babies (and their parents) will thank you!

Here is a link to President Obama’s committee on health care reform. You can send the link to the video directly to the committee–the more of us sending the link, the better chance it will be recognized as an important issue for consideration in the re-visioning of our health care system.

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“Pit to Distress”

There is currently a lively discussion going on about the order given to nurses to “Pit to distress”, apparently with the intention of causing fetal distress that can then result in an emergency cesarean.  Two days following the original post it went viral with well over 11,000 hits.  I do encourage you to read this discussion, since the trend is alarming and another very clear example of a health care system in crisis putting the safety and needs of mothers and babies last.  I feel no need to add to what has already been said by The Unnecesarean, Keyboard Revolutionary , and others, so I will only make a brief comment here about the perinatal psychological implications of this:

What astonishes me over and over again is that no-one ever, ever seems to consider (well, actually Sarah Buckley does) what it may mean to motherbaby to have a massive overdose of Pitocin binding with oxytocin receptors at a time when oxytocin is supposed to be surging ready for post-birth bonding, not to mention all the consequences of distressed babies, crash sections and traumatized mothers and babies. Michel Odent said somewhere: “When human beings release adrenaline, they cannot release oxytocin.” Why do we settle for so little? The “at least you have a healthy baby” offered as the consolation following a cesarean is questionable itself, unless “is breathing and has a pulse” is all you need to meet the criteria for “healthy”.

What does it mean to begin life with life-threatening trauma entirely as a result of someone who is too impatient to allow nature to take its course? Assuming that the cesarean ensuing from “Pit to Distress” is successful and there are no lasting physical problems for mother or baby (which, of course, we can’t assume in all cases!), what is it like to have adrenaline and cortisol flooding your system, likely an overnight stay in the nursery, a mother in recovery from major surgery, and delayed or failed breastfeeding, instead of basking in abundant endorphins and oxytocin, nursing and falling in love?

Animal studies have suggested that interfering with the oxytocin system at birth may have enduring consequences: for digestion (in which oxytocin is involved) and social functioning.  We also know that the oxytocin system is implicated in autism spectrum disorders and schizophrenia.  Now that is not to imply a causal relationship between the two–I’d be the last to suggest this, but I do wonder about social functioning when birth becomes disruptive to the hormones involved in the primary attachment relationship.  Rixa Freeze, in her own discussion of this issue, Pitocin Protocol and emergency cesareans, cited a recent study, Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries which noted that “As oxytocin utilization declined from 93.3% to 78.9%, emergency cesarean deliveries decreased from 10.9% to 5.7%”. I know I’m not the only person shocked that a hospital would consider 78.9% oxytocin use a good percentage!!  That means more than 3/4 of women birthing at that hospital are being given Pitocin! Does this mean that 3/4 of American women are incapable of giving birth without chemical help? Are their bodies “broken”?  Or is it the health care system?

What will it mean for all these babies/children/people to have started life rushed into the world with the wrong chemicals flooding their newborn bodies? What will it mean for their mothers: oxytocin receptors flooded with a synthetic  that, while a perfect chemical copy of oxytocin, cannot replicate its multiple functions at birth, in our bodies, and in our daily relationships.  And what will it mean for society?

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Here is a link to flow-chart of typical consequences of Pitocin use:

http://www.birthinternational.com/parents/obstetric/diagram.html

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Musing About Prenates

Imagine that you are fast asleep.  Suddenly you are awoken by a strange and frightening sensation. It seems to be inside your body and you might equate it to suddenly having 12 cups of espresso in your system, only worse—it’s more jittery, more jagged. You can’t escape the sensation, it doesn’t seem to go away, and you can’t possibly go back to sleep. But what’s really scary about it is that you don’t know or understand what it is, or if it might get worse. Your heart is racing and you seem to be having trouble getting enough oxygen. You don’t know if you are going to survive this onslaught that seems to be coming from inside you and racing through your body and you don’t know how long it will last. There is no escape. After your first or maybe second experience like this, you become too anxious to be able to relax and sleep, never knowing when this experience will be repeated and whether you will survive the next time.

