Moms having hospital births, a PSA about a drug called Hemabate

[DoomaYula]

I just want to give you all a heads up about this NASTY drug that is used to control severe post-partum bleeding. Normally it is a drug of last resort, but each doctor has their own preferences and some docs go for Hemabate first. A client I worked with had Hemabate FIRST and it has terrible side effects. First of all, it causes cramping (well obvs) and instantaneous diahrrea. My client also experienced hot flashes, sweating, vomiting, and a general sense of icky-ness. The diarrhea lasted about 12 hours.

So, I sincerely hope NONE of you have pp bleeding in a hospital setting (or any setting) but I'd put in your birth preference plan that you want pitocin first -- and you can have several shots of it or an IV.

[dynamicdoula]

Cytotec rectally is actually another good, safe and commonly used remedy for postpartum bleeding. I would definitely elect to have pit and then Cytotec rectally. I've not heard anything about the drug you're referring to, YD, so I can't speak on that.

[DoomaYula]

I'd never heard of it either, til a client had it. And then I posted about it in Birth Pros, and got more info.

Link to info

Due to its contractile effects on gastrointestinal smooth muscle, carboprost tromethamine can cause vomiting and diarrhea.

[Dena]

Yeouch. Thanks for the heads up.

At this point, one of the few reasons I would end up in the hospital would be due to clotting issues that I *may* develop as a result of Amalie's body dissolving into my blood stream. If bloodwork closer to my due date shows that I am not clotting appropriately, a hospital birth would be safer for me, and, of course, I would be facing the risk of heavy post-partum bleeding. I need to ask my OB now what drugs he would use to control that!

[mittendrin]

Thanks so much fro the info! Added a point more to my birthing plan!

[bygones75]

Poor Dena. I don't know how you're dealing with this. What a brave woman you are. I was thinking about Amalie the other day and incredibly hard this is. You remain in my thoughts and prayers.

[blueridgewoman]

Thank you so much for that information. I'll add that to my birth plan! (When I finally get around to writing it, that is.... )

On Cytotec- so it's safe pp, but not during labor? Or is it safe rectally and not vaginally? I was under the impression that it was wise to avoid it in general, so I'm curious about this.

[bygones75]

Originally Posted by dynamicdoula

Cytotec rectally is actually another good, safe and commonly used remedy for postpartum bleeding. I would definitely elect to have pit and then Cytotec rectally. I've not heard anything about the drug you're referring to, YD, so I can't speak on that.

I've heard some nasty stuff about cytotec used to induce. Is it safer when used postpartum? Why would they use that instead of pit? Just curious.

[bygones75]

Originally Posted by blueridgewoman

On Cytotec- so it's safe pp, but not during labor? Or is it safe rectally and not vaginally? I was under the impression that it was wise to avoid it in general, so I'm curious about this.

lol. We were thinking the same thing at the same time!

[Romana]

I understood the general consensus on cytotec was that, in small doses it is okay, but in larger doses it's quite dangerous. I'm not sure what amount small/large would be, though.

ETA: I clicked this thread from the main page and didn't realize it was a DDC thread until now. There was a thread recently in Birth & Beyond that discussed cytotec more in-depth and you might find it helpful/interesting.

[blueridgewoman]

bygones, well, great minds and all that....

I think too that cytotec is not AS dangerous if you haven't had prior c-sections, but I'd always figured it was just one of those things to stay away from. Cervadil does much the same thing without the side effects, right? It's just more expensive?

[DoomaYula]

Are we talking about induction now?

Back to pp bleeding for a sec: Cytotec can be used rectally to control severe pp bleeding. Yes, rectally. FUN TIMES!

Cytotec has been used as a tool of induction, however it is NOT FDA approved for induction. Hospitals use it because it's cheap -- about 25 cents a pill.

Cervidil, which IS approved for induction, is quite expensive, several hundred dollars. Cervidil is a safer induction drug because it can be removed. Once cytotec is in, it's in.

(there was just a long thread about Cytotec in the Birth and Beyond forum.)

Personally I am against induction except for medical reasons. And, "my doc is going out of town/I'm tired of being pregnant/I want this birthday for my baby" is not a medical reason.

[dynamicdoula]

Originally Posted by blueridgewoman

On Cytotec- so it's safe pp, but not during labor? Or is it safe rectally and not vaginally? I was under the impression that it was wise to avoid it in general, so I'm curious about this.

Well my concerns about this thread stem from anyone making decisions about their care based on one article, one person's experience, etc. I suggest that if you are unsure about Hemabate or Cytotec for PP bleeding that you do some reading on it and make up your own mind. I would feel comfortable accepting Cytotec rectally for PP bleeding (it's safer than a hysterectomy!), but I can't tell you that YOU should be okay with it. Ykwim?

I am not ruling out hemabate because a) I have never seen it used and know nothing about it, but mainly b) because I know nothing about it. What if it is indeed safer (despite the risks of side effects) than cytotec? We should definitely look at all the risks/benefits before making decisions about which medications we will or won't accept.

