The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Low-Dose Pitocin

PURPOSE: To provide guidelines for using low-dose pitocin to stimulate the latent phase of labor and smooth the transition into active phase labor. This is achieved by using lower doses. low-dose pitocin also seems effective for cervical/myometrial ripening.

1. OB providers are to document appropriateness of using low-dose pitocin, and the indications for induction.

Examples would be:
a) someone who has had a day of pitocin induction without significant cervical change, but for whom prostin is not appropriate ( eg presence of some uterine contractions), and rest for the night is indicated.
b) an alternative to prostin for cervical ripening.
2. Monitor for a 20 minute baseline strip before initiation of pitocin. Notify CNM/MD for deceleration, absence of beat to beat variability or other signs of fetal. distress.
3. Primary IV of LR 1000CC.
4. Add 10 units of pitocin to secondary IV of 1000cc LR.
5. Start pitocin infusion at 1 MU, increasing 1 MU every 45-60 min up to a maximum of 8 mu. Levels of 4 might be appropriate throughout the night. The object is to create mild contractions, not aggressively manage labor.
6. The pitocin need not be increased and may be stopped if the patient achieves cervical change, a good contraction pattern and good subsequent labor progress.
7. Vital signs per hospital protocol.
8. Discontinue pitocin and notify the provider for:

a. fetal distress, unresponsive to normal measures
b. uterine tetany or prolonged contractions
c. inability to maintain adequate nursing coverage
9. If pitocin is restarted, start at 1/2 the previous rate and increase slowly.
10. The OB provider should be readily available when pitocin is used.
11. More aggressive pitocin can be used for induction/augmentation. Some suggest doubling the dose fairly quickly up to 8 MU ( eg: 1,2,4,8, ) then increase by 4 MU done every 15-30 minutes. Notify the CNM if inadequate contractions at 20 MU. This is individualized based on the situation and indications.

We've used low-dose Pitocin for cervical ripening for probably 5-6 years with varying degrees of success, we have a protocol at all of the hospitals here that spells out procedure, essentially the mom is admitted in the evening, has a baseline efm strip run, has an IV started and pitocin is begun at 1mu/min and slowly advanced until mild/moderate uc's are occurring q 3-4 min, monitors are usually left in place if the mom doesn't mind (I usually write orders to take them off after 2 hours). She is offered Seconal 100mg po for sleep (may repeat x 1 if not asleep in 1 hour) and has vitals and fht's (if not monitored) q 2hours while awake, if asleep is left alone, with an unripe cervix (low Bishops score) the cervix usually softens and begins to open, usually at 6am an exam is done and the pit is changed to the normal dosing regimen increasing it q 15-30 min by 1-2mu/min until uc's are q 2-3 min. With the advent of cervidil we choose one over the other dependent upon the Bishop's score and maternal preference. According to our policies one on one nursing is not needed until active management begins.