How long does Cytotec take to work?

[sweeetpea]

I haven't had any clients induced with Cytotec before, so need some info. If a mom has an unfavorable cervix, and is induced with Cytotec (25 micrograms vaginally, repeated after 4 hours), any idea how long it might be before contractions begin?

The OB told the mom to be prepared for a 36 hour labor. : :

The mom will be 42+ weeks, and uncomfortable with going any longer.

(Don't flame me! : I've had the "RUN FROM CYTOTEC" and "There's no such thing as induction police" conversations with her. These are her informed decisions)

TIA,

Sweetpea

[onlyboys]

Check out www.gentlebirth.org for their archives. You can do a search on cytotec to see what other midwives say.

I think it's pretty non-standard. That's one of the issue with it, that I won't address with you because it's preaching to the choir.

[jengacnm]

Response to cytotec is as individual as response to pitocin-some women respond immediately, others take several doses. Most respond within 2 or 3 doses.

FWIW, using the 25 mg dose tends to induce people nicely-the horror stories of uterine rupture, crazy fast labors, etc, are usually in doses of 50 mg or more.

[Veritaserum]

I've attended one Cytotec induction (25 mg). She had two doses and a little pit to get going. Then the pit was turned off. Once things actually started happening it was less than 12 hours. Lots of waiting in the beginning for labor to actually start....

[heartandhandsdoula]

I have heard of cytotec being done homeopatically. I pill in about 1 liter of water, or maybe 1/2 pill. Swish in mouth every 20-30min. It worked too. I'm sure her doc would go for that!!

[Belle]

I'm sorry that the only personal experience I have with cytotec is not positive. A mom that I met was induced with two tablets (25mg) of cytotec (no pit) and had an emergency c/s two hours after the initial dose.

[jengacnm]

Originally Posted by Belle

I'm sorry that the only personal experience I have with cytotec is not positive. A mom that I met was induced with two tablets (25mg) of cytotec (no pit) and had an emergency c/s two hours after the initial dose.

This is more support for my theory. I've not heard a bad cytotec story when the dose was 25 mg.

TBS, I'm all ears for anyone who has...

Jennifer

[chandasz]

Is there a reason why they are choosing such a dangerous drug instead of cervidil or a foley catheter???

Have you prepared mother for the likely c-section that will follow?

Not flaming, just super concerned

[CEG]

I was induced with 25 mcg of cytotec, one dose and did not deliver until about 20 hours after placement, but it was in combination with a foley bulb. I was 4 cm about two hours after placement (from 1 at 42 +2) and kind of poked along for about 12 hours until pitocin was started.

[sirref]

I've seen it work s-l-o-w-l-y and "normal" induction speed. One mom had a dose, iv pit.... walked miles & miles on telemtry.... round & round & round, only to shut it all off for the night, have dinner, sleep & do it again the next am. (The dinner & rest was a wonderful idea. She really needed it. Unfortunately she was moving slowly the next day too & finally sectioned. grr.)
My other client who had cytotec starting contracting within 2-3 hours even tho she was told it would likely take 2+ doses before she was in labor. She only got the one dose... kicked in, had good labor all night (started at 10 pm thinking she'd sleep till dose 2. They were wrong!) It was wearing off & slowing by mid-morning & she had pit added, had her baby at 5 pm. (After a demerol-induced nap)

Just like anything there are few rules. Anything could happen. I've seen it work great, and seen it do nothing. Happily I haven't seen anything scary first hand!

Lots of luck to you both, I hope she has a good birth

[roadfamily6now]

against my advice my friend did a cytotec induction and it lasted 2 days. I am amazed she actually walked out of the hospital.

[DoubleLove]

Anywhere from almost immediately into booming labor followed by a birth several hours later to several unsuccessful attempts on mulitple days, several days apart. IMO, I think it just depends on how ready that baby really is. For true post-dates (if there really is such a thing), I see it most commonly leading to progessive cervical change after 1-3 doses of 25mcg, with mostly just uterine irritability after the first dose.

