Emily Oster

3 min Read Emily Oster

Emily Oster

Is There a Link Between Pitocin and Postpartum Depression?

Q&A on induction

Emily Oster

3 min Read

I have read in a few places that there may be a link between postpartum depression and Pitocin use to induce labor (not post-delivery use for hemorrhage control), the theory being that IV Pitocin does not cross the maternal blood-brain barrier and a normal cascade of maternal hormones (oxytocin/catecholamines) does not occur within the laboring person’s brain with induction, setting them at increased depression risk. 

I’m already at high risk for PPD, with a remote history of major depression, though I’m in a really good place right now and want to do all I can to maximize my mental health going into my first postpartum time. My provider has set a backup induction date at 41 weeks, dismissing my worries about Pitocin as unfounded. She also states the risk to my very healthy baby that going past 41 weeks at my age of 37 is too high to push to 42 weeks. Is there any credible data on Pitocin vs. PPD?

—Hoping for Spontaneous Labor

There are a few things to unpack here. One is the positive value of induction — to your last point, is there a strong reason to induce at 41 weeks? The second is whether there is a true relationship between Pitocin, used in induction, and postpartum depression.

To the first point: There is good reason, based on the data, to schedule an induction at 41 weeks. Our best evidence comes from a study in Sweden that looked at outcomes for women who were induced at 41 weeks versus those who underwent “expectant management,” waiting until as long as 42 weeks. The study was a randomized trial, meaning we have a higher level of confidence about causality. The authors had to stop the study early when they found that stillbirth rates were higher — still low, but significantly higher — in the waiting group than the induction group. It is for this reason, combined with evidence from other trials suggesting that inductions do not lead to increases in cesarean section risk, that doctors will generally not allow pregnancies to progress past 41 weeks.

To the second point: There are a couple of small studies that correlate Pitocin use in labor to postpartum depression. However: these studies are problematic. Induction is more common in higher-risk pregnancies, and it is extremely difficult to separate out these other risk factors from the use of Pitocin. In addition, even the studies that argue this are very small, and results are mixed. A review article from 2020 argued, effectively, that we can conclude nothing about this link.

There is little in the way of a strong biological reason to think there would be a link here, so I think a reasonable baseline assumption would be that there is no relationship. Having some flawed data that, in some cases, points in the direction of a relationship (and in other cases, rejects a relationship) should leave us with no change in our beliefs.

Bottom line: the evidence doesn’t provide much support for these fears, while providing a lot of support for induction at 41 weeks. Most people have their babies by then, though! So I am hoping for spontaneous labor for you, too.

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