 Imagine then that this same experience happens unpredictably for a number of months: perhaps only occasionally, perhaps daily or even more often. This may be what it is like to be a fetus exposed to maternal substance abuse: particularly a substance like methamphetamine. The fetus is also exposed to its mother’s stress hormones–adrenaline, cortisol, norepinephrine—depending on her circumstances: there may be domestic violence, she may be homeless, prostituting, and not eating well. She is unlikely to get regular prenatal care and her baby may come early, and spend time in the N.I.C.U., where its already hypersensitized nervous system is further assaulted by the standard care that infants receive in most neonatal intensive care units: no warnings before a diaper change, a bath, or a needle being poked into a vein: if they are lucky, a nurse will speak softly to them, if not, sounds, lights, sensations and medical procedures can be exhausting and overwhelming. In addition, many of these children are detained from their mothers at birth and find themselves in the care of others: perhaps family members, or strangers. Some of the babies not detained at birth show up in the child welfare system months or years later: victims of neglect and possibly abuse.  

 By age three many of these children are being “suspended” or “expelled” from their preschool or day care for their aggressive behaviors, their resistance to following directions, their disruptiveness and their inability to relax and sit quietly through an activity or story. Many also have problems with falling or staying asleep, which may add to their irritability. By five, many of them will have been diagnosed with Disruptive Behavior Disorder, AD/HD, Oppositional Defiant Disorder and other similar childhood diagnoses. Some will begin on medication early, sometimes for a lack of alternative treatments (such as occupational therapy for sensory processing and/or regulatory disorders that often co-occur with AD/HD), or to keep their teachers happy and keep them in school, perhaps making it possible for them to avoid being placed in Special Education classes or classes for “emotionally disturbed children.”

 I have a theory. I wonder if the sensations of angry feelings inside a preschooler are experienced as similar to the sensation of drugs in their bloodstream prenatally. I wonder if these children therefore believe that they cannot control angry feelings (the very big angry feelings common in 3-5-year-olds) because they couldn’t control the sensations of the drugs entering their fetal bodies carried by blood from their mother through the umbilical cord (although apparently many try—they instinctively contract the muscles around the umbilicus in a vain attempt to squeeze off the offending substance, but of course, can’t do this with complete effectiveness because they’d also be reducing their oxygen levels. These children tend to have constipation as infants and gait problems when they begin to walk from this chronic pattern of muscle contraction.  I wonder if each time they experience feeling angry and frustrated they also feel the terror of possibly being annihilated by those sensations, just as they formerly feared the very real possibility of dying as a result of a huge overdose of a drug for the size of the fetal body. I wonder if their hyperactivity and inability to settle and focus results from the hardwired need to be hypervigilant, to watch out at all times for the next possible threat to their survival. I wonder if their aggressive behaviors are the result of the fight/flight system having become the dominant operating system at such a young age. Not necessarily that they are just plain aggressive, but that they perceive every stick to be a snake, every movement around them to be a potential source of danger.

 I wonder what these souls seek in such a life experience. What makes them survive circumstances that might result in miscarriage for another fetus in a similar situation? They used to say that our fears for “crack babies” were overstated and that many turned out just fine. A psychiatrist I know said that prenatal drug exposure is such a random process it affects the brain like scattershot, so the damage is like Swiss cheese: little pockets of damage concealed among normal brain tissue.  You may see the effects right away or not until later on. And no two children so affected are affected in quite the same way, though there are commonalities in many (see above).  Is it treatable?  Yes, I think so, in most cases. But whether the appropriate treatments are available and affordable varies by location and family circumstances. And then there are the families. Some are in denial that there is any problem. Others simply don’t notice anything out of the ordinary until later on. Some have limited resources. Some are misled by practitioners who are unaware of the possibilities for helping such children into thinking there is little or nothing they can do. Many children ultimately get medication, which treats symptoms, but not the source.