[junamoss]

Remembering it's 25 mcg, i have noticed when someone is ready and a multip one dose starts them nicely. I have rarely given 3 doses to someone who is term. Most of the protocols are for 2 doses and pit with our docs and if it doesn't work we try again the next night.
I am an l&d RN and work nights, our docs are family practice and a handful of obs. I have never seen a foley done, but that sound interesting and I have read the protocol. The drug of choice is cytotec with pit to follow.
I am a really cautious cytotec placer, and pay attention to my pts. I have been told I am not aggressive enough by other RN's, but it scares the sh** out of me, especially because I don't have long fingers to "go in after it" if a woman starts to hyperstim and I have seen one scary abruption from what I think was cytotec.
And I don't like to blast the babies out.
But when it works it's good.
sorry i ramble, i am sleepy.

[junamoss]

Contractions, usually in the 1st 15 minutes-those period type cramps if the
1st dose is going to do anything, and they might last 2 hours until the dose is absorbed. If her body kicks in she'll keep going.

[familybirth]

With a reactive baby (either by NST or auscultation) 25 mcg cytotec can be placed in the back of the vagina for cervical ripening 24 hrs prior to hospital induction and the mom sent home to wait, after observing her and baby for an hour. The vast majority (like 90%) will go into spontaneous labor before coming in for their "scheduled" induction. My biggest problem with cytotec is that we just hit moms with it over and over again, and then , surprise, when it does kick in, there's too much on board, sorta like "pit to distress".

[Reha]

Originally Posted by familybirth

The vast majority (like 90%) will go into spontaneous labor before coming in for their "scheduled" induction.

I disagree with this statement....: Moms who have been given cytotec aren't going into "spontaneous labor"...they have been induced, but started contracting at home.

Personally, I feel the only safe use of cytotec is postpartum....and even then it has some nasty (though not life threatening) side effects.

[onlyboys]

Originally Posted by Lennon

I disagree with this statement....: Moms who have been given cytotec aren't going into "spontaneous labor"...they have been induced, but started contracting at home.

Personally, I feel the only safe use of cytotec is postpartum....and even then it has some nasty (though not life threatening) side effects.

I agree with you, this is an induction of labor, not spontaneous labor.

[memiles]

Originally Posted by onlyboys

I agree with you, this is an induction of labor, not spontaneous labor.

I 100% agree.

That being said, I know of at least one local practice that specifically tells women that cytotec is a cervical ripening agent and NOT an induction.

:

[sweeetpea]

My client's story - update on orig post

well, my client got her first dose early morning, and started having mild contractions almost immediately (at 0cms dilated 50% effaced). Four hours later received the second dose (finger tip dilated and 75% effaced). Contractions increased steadily and were 2-3 minutes, lasting 45-75 seconds for the next twelve hours, when she pushed a healthy baby out. Since the "dose life" of Cytotec is about 4 hours (according to the nurse), her body was kicked into laboring by itself. She never had pit. She never had pain meds. She never even had an IV. After the initial 1.5 hours after dose continuouus monitoring, she had intermittent monitoring and full mobility, including the use of the shower.

After a little manouvering to rotate an OP baby (obviously baby didn't choose that day to be born), baby was born without complications.

I completely understand the dangers of Cytotec, and would never recommend it. I will always give full information to any client being faced with the choice to use it or not. But this induction was one of the easiest on mom and baby I have ever seen for a primip. No wonder OBs are seduced by it!

Sweetpea

[junamoss]

congrats! Although cytotec wouldn't ever be my choice, it seems to really do the job in a more gentle way than pit could ever do.
I wish they would come up with a safer way to give it, for example extended release in some sort of tampon that could be removed if there were any problems (hyperstim). It sucks to go digging for a quarter of a pill with these stubby fingers.
This is included in our "cervical ripening" protocol, not induction of labor where I work.