Cervidil for induction has its own risks; baby can still have decels, you can hyperstimulate your uterus which can lead to rupture, etc. It's safer and studied better than Cytotec but it's not without its own risks, just to be clear. I've seen women go into labor with JUST Cervidil and one did have her uterus hyperstimulate - fortunately that baby came out fast and they got her stabilized. Removing it, giving IV fluids, giving O2 - it didn't slow down those fast, hard contractions.

If I looked solely at my 5 years of doula practice and reacted only to what I'd seen, I would suggest that Cytotec is safer than Cervidil - I've seen bad side effects with Cervidil, and nothing but smooth sailing with Cytotec. But we know the data says otherwise, right? So going from experience is risky and might not lead to care that is truly in your best interest. So definitely read the information YD shared but don't stop there! See what your provider has to say about the different options for PP bleeding, what their usual treatment protocol is. Could be you never even have to make a decision about hemabate vs. cytotec anyway.

So my point overall is... look at all sides before deciding. Every drug carries risks, and different drugs are appropriate in different situations.

[DoomaYula]

In six years of attending births I'd never seen Hemabate used until about 2 months ago. It may be only one experience, but I've venture that one experience with an unnecessary c-section is enough for a woman to decide that it's not for her, yes? Or one experience with an induction gone wrong, or one experience with an episiotomy?

My original point is, you may never see anyone use Hemabate, as it's the doctor's discretion what he or she gives for a pp bleed (most mw's don't carry it because it needs to be kept cold), but I'd want to be advised if it's a drug commonly used by your doc.

Feel free to ignore my experience because I've only seen it once, but I wouldn't wish this client's first hour postpartum on anyone.

[dynamicdoula]

Originally Posted by YumaDoula

Feel free to ignore my experience because I've only seen it once, but I wouldn't wish this client's first hour postpartum on anyone.

Eek, I think you're honing in on something I'm not actually saying. I'm not saying to dismiss your experience at all- not at all! I am just concerned about women making decisions about medications they might not be at ALL informed about (basing their decisions on one person's experience, rather than data/research). As doulas, we teach women to be informed about risks and benefits, right? I'm just emphasizing that- we wouldn't want our client to go to her doc and hear "you need to have a cesarean, you're too small to give birth." and base that as gospel, we'd encourage her to do her research. That's all I'm saying. Women should do their research and not base their decisions on the experience/opinion of one article, one experience, that's all. It's not personal, YD, I value your opinion, experience and conclusions very much.

[DoomaYula]

I understand, I agree -- I'm not writing the gospel of avoiding Hemabate and think that all women should avoid it in every circumstance.

I'm sure it's highly effective for very serious pp hemorrhages, and of course between bleeding out and having Hemabate, I'd advise to take the Hemabate.

However, there are docs out there who go for it FIRST, prior to dx an actual hemorrhage, just at their own discretion, and from what I've seen and now read, it has more serious side effects than pitocin or methergine or cytotec. Also, I recently read on Birth and Beyond about a hb mw who refused to take a client who'd had a shot of Hemabate at a previous hospital birth, because she believed that the woman must have had a SERIOUS hemorrhage in order to warrant Hemabate. And yet, the woman had had Hemabate merely at the doctor's discretion, instead of pit. So that's another issue.

The entire point here is probably it's worthwhile to have a discussion with your provider about what he or she does if you have a pp bleed or hemorrhage! And if you don't know about the drug or herb, read up!

[dynamicdoula]

Originally Posted by YumaDoula

However, there are docs out there who go for it FIRST, prior to dx an actual hemorrhage, just at their own discretion, and from what I've seen and now read, it has more serious side effects than pitocin or methergine or cytotec. Also, I recently read on Birth and Beyond about a hb mw who refused to take a client who'd had a shot of Hemabate at a previous hospital birth, because she believed that the woman must have had a SERIOUS hemorrhage in order to warrant Hemabate. And yet, the woman had had Hemabate merely at the doctor's discretion, instead of pit. So that's another issue.

That's VERY interesting and has me doing a lot of questioning... so thank you VERY much for sharing that. I am going to definitely ask my doc what he knows about this trend! I know when Cytotec came on the scene it was a lot of discussion and concern and no data to look at. I think it's great that you brought this up for discussion and I'm definitely curious to know more.

[crazy_eights]

Originally Posted by dynamicdoula

Cytotec rectally is actually another good, safe and commonly used remedy for postpartum bleeding. I would definitely elect to have pit and then Cytotec rectally. I've not heard anything about the drug you're referring to, YD, so I can't speak on that.

Actually, cytotec and hemobate are related (both prostaglandins) and can both have the same side effects. Hemobate is a great drug for severe post-partum hemorrhage. However, it's very expensive. For that reason alone, most OB's don't turn to it as first line drug against hemorrhage. I'd add that most people do NOT get the side effects described by the OP from one dose. Multiple doses, yes. And I'd add that cytotec does not have the risks that most people worry about (uterine hyperstimution, rupture, etc) in the post-partum period.