Surprise! Pitocin and Postpartum Depression are Linked!
Much to the surprise of the medical community, a 2017 study showed that Pitocin and postpartum depression and anxiety are linked (not a causation but a link). The mothers aren't surprised.
Pitocin®, a synthetic form of oxytocin, is routinely given to women before, during and immediately following birth to induce and augment labor, and to also prevent and treat postpartum hemorrhage.
--->>> According to the 2017 study, women with a history of depression or anxiety prior to pregnancy, receiving Pitocin® increased the risk of postpartum depression or anxiety by 36%. For women with no prior history of depression or anxiety, receiving Pitocin® increased their risk of postpartum depression or anxiety by 32%. Let that sink in for a moment.
I Bet the Numbers Are Even Higher
While I pondered these incredibly high numbers, it occurred to me that the numbers may actually be higher. The information used in the research study came from women that received a diagnosis and/or a psychotropic medication. What about those that didn't seek help?
In my experience, many women do not seek professional help when experiencing postpartum anxiety and/or depression. How many anxious or depressed mothers never confide to their care providers about what they're feeling? Or even worse, were dismissed and told "everything will be fine".
It's Not Just in Our Heads
Even if the numbers may be higher, the research as is, is incredibly validating. Ladies, what you are feeling is not "just in your head". It's real, and it's a big problem (that society has no idea how to handle).
*For a list of symptoms of postpartum mood disorders please visit Postpartum Progress. (Postpartum Progress is a non-profit that aims to raise awareness, fight stigma and provide peer support and programming to women with maternal mental illness.)
Pitocin Is Not the Same as Oxytocin
The strangest thing about the research study was that the hypothesis was the opposite of what made sense to me as a mother and childbirth educator. The hypothesis suggested that synthetic oxytocin, Pitocin, would in fact lower postpartum depression and anxiety.
The underlying assumption I am gathering is that, despite the evidence, medical professionals believe that Pitocin® is the same as oxytocin.
A few years ago I was attending a Pitocin® induction at my local hospital. My doula client was struggling BIG TIME with the sudden wave after wave of strong, painful contractions. Her nurse, not knowing what else to do, told her, "this is just labor, honey". As if what she was experiencing were normal labor sensations. How sad.
Believe me, Pitocin® does not feel warm and fuzzy, and isn't "just like labor". My pitocin augmentation birth was much harder than my first two births. For me, Pitocin® made my active labor phase feel like the transition phase, and lasted far longer than the transition phases I had experienced in my non-Pitocin® births.
Oxytocin is Needed to Mother Well
Oxytocin, on the other hand, is helpful for coping with stress, supporting emotional and mental well-being and also helps with bonding - which are absolutely necessary for a successful transition to motherhood. (source)
Another study showed that women given Pitocin in labor had low oxytocin levels during breastfeeding. This revealed that the exposure to Pitocin® has consequences that last on into mothering. (source)
But What About the Baby?
If oxytocin is an important hormone for becoming a mother and synthetic oxytocin is linked to postpartum depression, anxiety and low oxytocin during breastfeeding. I can't help but wonder - what about the baby?
If oxytocin affects how women transform into mothers, how is this synthetic hormone affecting the baby? How is the baby affected by synthetic oxytocin before, during and after labor? Frighteningly, we have no idea.
Re-Examine Routine Procedures
If Pitocin® is linked to postpartum depression and causes a lack of oxytocin during the postpartum period, maybe it's time to re-evlatulate the use of Pitocin® as it pertains to each woman. (Never mind the baby...)
According to the CDC, induction has more than doubled from 1990 (10%) to 2010 (23%) (source). One source reports the 2020 induction rate was now at 31% (source)... which may be due to the Arrive Trial. However, just because a procedure is routine does not mean that it's a good enough reason to do it.
Another 2020 Study
Beyond the 2017 study, a 2020 study (source) highlighted that higher natural oxytocin in a postpartum woman often showed less incidences of postpartum depression, but couldn't make any conclusions regarding synthetic Pitocin®. Like the 2017 study, they "strongly recommend that rigorous studies examining the effects of synthetic OT exposure on PPD should be performed". For whatever reason, a rigorous study on Pitocin and postpartum depression has yet to be published.
We Need More Research
I'm not suggesting to eliminate Pitocin®, as it is an important life saving tool in modern obstetrics. (Shoot, I've even experienced it first hand!) However, because the consequences of routine childbirth interventions such as Pitocin® on human maternal behavior have been understudied, it would be wise to limit the use of Pitocin® until further research is completed. And if Pitocin® is deemed necessary, it would be wise and compassionate to provide quality postpartum mental health resources, especially to those with high risk factors for postpartum depression.
