Question about Cytotec

[AlaaJ]

I just read in another thread that, unlike pitocin, cytotec is swallowed or inserted into the vagina. I did not know this before. Are any other drugs used to augment or induce labor administered in the same way? I ask because my OB inserted a pill inside of me to induce labor for my first birth a few yrs ago. She did not mention its name and I have a creeping suspicion now that I'd been given cytotec without being told about its side effects and risks. So are there any other drugs used for induction, other than cytotec, that are inserted vaginally or swallowed orally? Thanks..

[MegBoz]

Cervidil is inserted vaginally - it's a prostaglandin that dilates the cervix (I don't think it's as likely to cause contractions as cytotec or pitocin, moreso just to thin the cervix.) But I believe it looks like a tampon rather than a pill (although I"m not certain.) So if it was a pill, it probably wasn't Cervidil.

I'm not aware of any other induction pills that are inserted vaginally or swallowed orally. Lots of mamas recommend evening primrose oil (EPO) capsules inserted vaginally in late pregnancy to thin the cervix, but I highly doubt that's what your OB was using.

ETA:
http://www.drugs.com/pro/cervidil.html

"Cervidil Description

Dinoprostone vaginal insert is a thin, flat, polymeric slab which is rectangular in shape with rounded corners contained within the pouch of an off-white knitted polyester retrieval system."

Sounds like that confirms what I heard that it's like a tampon.

[cileag]

I suspect it was cytotec as well.  We only use cervidil and cytotec where I work but other methods I've heard of still don't involve a pill inserted vaginally. 

[AlaaJ]

I was mentioning this to a friend and she said it was probably just some prostaglandin  (in pill form, not the tampon thingy -- it was definitely a pill that doc inserted, not a tampon like thing with a string attached). I could pursue this with the dr herself but am just like ah what the heck.

[AlaaJ]

Originally Posted by cileag 

I suspect it was cytotec as well.  We only use cervidil and cytotec where I work but other methods I've heard of still don't involve a pill inserted vaginally. 

So cytotec is still commonly used? My medical knowledge is totally limited but I've read such terrible stuff about it!!

[womenswisdom]

Originally Posted by AlaaJ 

Originally Posted by cileag 

I suspect it was cytotec as well.  We only use cervidil and cytotec where I work but other methods I've heard of still don't involve a pill inserted vaginally. 

So cytotec is still commonly used? My medical knowledge is totally limited but I've read such terrible stuff about it!!

Yes, Cytotec is still commonly used. I have never heard of a anything other then Cytotec that is used to induce labor and is in a pill form.  I'd be willing to be money that's what it was.

[minkajane]

Cytotec is pretty much universal for induction in this area. It's becoming shockingly common and the vast majority of women have never even heard of it. What's even scarier is that I've heard multiple stories of doctors slipping it in during a cervical exam without saying anything to the mom. It's such a tiny pill and most moms aren't looking at his hands during the exam, so it's easy to do.

[AlaaJ]

Originally Posted by minkajane 

What's even scarier is that I've heard multiple stories of doctors slipping it in during a cervical exam without saying anything to the mom. It's such a tiny pill and most moms aren't looking at his hands during the exam, so it's easy to do.

I think that's what happened to me. I'm pretty disappointed about that. I know that all is well that ends well, and hey, I'm still alive. But what a breach of trust.

[Hedgehog Mtn]

The induction I just attended was supposed to use cytotec but not ONCE was that name used. It was "miso" and nothing else the whole time.

[MeepyCat]

Misoprostol is the non-brand name for Cytotec (like acetominophin is Tylenol, or ibuprofen is Motrin).  It's reasonable for them to use it, or to abbreviate it, particularly if the hospital is using a generic. 

[minkajane]

Maybe I'm too cynical, but I can't help but think they're getting wise to the fact that women are hearing all the bad stuff about Cytotec and would say no to it, so they're using the generic name in hopes that they won't know it's the same thing.

[Hedgehog Mtn]

Sorry - I should have been more clear. This mother was adamant in her birth plan that she wanted to avoid cytotec. She had researched it extensively and didn't feel comfortable with it's use.

The hospital explained that miso was their standard for inductions. We were told if she refused the miso she would be required to sit and wait for the OB to arrive as per policy pitocin cannot be administered without the OB physically present in the hospital. We were made to wait for hours until the OB was able to get childcare so she could come in.

Interestingly the cytotec / misoprostal cannot be removed, once dissolved (or swallowed) it cannot be shutoff unlike pit. Why the Dr must be there for pit didn't make sense at all.

Sorry the babies are jumping on me and interrupting my thought train.

[MeepyCat]

Hedgehog Mtn, it makes sense to me that they want an OB (and also, I hope, an anesthesiologist) present in the hospital before administering pitocin.  What doesn't make sense is that they wouldn't insist on the same staffing precautions before administering misoprostol, or any other labor-enhancing drug.  I do not understand why a doctor was not routinely present at a time when any labor induction was scheduled.  I do not understand why or how it is acceptable for the on-call OB to delay for hours for *any* reason before coming in when paged.  I know that child care is a constant problem for working families, but for parents with jobs like this one, I think the employer needs to make it clear that YOU COME IN WHEN PAGED.  If, for some reason, you cannot come in (because you've been in a car accident, or because you were paged an hour ago for some other emergency and you're still in the OR with that one), there needs to be a backup on-call.  It would also be nice if the employer provided on-site emergency childcare. 

I feel like there are major problems with medical care in this country, that could best be addressed by better staffing.  And I know that your situation will sound absolutely absurd to women in live in or near big cities - the population of doctors is not evenly distributed over the U.S., and this results in extremely uneven quality of available care.  The closer you live to a major medical research center, the more likely it is that your doctor will be current with regard to recent research, and the smaller the delay will be between arrival at hospital (especially in an emergency) and the initiation of treatment.  I have no idea how to solve this problem, but I think it's a vital one to consider, and to work on.

[MegBoz]

Originally Posted by MeepyCat 

The closer you live to a major medical research center, the more likely it is that your doctor will be current with regard to recent research, 

Great post & I agree except this quoted part.

I live just north of Baltimore city & started my first pregnancy seeing OBs who deliver at Johns Hopkins Bayview - widely regarded as one of the best hospitals in the whole nation! (By US News & World Report.) A family member of mine comes down all the way from Connecticut to see docs there for his epilepsy. I remember thinking I was lucky to live so close to such a great hospital.

HUMPH! They do "nothing by mouth" & continuous EFM for ALL births. & no, they did NOT bother to tell me when I started there that they treat everyone as if you are high-risk even if you're not. (I read "Thinking Woman's Guide" & asked these Qs when I was 20W along, & then decided to transfer out to midwives at a smaller hospital farther out from the city that is very NCB-friendly.)

I guess they are a quintessential example of Dr. Marsdan Wagner's great analogy, "Fish can't see the water they swim in." I guess since they deal with high-risk cases, THEY SIMPLY HAVE NO IDEA how dangerous & damaging it is to interfere with the normal physiological process when nothing is going wrong. I guess they don't realize how such unnecessary interventions CAUSE problems - they think the problems are always there.

Also, because it's a teaching hospital, I was told there was a 50% chance the OB attending you could be a resident you've never met! What is the point of rotating through the various OBs in the office practice during prenatal apts if there's a 50% chance it won't even be one of them anyway! No thanks! I'm not cool with such a high risk that a total stranger will be my HCP.

I don't know if other teaching/research hospitals are like this. Just wanted to share about Hopkins. I consider NPO (in general) and cEFM for all births both to be so astoundingly contradictory to research, that it appalls & sickens me.