 I would so love to find out what’s being done for these little ones around the country, and around the world. I’ll bet there are pioneers all over the place, some of whom are doing marvelous, brilliant things. I only wish they were right here where I live and work!

Here is a link to a report of a recent study on prenatal methamphetamine exposure: http://tinyurl.com/lgf5do

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Michael Jackson: The Power of Early Trauma

What is tragic about Michael Jackson’s death, by whatever physical cause is ultimately determined by the Coroner, is how it was the perhaps inevitable outcome of a perfect recapitulation of his traumatic childhood. He said that he never had a childhood, and was “terrified” of his father. He said that he felt safe onstage, where he could shine and feel loved by thousands of people at a time, and unsafe just about everywhere else. Behind the scenes, he faced a father who was abusive and experienced tremendous pressure to perform perfectly. He spent a lifetime trying to make himself over to please those he loved, and those who he believed loved him, and clearly found himself flawed.

At the end of his life, looking less than robust and possibly continuing a long-standing addiction to narcotics, once again he was under tremendous pressure to perform—in 50 concerts, for heaven’s sake! And again, by powerful, intimidating father figures in the form of his financial backers who expected him to sing and dance his way out of monstrous debt while making them a handsome profit. Whether these individuals were truly intimidating or not doesn’t matter: Michael would have experienced them that way—that’s part of the recapitulation. Terror induces trauma and similar situations may trigger trauma memories on a physiological level. The expectation was essentially to equal or surpass his performances at his prime—and make no mistake, Michael Jackson at 50 was no Mick Jagger at 64—the robust Jagger’s life story is a very different one. While he clearly longed to be back on stage and adored, and was working hard to prepare for it, perhaps Michael knew there was no way he could meet those expectations and struggled with the anxiety of attempting to do so, or perhaps he just “lost heart” for such a crazy endeavor and felt as trapped and helpless as the little boy he was when all this began. What fascinates me is how he managed to manifest such a sadly similar experience at the end of his life as he had experienced as a child. What a brilliant, shining star he was, and what a truly tragic life he lived! I really hope he is at peace now.

Here is a link to a related article describing Jackson’s life: http://www.cnn.com/2009/SHOWBIZ/06/26/michael.jackson.spotlight/index.html

Baby Daddies: In memory of my father, Samuel Winstone, who passed away March 1977.

Claire and her daddy

This is for all the baby daddies who aren’t at home for their children to celebrate; for all the daddies who sowed the seed but were not around to water the plant and support it to grow straight and strong into flower.

This is for all the baby daddies whose boys are lost and angry because no-one has shown them how to grow up to be men; who seek fathering from their peers, from gang-bangers and drug-dealers bedecked in bling. Who endlessly question what they did, or what was wrong with them, that made those daddies go away and not return, who medicate the pain of loss with booze, with speed, with weed, and grow up to walk out on their own babies because they have no other blueprint.

 This is for all the baby daddies whose daughters have never heard from a trustworthy male that they are wonderful, beautiful, and brilliant, that their sexuality is awesome and precious, and not to be toyed with frivolously. Who never learn how to be in a healthy intimate relationship because no-one has shown them, who trade sex to try to get the love they missed, and who make babies with new baby daddies who leave them loveless and with child.   

 This is for all the baby daddies whose children were harmed because they were not there to protect them, who went hungry because they were not there to work for food to put on the table.

 This is for all the baby daddies who were hurt, neglected or abandoned by their own fathers and have never confronted the pain of their losses, but unthinkingly followed in those tracks . . . and those whose anguish has led them to be behind bars.

 This is for all the baby daddies whose children have no-one there to celebrate on this day . . .

 Today is your day too.  It could be the day you decide to break the cycle, to be the generation in your lineage who found the courage to go home, to ask forgiveness, and find a place with your children. Today could be the first of many on which your children will have reason to celebrate—and so will you . . .

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More on absent fathers:

Here is a link to a terrific spoken word piece:

http://www.youtube.com/watch?v=nktBsI0PYPs