What if care providers were required to pay for 40 hours of postpartum doula services, a wonderful holistic postpartum mental health resource, to women that received Pitocin®? I bet we'd quickly see the true motivations behind the choices made in the care of new mothers.
Oxytocin is essential for our species to thrive as mothers. Our current methods may be meddling with the mental health of these new mothers - the backbone of society. Is the crumbling mental health of new mothers important enough for us to take action?
Comment on Pitocin and Postpartum Depression Are Linked
Thank you so much for reading! Please leave a comment and let me know your thoughts. What do you think about how Pitocin and postpartum depression are linked?
Hello Lindsey Morrow: Thank you for your article, very informative.
25 years ago, I gave birth to my daughter. I insisted on no pan relief during labour. I'd read that my body would produce it's own Oxytocin if I let it do it naturally. I also went through almost the entire labour staying upright, & the birthing was done with the bed back raised to facilitate gravity. For about 1/2 hour during the hard labour, my coach insisted that I lay down. I did it for her sake, she was tired of holding me up during contractions. During that short time of laying down, the pain was excruciating. When I got back up, there was almost no pain. Not much more than a mild toothache. I did not bleed after birthing, so I did not receive Pitocin. Do you have any theories on why staying upright during labour is helpful? Do you have any theories on why natural body Oxytocin might alleviate postpartum anxiety & depression?
Thanks for posting this. I agree that we should not use Pitocin for the convenience of moms and doctors. I'm so glad there's good research now to back it! I hope you keep advocating for postpartum maternal mental health care. 🙂
Obstetrical abuse is real and imprinting on both mother and baby. See: http://members.tranquility.net/~rwinkel/MGM/birthUSA3.html
Thank you for this article.
I think this is the drug I was given to help speed up the final stages of my labour. Honestly it was horrific - I can't bear to think about those last few hours. I think I suffered from Post Natal Anxiety.
I'm now pregnant with my second baby and am nervous about the PNA returning. I will definitely try to avoid the drug this time round if I can.
The trouble is once you are in hospital I found that nothing is offered to you in terms of choices. The doctors and nurses never remind you everything is a choice. I blindly went along with everything they told me I should do or have. And the result I feel was a terrifying experience with no friendly face or kind words. I spent the first few hours after the birth sobbing my heart out in a room in my own.
Thankfully with the help of wonderful online communities like this I have armed myself with hopefully extra self confidence and awareness - hopefully this time round it will be a different story x
I was also given Pitocin just like many others who have commented here since my water had broken and I wasn't having enough contractions to get labor going. Then, my baby's heart rate was having a lot of decelerations and they told me I would have to have a C-section to get him out safely. And *then* they told me that my baby had pneumothorax at birth and would need to be in the NICU for three weeks. After he came home I started experiencing really intense postpartum depression and I really wish I knew about this beforehand. Thank you for educating all of us!
It's so important that subjects like this are discussed and that awareness is increased. There are so many unknowns within the birthing arena and I'm glad there is at least scientific research being done in this area. We need more research. Procedures have been brought in - Not sufficiently researched first - Have then become the norm - Then clean, double-blind trials become unethical. Ultrasound, strep B & vitamin k are just a few areas with such issues...but the list goes on...it makes our right to informed choice incredibly challenging
Thank you! I agree... we need more research!
I had my son a year an a half ago. I did not have any complications during pregnancy or labor and my goal was to have a natural child birth. My doctor came in at the very end when my nurse said I was ready to push. The doctor rushed in, told me how long this would take all depended on me. Told me to stop making so much noise and start pushing. My body did not feel like it was time but at the doctors orders I pushed as hard as I could for 20 minutes. My son was born healthy. My placenta and umbilical chord were still connected and the doctor didn't want to wait for it to come out on it's own. She gave me Petocin to get the placenta to come out quicker. This could have been avoided if the doctor was patient. I don't know if it's related or not, but I had a terrible post partum experience. I had pretty bad depression that lasted nearly a year.
