my OB and his love of cytotec

[tzs]

i'm not 100% sure about my OB. he delivered dd and i like him as a person and as a doc very much. he spends alot of time with you, remembers you, has one of the highest vbac rates in the area which to me adds credibility to his statements about avoiding c-sections, and is generally very low-key. he managed my rising blood pressure without intervention but careful monitoring, he supported my decision to stay on a risky medication and was the one to shatter the myth that i wouldn't be able to nurse on it. he's fairly old-school and can palpitate w/o ultrasound, goes along (begrudgingly) with my decision to avoid non-medical sonograms, and did a great job turning dd from posterior during birth.

however...there's just some things that raise a red flag. one of them being his love of induction and pitocin. now, apparently if you stand up to him it works out but he's always going to start to put the pressure on towards the end (according to a past patient.) in my case my water broke without labor starting and with meconium present so we did use pit. on the other hand, despite my blood pressure rising and dd in decel with every contraction, he never once mentioned c-section.

but at my first appt for this pregnancy we were having a chat about hospitals and how much he loves a hospital i'm not using....he mentioned how great they were b/c they allowed the use of cytotec for induction (which mine doesn't.)
now...i've always heard terrible things about cytotec from various different angles. there's the medical risks, the fact that it's used b/c it's cheaper, etc etc...

so although he doesn't have the option to use it on me....this kind of creeps me out about the guy. or am i overreacting? i've also heard that it allows drs to avoid pitocin in women who haven't had previous abdominal surgery and after my 1st experience, i hate the stuff. or is the evidence against using him mounting????
ugh i dunno....
thoughts?

[tracymom1]

Being a nurse who worked in Ob/Gyn, I can tell you with certainty that most Ob's greatly approve of the use of cytotec. I think it would be a challenge to find one who said, "bah, I never use the stuff". If you are feeling the red flags are looming, I say shop around. It really doesn't hurt to schedule a few consultations and see who else is out there. What about a midwife? Are you risked-out of midwifery care because of the high BP? Not sure how far along you are, but keep in mind that you have many months to change your mind about care providers - take your time. Maybe do some research about cytotec and then bring the info in to the next appointment and see what he says?

[tzs]

thanks. that's really helpful info.
i'm not sure if i'm not eligible for midwife care. i thought about it but i do like that my OB knows my history and his office is super convenient and easy to get into if you are ever nervous about anything.
the midwife that i know is amazing works on the other side of the city in a free clinic so i don't think she would be as available (the plus side being that the clinic is next to the mexican mart with amazing produce....but it's not enough to do it for me!)
there is another OB who is known to be as close to midwifery as you can get in the OB world but i'm not sure she would be as laid back about some of my issues.
i do have alot of time though so i may end up checking her out.

[Evergreen]

Everything sounds great about him besides that. I think if you make it clear that you will not be induced (barring medical emergency) and hammer it in every appointment you'll be fine.

[mom2fussy]

Originally Posted by Evergreen

Everything sounds great about him besides that. I think if you make it clear that you will not be induced (barring medical emergency) and hammer it in every appointment you'll be fine.

I agree. At least around where I live, it would be hard to find a dr who was like the one you described. One negative thing out of lots of positives wouldn't rule him out for me when the other things were so positive. And honestly, comparing induction vs C-sections... I'd rather have a dr that was prone to induction than one that was prone to C-sections. (Not that either is great, but I hope you know what I mean...)

[rparker]

I just had a great natural hospital birth with a family practice doctor who ADORES Cytotec. We discussed this early in my pregnancy and he claims one of the reasons he prefers it is because it is more effective in women with an unfavorable cervix than straight pitocin. (The pharmacy at the hospital he practices at no longer stocks cervidil or anything similar.) He also claims that its use will never be "on label" because it's so cheap... (Contrast with my husband who is an MD--but does no OB--who claims that hospitals prefer Cytotec because pitocin costs more to administer... they're basically saying the same thing but coming to different conclusions.)

Even after our discussion I still strongly disagreed with him about the use of Cytotec, but there were two other factors which prompted my decision to stay with him. 1) He doesn't talk about inductions until 41 weeks and agreed that in my case we could postpone an induction until after 42 weeks. He just really isn't "into" inductions. 2) He agreed to have the pharmacy order Cervidil and start with that before using a small dose of pitocin despite his love of Cytotec (this was totally hypothetical at my 8 week appointment).

There were other issues throughout my pregnancy that we disagreed on, offhand: placement of a hep-lock, active management of the third stage... those were the two biggest and in both cases he was perfectly fine (and calm) about going with my preferences, but he also took the time to explain why he thought each intervention was beneficial. I ended up having a birth with fewer interventions even than I had been prepared to consent to (i.e. I would have allowed for a greater degree of fetal monitoring than I received) so it definitely worked out, but I have to admit that I was a bit apprehensive right up until the end.

[tzs]

thanks all!

i didn't really have much to base a comparison on so your opinions really help.