Drug Commonly Used During Labour Linked To Postnatal Depression
Synthetic oxytocin is routinely given to women before, during and immediately after birth.
It’s used to induce labour, speed up labour, and cause the uterus to contract down and expel the placenta.
It isn’t clear exactly how many women are given synthetic oxytocin (known as Pitocin and Syntocinon) but we know up to 30% of women have their labour induced with this drug.
Most maternity care providers view synthetic oxytocin as a very useful and even life saving medication.
Drug Commonly Used During Labour Linked To Postnatal Depression
Much to the surprise of medical experts, however, a new study has found a link between synthetic oxytocin and maternal mood disorders.
What Is Oxytocin?
Oxytocin is a neurotransmitter and a hormone, naturally produced in the hypothalamus, a part of the brain. Women tend to have higher levels of oxytocin than men.
Also known as the love hormone, oxytocin is released when we bond with others. This happens during orgasm, skin to skin touch, laughing and so on.
Oxytocin also has a very important role during pregnancy and birth. During the last trimester, oxytocin receptors in the uterus increase and oxytocin levels begin to rise. During labour, oxytocin promotes regular and strong contractions which dilate the cervix and expel the baby and placenta.
Synthetic Oxytocin And Postpartum Mood Disorders
This new research, published by the Depression and Anxiety Journal, looked at whether use of synthetic oxytocin during labour would lower the risk of postpartum mood disorders.
The results of the study actually showed it had the exact opposite effect.
Researchers looked at the effects of synthetic oxytocin, using data in women’s birth records from 2005 to 2014.
Almost 9,700 women were exposed and just over 37,000 women were not exposed to synthetic oxytocin during labour or immediately following birth.
Women with a history of depression or anxiety had a 36% increased risk of developing a mood disorder in the year after birth if they were exposed to synthetic oxytocin.
In women with no history of depression or anxiety, the risk increased by 32% if synthetic oxytocin was used.
The researchers took into consideration other factors that might have influenced the results. These factors included whether the women gave birth via c-section or vaginally, and whether they gave birth to twins or triplets etc. In all cases, the risk remained significantly higher when synthetic oxytocin was used.
How Does Synthetic Oxytocin Affect Mood?
The researchers had hypothesised women who were exposed to synthetic oxytocin during labour and birth would have a lower risk of developing postpartum mood disorders.
In fact, they found the opposite to be true.
The researchers had made a basic assumption: that synthetic oxytocin would have the same effect on the body and the brains as naturally produced oxytocin would.
During pregnancy and birth, the maternal brain is in a very distinctive biological state, which supports the wellbeing and survival of both mother and baby. Changes also occur in the maternal oxytocin system, which protect women from the stress and physical demands that come with pregnancy and motherhood.
A normally functioning and well adapted oxytocin system works to relieve anxiety and stress, and protects against negative moods.
Naturally produced oxytocin is released in pulses into the bloodstream and brain. You can read more in this article.
Synthetic oxytocin, however, behaves differently from natural oxytocin in the body.
The synthetic version of oxytocin is delivered to the body by an IV drip. It doesn’t cross the blood-brain barrier and can’t affect the central nervous system. Consequently, synthetic oxytocin doesn’t have any positive effect on maternal mental health.
Other Contributions To Mental Health
Induction and augmentation often lead to other interventions. A synthetic oxytocin drip means there will be continuous fetal monitoring, which limits the movements women can use to help them work through contractions and fetal positioning.
There are some very real differences between normal labour and induced labour, which you can read about here.
It’s also very rare for a woman to have a synthetic oxytocin drip without eventually requesting an epidural. This is because contractions are extremely intense from the beginning, and because her brain isn’t triggered to release endorphins, the body’s natural pain killers.
Instead, her body is pumping adrenaline, in response to the pain and stress of induction. Eventually, she will be unable to cope with the pain and will request an epidural. In many cases her care provider will do little to support or encourage her to avoid one.
Epidurals, combined with synthetic oxytocin, have been shown to reduce the levels of naturally produced oxytocin in mothers; this increases their risk of developing mood disorders after birth.
Why Is This Cause For Concern?
In many countries, up to 30% of women are induced or have their births augmented with the use of synthetic oxytocin. Yet there is very little research being done into the long-term effects of such a commonly used drug.
Induction can be life saving, especially if a mother or baby has developed a medical problem that means it is safer for the baby to be born than for the pregnancy to continue.
However, many births are induced for entirely non-medical reasons – such as maternal impatience, or because the pregnancy has gone past the estimated due date.
You can read more in 8 Reasons To Say No To Labour Induction.
Synthetic oxytocin is also used to stimulate contractions when a care provider decides labour has stalled. In fact, the guidelines for labour progression are based on outdated studies, despite more current evidence that shows women can dilate more slowly than the widely accepted benchmark rate of 1cm per hour.
One of the more common uses of synthetic oxytocin is in an injection, to speed up the expulsion of the placenta after the birth. This injection is often given without informing the mother or requesting consent, and in spite of strong evidence showing the benefits of a natural third stage.
The study cited used a large sample size, which makes the results very significant, and raises very important questions about the use of such a commonly applied drug.
What Does This Mean For Women?
If the use of synthetic oxytocin is suggested in your case, it’s important you understand the risks and benefits of this drug.
In a situation where continuing the pregnancy is not safe for you or your baby, discuss with your care provider all alternatives to synthetic oxytocin for induction.
You can read more about this in Methods Of Induction Of Labour – 4 Different Methods.
However, if synthetic oxytocin is the only safe option available, you can plan to have a positive induction.
High quality and supportive postpartum care are essential for all women who are exposed to synthetic oxytocin, especially those who have a previous history of depression or anxiety.
Improving maternity practices and ensuring women have access to models of care that promote normal birth will go a long way to reducing unnecessary inductions and augmentations.
When oxytocin is produced naturally through undisturbed labour, skin to skin and breastfeeding, it lowers a mother’s risk of postpartum mood disorders. Oxytocin is critical to ensure mothers thrive; their wellbeing has long-term effects on their babies and on community health.