I'm so sorry you were rushed during your birth. And I'm so sorry you struggled postpartum. I hope you find healing. ❤
Frankly, I'm a little disappointed in some of the above replies from medical professionals. Sure, faults can be found in virtually any study, depending on the research, how it is conducted, and the side for which you're advocating. The initial hypothesis of the study was to investigate the role pitocin plays in reducing PPD. However, the data collected, as biased as it is, seems to be the opposite. Because the study was conducted to produce a different result, of course there are going to be flaws in it due to the way they selected the "control" group. But, just because the numbers aren't completely accurate for pitocin hypothetically contributing to PPD doesn't mean that the whole thing is invalid. This blogger clearly states that this is not hard evidence of an issue, but rather there is absolutely a cause for concern with the use/overuse of pitocin as it relates to PPD, the stigma associated with PPD that is often why women don't seek treatment for, the lack of knowledge and research there is on the matter, and the need for more information, research, education, and understanding that both doctors and patients not only require, but deserve in order to make truly informed healthcare decisions.
My baby was growing rapidy inside of me. I was given a choice of inducing 2 weeks early for natural child birth,, a scheduled c-section a few days before due date, or let baby decide but if she comes in between it would be a difficult natural birth and possibly lead to emergency C section. The doctors never told me about the risks of Lito in and I am suffering from post partum OCD/anxiety.
Given the risks that come with C-section, and the risks with pitocin for induced labor- which is the larger evil? Is it better to be induced to avoid csection or better to wait and see with a high risk of emergency c-section?
I wish I was given more facts before making the choice.
Check out this article: https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/ Unfortunately the evidence doesn't necessarily backup induction or scheduled c-section for suspected big baby. How big was your baby anyways?
Does Pitocin cause postpartum depression? If you believe headlines like these (“Pitocin Use May Increase Risk of Postpartum Depression”), you might think so. But a closer look at the study reveals the headlines are not always what they seem.
The study appeared in the journal Depression and Anxiety and noted an association between synthetic oxytocin (US brand name: Pitocin) and postpartum mood disorders. Let’s review the actual numbers.
This is a retrospective study, meaning it looks at events that have already happened. Charts were reviewed for one medical system between 2005 and 2014. 46,732 women were identified who had one or more deliveries in the time frame. Of these, 9,684 had pitocin within 2 weeks of delivery and 37,048 did not. The pitocin may have been for induction, a contraction stress test (stimulating contractions while monitoring the baby to make sure the baby can tolerate labor), or postpartum hemorrhage.
Among women who had pitocin, there was a 32% increase in postpartum mood disorder (36% increase if mom had a history of a postpartum mood disorder). This increase held true whether the birth was the first or second, whether it was term or preterm and whether it was vaginal or cesarean delivery.
So, if there is an increase in postpartum mood disorders, doesn’t that mean that pitocin causes depression? Not necessarily. Just because two things are linked does not mean one is causing the other. The classic example is ice cream sales and shark attacks. When ice cream sales go up, so do shark attacks. Obviously, the ice cream sales are not the cause of the shark attacks, merely an indicator of summertime, when folks hit the beach and are therefore more likely to encounter a shark. In that case, the headline shouldn’t read, “Eating Ice Cream May Increase Risk of Shark Attack” because that’s not true.
This study is an example of a correlation. Pitocin use in women is correlated with postpartum depression, but that doesn’t necessarily mean that it causes depression. In fact, there are a number of reasons why the correlation may exist.
Oxytocin, sometimes called the “love hormone” is responsible for those loving feelings mommas get when they see their babies. Oxytocin levels in women with postpartum depression have been found to be lower than levels in women without postpartum depression. This “love hormone” is also responsible for uterine contractions. Postdate, or overdue, pregnancies and “failed inductions” have been shown to have decreased levels of oxytocin receptors. Perhaps these low oxytocin levels and decreased receptors are the reason why the patient needed pitocin for induction or augmentation of labor in the first place. Obstetric complications in general increase the risk of postpartum depression. Many of those complications involve treatment with pitocin.
Just like the ice cream in the shark attack example, the need for synthetic oxytocin use may simply be a marker for those with already low levels or low levels of receptors.
A more helpful study would randomize women to elective induction or spontaneous labor and then compare subsequent postpartum mood disorders. That might help tease out some of the questions about whether the pitocin is causing the depression or merely being used in women who have decreased oxytocin levels or receptors to help with labor progress, who also happen to be at risk for depression.
Still, this study is important, even if it isn’t quite what the headlines made it out to be. While all postpartum women need to be screened for depression, knowing which mommas needed pitocin for an obstetric complication will help healthcare providers identify women who may be at increased risk for postpartum depression.
