Studying the Relationship Between Pitocin, Labor and Behavior

The Joy in Birth blog posted a summary of a very interesting study of whether the administration of pitocin during labor affects a child's later behavior.

As her Ph.D. thesis, Claire Winstone devised a survey to see whether the personalities or behaviors of three-year-olds differed based on whether their moms had pitocin or not. She found two distinguishing characteristics:

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. ... 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.

Blog author FairyMom doesn't provide a link to the study or information on who Winstone is; I think she may be this prenatal psychologist. In any case, the synopsis of her study is worth reading on the blog.

Comments

[Phil]

I was intrigured with the article, but was a bit non-plussed at the decor and not citing the link, as I did not locate this article on her website.

What would interest me regarding those who choose to induce labor via Pitocin:

Circumstances regarding the pregnancy.

Coping styles of the mother.

If they are single.

[Susan Kuchinskas]

I agree, Phil, it's a personal blog and doesn't follow journal standards. This was a Ph.D. thesis, and maybe the psychologist gave it directly to the blogger.

Re those questions about the pregnancies and coping styles of the mothers, I would say that most women don't "choose" to induce labor via Pitocin. Instead, they are often pressured or simply ordered by their doctors. Many hospitals have guidelines and strict timetables for the labor process. If she's dilated x amount by this time, but not y amount by that time; if she's had contractions for x amount of time, start the drip!

[Phil]

I agree that the protocol for labor is harsh, and I gathered that tone by Claire. The feel of labor has a assembly line mentality, and it looks like Claire offers services to resolve those issues.

My intent for the questions was Pitocin not being the sole variable responsible for the results of said example. I would venture to say their may be several variables that synthesizes the outcome. The whole psychological atmosphere would be conducive to this, Pitocin 'adding to the problem'. The activation of flight/fight would at the very least flood the system with corisol. Imagine dealing with 2 floods, Pitocin and Cortisol, and the subsequent confusion for the woman and infant.

[Susan Kuchinskas]

You make very good points, Phil. You're right, the whole constellation of the experience itself and the emotions, hopes and fears the laboring woman brings to childbirth, as well as her mothering style in those crucial first three years of the child's life, have much to do with the child's behavior. A really controlled study would somehow have to standardize the children's early experiences, which would be pretty impossible unless you raised them in a lab. And then they would really have problems.

[Faerylandmom (aka Tiffany)]

Hiya Susan,
I wanted to stop by and let you know that I found the link to the actual study, and reposted it in my post. I too, found the results very interesting, and worth further study. It is my hope that some attention is brought to the study, and that "someone" can do something similar on a larger scale.

Again, thanks for coming by! I'm glad my blog has been even remotely interesting or useful to you. :-) I can assure you, I'll be back to visit yours!

Tiffany (aka Faerylandmom)

[Susan Kuchinskas]

Your blog is extremely interesting and useful, Tiffany. Keep up the good work. And thanks for posting the link.

[Claire Winstone]

Susan,

I read your comment on the Joy in Birth blog and then found my way to your site. I am the author of the study being discussed above and I would really like to clarify a couple of things, if you don’t mind.

First, my speaking4baby website is very old and out of date. That’s why there’s no link from it to the study. During my years in graduate school I didn’t have time to learn how to do a site myself and should probably take that one down, except that every once in a while someone finds it and contacts me and sometimes I can be of use to them with ideas or referrals.

Second, the “study itself” is not what was found. The study has not yet been published and it will be a few months before I have time to write it up appropriately and submit it for publication to peer-reviewed journals. I haven’t even figured out yet which journals to target! What you found was the “summary of findings” I promised to survey participants when the dissertation was finally finished. For convenience I posted it on a web page for participants to access there: the .pdf contains exactly the same content as the web page. My committee asked me to simplify and expand on the abstract since they felt that the participants, in general, might not want to read the original abstract which said relatively little because of word limits, and very dryly. So I rewrote it in a less formal and more friendly style and included the main findings without a great deal of technical or statistical detail. While the summary was not intended for “publication” per se it also was not exactly private, and I don’t actually object to it being passed around and discussed¬: more grist for the mill! I don’t know this, because I wasn’t asked first, and promised to protect participants’ identities, but the doula who posted the summary on her site may have been a participant, or knows someone who was. Or maybe she wasn’t involved at all, and just happened to do a Google search for the right keywords and found the summary. The entire 300-page dissertation may eventually be in .pdf format for anyone willing to wade through it, but it isn’t yet. I think a journal article would be a much better version.

I appreciated the dialogue between you and Phil. Phil is correct, of course, that Pitocin would not be the sole factor contributing to any long-term correlates and you were equally correct that it would be impossible to standardize early experiences, while obviously they can contribute to a child’s behavior and/or the style and quality of the mother-child relationship. Use of medications (anesthesia and analgesia) were also found in my study to contribute to making the mother’s experience of labor and delivery statistically overall more negative or challenging than the experience for mothers who did not use/receive these. One of the criteria for the study was that the mothers were still in an ongoing relationship with the fathers of their 3-year-olds and that the fathers were involved with the family. A significant flaw of using an online survey (actually there are many flaws) is that you can’t guarantee that every participant actually meets all the criteria (although I had over 100 people e-mail and ask if they qualified, or plead to participate anyway, even though they didn’t: they’d had a cesarean, they’d had a home birth, they gave birth in a hospital in another country, etc.) I wrote back to every one and explained the importance of shooting for as level a playing field as possible for such a study in order to control for confounding variables as best I could.

I would be the first to admit that the study wasn’t even close to ideal: this is how one is limited by the cost and time constraints of doctoral research. My section on the limitations of the study is pretty huge! On the other hand, if you can suggest an organization that would fund a larger scale study to follow up on mine, I’d be intrigued to hear about it. I doubt the pharmaceutical companies would do so! My intention was to raise the question of whether or not Pitocin use is a benign intervention for the offspring. I think my study accomplished two things: a summary of what expert clinicians have learned who work with infants, children and adults from a prenatal/perinatal perspective, when treating folks who were born with Pitocin use, and learning what mothers themselves report about their children, and their relationships to them, who were born with Pitocin. Optimally, it would have been great to do a third section in which trained observers looked at the mother-child interactions to see if what the clinicians and mothers had reported could be observed by them. And/or a survey of the children’s teachers at age 5! I have lots of ideas for improving or following up on the study!

What Tiffany said about study follow-up would be very exciting and it is what I could hope for: to create a stepping stone from which further research could develop. My hope was also that the study would provide mothers, doulas, CBEs, labor/delivery nurses and other interested folks with at least one piece of research to allow moms to raise the question of whether or not they should agree to induction/augmentation with Pitocin. Hence the plan to write at least one journal article (but not immediately! Unfortunately I have other priorities for the next few months).

So I’m not a blogger and my time is very limited right now, but I felt your thoughtful consideration of my summary of findings deserved a response from its hapless author!

I very much appreciate the work you are doing and certainly support you in continuing to do what you do!

Claire Winstone, Ph.D.
claire@speaking4baby.com