After baby formula and tampons, the next shortage to affect women nationwide is oxytocin, the most common drug used to induce labor and control bleeding after childbirth.
A nationwide shortage of oxytocin, the hormone branded as Pitocin, has forced hospitals to ration it, leaving pregnant patients concerned about their births.
In late September, the U.S. Food & Drug Administration reported that Pitocin was in shortage due to manufacturing delays at one of the two companies that supply it to the United States. Pitocin is the drug of choice for preventing postpartum hemorrhage, a serious and potentially fatal complication where a pregnant person loses more blood than usual during birth. It occurs in 1-5 percent of births, but certain women are at higher risk, including those who are older than 35 and those who have cesarean section births.
Pitocin is also the most common medication used to induce labor, which it does by stimulating contractions in the uterus. More than 1 million labor inductions occur each year in the United States.
Pregnant people and their loved ones don’t need to panic, said Michael Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists, which tracks drug shortages. “But,’ he said, “be aware and have a conversation with your OBGYN to find out if this is something that might affect you and if it would, what’s the plan?”
While the FDA originally reported the Pitocin manufacturing delay would last until October, the manufacturer at the center of the shortage now estimates release dates from mid-November to early December. The shortage is nationwide, affecting hospitals in all 50 states, said Ganio.
But excctly how pregnant patients are impacted, however, depends on the hospital.
“Every center is dealing with this differently because their levels of remaining Pitocin are different,” said Dr. Brian Casey, director of maternal-fetal medicine at UAB Hospital, the largest hospital in Alabama.
Casey estimated that at one point UAB Hospital was down to less than a two weeks’ supply of Pitocin. So hospital staff reevaluated how they use the hormone and made changes that included giving smaller doses to postpartum patients who are at low risk for hemorrhage. That has helped stretch the hospital’s current supply.
Casey said he’s seen recent TikTok videos where pregnant women describe concern over hospitals in their areas discontinuing elective inductions, where Pitocin is used to jumpstart labor without an immediate medical need. UAB Hospital – which allows elective inductions no earlier than 39 weeks gestation – hasn’t had to pause that practice so far.
Drug shortages are common, but a cascade of recent high-profile shortages has flooded the news in recent months for well-known drugs like amoxicillin, a common antibiotic, and Adderall, which is used to treat ADHD.
The ASHP is currently tracking 260 active drug shortages, said Ganio.
“That’s not quite a record but we’re getting close to a peak,” he said. In general, the number of new drug shortages reported each year has fallen since 2011, when a new federal law gave the FDA broader authority to prevent shortages. “But the problem is,” said Ganio, “(the shortages) are not resolving.”
Manufacturing quality issues are among the main drivers behind drug shortages, said Ganio. While the United States has improved the FDA’s ability prevent shortages, not enough has been done legislatively to improve quality in manufacturing, he said.
For now, pregnant people and their loved ones don’t need to panic, he said. Some Pitocin is still being manufactured through a smaller supplier, and new shipments of the delayed Pitocin should begin rolling out by early December. Drug shortages due to supply chain issues aren’t uncommon, and hospital staff are accustomed to planning how to weather those shortages. There are also alternative medications available for some of the situations in which Pitocin is normally used.
“Thankfully,” said Casey, “we believe the shortage is going to be short-lived.”