If you are having symptoms of postpartum depression, whether you had pitocin or not, see your healthcare provider right away. You are not alone, mommas.
Thank you for such a detailed and well thought out comment. I love it.
I think there is a difference between how may oxytocin receptors were formed in the myometrial tissue of the uterus and how many a person has in an already formed brain. I don't think it's entirely accurate to assume the two are related, since they form in the uterus as the pregnancy progresses, and are formed in the brain starting at birth.
I am absolutely a believer in using Pitocin when it's NEEDED. However, that's not it's primary use. Elective induction is a primary force in onset of labor these days. Elective, meaning no medial reason to do it. The ARRIVE trial didn't help that situation any at all. It, of course, is loaded with all of it's own issues that make it NOT generalizable to the U.S. birthing population at large.
I think the thing to keep in mind is that, generally, allowing for spontaneous labor and physiologic birth is the best way to approach birth in general. Only intervene when it's medically necessary. It seems like it should't need to be said, only intervene when necessary, but here we are. This is birth in America. And we've got the crappy outcomes to show for it.
Correlation and causality are super important to understand. In this case, it could be that women who hemorrhage are also more likely to depressed, perhaps because an underlying oxytocin deficiency led to both things. This isn't the likely explanation, though. That's because Pitocin isn't limited to women who hemorrhage. Almost all birthing women receive Pitocin as hemorrhage prevention immediately post-birth, and we're seeing this association in the entire cohort, not just those who hemorrhage postpartum.
My son was born in 1990, before postpartum depression or pitocin were talked about much, and long before blogging had hit its stride, so I could do no real pre-labor research.. I had been in labor for 12 hours when I went to the hospital, and the pain was fairly tolerable. They set up an IV of pitocin (they didn't tell me what it was, they just did it, so I thought it was water). The pain became incredibly bad, I was begging them to rip the kid out of me, kill me, just stop the pain. They also didn't do epidurals at that hospital.
I had never been prone to depression before the birth. Well, after I had him, I suffered from postpartum depression for over a year, and he suffered from colic for months, then night terrors--he didn't sleep through the night for two years. I didn't know what caused any of it, only that I wanted to hurt myself, I felt like a terrible mother. I even called a hotline once because I felt like I was going crazy --and hubby had called my mother to tell her to come and stay with me because I'd gone nuts. So no sympathy, no understanding, just a ton of pain and suffering. Thank you pitocin, and the nurses who administered it without a thought of the patient.
Not true that we know nothing about the effects of Pitocin on babies. My doctoral research, completed in 2008, looked at the use of Pitocin in birth (not post-partum) and the psychosocial functioning of 3-year-olds and found some interesting effects: on interpersonal relationships, among other things. https://www.amazon.com/gp/aw/d/B016OBFQK2/ref=mp_s_a_1_1?ie=UTF8&qid=1507958180&sr=1-1&pi=AC_SX236_SY340_FMwebp_QL65&keywords=Claire+Winstone&dpPl=1&dpID=51pm3awTrVL&ref=plSrch
I would like to see where those numbers came from. How many of the 32-36% were single moms, Or didn't have support at home, Or had other children?? By associating pitocin with PPD you are going to encourage moms to refuse it. This is a dangerous road you are steering these moms down.
I had pitocin in my first labor and it was aweful. I had postpartum depression that was undiagnosed because we were spending so much time dealing with our infant with full blown colic! (He's now 17, and a wonderful young man!). I have talked to SO many other Moms that had babies with colic, and they ALL were born with pitocin! This really needs further research!
Incidentally, my second labor proceeded naturally and it was COMPLETELY different! Painful, yes, but in a tolerable, rhythmic way that was very manageable. My second baby was also fairly calm and could be soothed when upset. It wasn't until she was born that I realized how much I internalized my previous struggles, and believed I was a "bad" mother. If I could go back, I would have refused the pitocin.
I’m curious what are better options to combat the “risk of hemorrhaging” postpartum other than Pitocin, there has to be something!
Nature's way is immediate breastfeeding, which is so powerful that when the nurses come to mash my uterus post-birth, I have to beg them not to because my uterus is already contracting massively ... and without mashing, and without Pitocin, it contracts back down to normal size far faster than the one time that I did have Pitocin.
That doesn't work for every woman, and not every woman will attempt immediate breastfeeding, but it's powerful enough that it should be the #1 recommendation, and Pitocin should only be given to those who can't or who refuse to attempt it, and certainly to those at high risk of hemorrhage and/or showing signs of hemorrhage.