labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, July 8, 2009

My Take On Pit To Distress

Wow. This one has me shaking my head....pit to distress is a saying I've heard kicked around, but not in the sense that is being discussed in the blogosphere. Let me explain:

-Pit to distress is being discussed as a method of pushing the IV pitocin to a point of fetal distress, thus giving a reason for a c-section.

-Pit to distress has never been anything I have ever seen as a nurse or midwife as described above. But- and this is a big but- I've heard of it being used in the past a bit differently, before more research went into effective & safe protocols for labor induction and augmentation. But (again)- never in a way to purposely gain a reason for performing a c-section. It was done more because the thinking was "more equals better and gets the job done quicker" and then all of a sudden trouble began. Or, I've heard it being used to describe how a physician was on a nurses case for not "pushing the pit" fast enough (like every 15 or 20 minutes on the nose) and the nurse muttering something like: "what- do they want me to pit to distress here?"

I can not imagine that such pit to distress protocols for the sheer purpose of requiring or leading to a c-section for fetal distress exist. It is such blatant malpractice, I can't imagine that it happening on several accounts. First, the nurse is the one physically "pushing the pit". Labor nurses put their licenses on the line if they were to administer a medication that caused injury. If a physician or midwife was to order an unsafe dose at an unsafe rate, a prudent nurse will question the order. If she gets resistance, she goes to her charge nurse or manager. Ideally. And even if she doesn't go through her channels of management, she can "push the pit"slower than ordered based on fetal heart rate and uterine activity, or because she doesn't feel safe going at doses and rates ordered. Technically this is a med error because she is not administering a medication as ordered, but if there are protocols in place that dictates safe usage she usually just has to maintain proper documentation to say why she is "holding" the pitocin at whatever rate she is at.

There are standard protocols that most hospitals use when it comes to pitocin, so a provider who goes off the protocol is calling attention to what they are ordering. Here is another opportunity to question such use of pitocin.

There are "high dose" and "low dose" regimes published in the literature and obstetric textbooks. The high dose regimes are not necessarily more effective than low dose, in my personal experience, but they still have never been used that I've seen to purposely create a distress situation that requires emergent c-section delivery.

Not sure exactly how this all got started, but thought I'd throw in my two cents on the matter. I'd be interested in hearing from other nurses or midwives who have experience with this, either seeing it first hand or not at all. I've worked in several hospitals and have never seen the pit to distress thing as described by others.


Reality Rounds said...

I have never heard and certainly never seen an order for "pit to distress." I am a NICU nurse though so I may be unaware. I am going to ask around at work about it tomorrow. I agree that no prudent nurse should ever follow an order like this.

Maria @ A Mom Is Born said...

This is one of those things that is so horrifying I want to close my eyes and insist that it's not there.

What Jill is describing in her blog sounds like megalomania, docs drunk on their own power.

And, truly, I believe in the goodness of people, even MD's who see birth as a medical event to be managed. I just don't want to imagine that there are docs out there looking to create fetal distress.

Am I naive?

RN to be CNM said...

I agree. I currently work in a large tertiary care labor and delivery unit. I have never once heard "pit to distress" while I've been here. There are 2 doses of pit: low dose starts at 1 unit and is increased by 1 unit every 30 minutes and high dose starts at 2 units and is increased by 2 units every 30 minutes. Their protocols were based on the latest evidence research that less is more and most of the providers use the low dose method.

kori said...

yes. won't go into much more detail since I can't be anonymous here. but instructions that I have received verbally are "pit to progress, or pit to distress." as in, crank the pit because that baby's coming out by X pm one way or another.

Joyce in the mts. said...

Well, I hear you and I was pretty shocked when I first heard about this "Pit to distress" stuff myself. I met a woman just a few months ago; a nurse working L&D at an urban teaching hospital in the mid-west. She told me about this (she was clearly shaken and upset by what she'd witnessed) and I was actually dumbfounded as the info percolated through my head- my jaw probably hit the floor. (Apparently I am naieve. I'm a doula and have never seen or heard of this nearby to me, but who knows?) I couldn't imagine this being allowed to happen, but that's the thing- I don't think it's supposed to be widely known.
Perhaps, at this juncture, it's best nipped in the bud by exposure to the best disinfectant: sunlight, before it gets too entrenched. (But I have this sinking feeling, that is happening more routinely in more places than you or I would want to imagine.)

Milk Chocolate Midwife said...

The term "pit to distress" is one I learned of years ago while talking to a well-seasoned L&D nurse. She referred to it as "pit to D & D" - distress & deliver. It may not be a practice done with the intent of distressing a baby (I don't think most doctors are actively trying to hurt moms and babies), but isn't that what often happens when high dose pit is ordered? Too many nurses and midwives have seen too many docs trying to get pit pushed high and quick with the intent of getting mom delivered by a certain time or day. The term is not one that would be stated in an order due to malpractice issues, but the practice exisits nonetheless.

Real said...

It sounds like "pit to distress" is so purposeful. But with our current birth culture, isn't that essentially what's happening so frequently anyway?

mitchsmom said...

I have heard this term thrown around, usually as an exaggeration or means of complaining about the effects that pit can sometimes have. I've always just heard it as an off-hand expression and never a literal term or literal order.

We do have one provider who tells us to "crank up the pit" all the time, but we have routine orders and limits that we adhere to at all times. She really just wants us to hurry and get the patient started and keep on track with it.