Oral cytotec induction?

[Contented73]

Just found out a client is being induced with cytotec, orally. Anyone have any first hand experience with this? What to expect?

[minkajane]

Oral cytotec is even worse than vaginal cytotec! At least when the tablet is inserted vaginally, it can be removed if the contractions get too strong. Orally, it's in there for better or worse. Not to mention the fact that the manufacturer states that cytotec is contraindicated in pregnant women and should NOT be used to induce labor. Then there are all those women who had uterine ruptures after no previous uterine surgery...

[Contented73]

I have zero influence on the situation right now. : Induction is happening tonight, with or without me. So I guess I'm just wondering if anyone has any personal experience with it, or maybe an article or something. Basically for my information to know what to expect. Basically, does it work? How well does it work? What kind of side effects can we expect?

[MsBlack]

This is an extremely bad idea!!!

cytotec/misoprostal is NOT safe for induction. I personally know a CNM w/a client whose uterus ruptured with only 1, 25microgram dose of cytotec (vag insert). I just had a client choose early induction (due to an extremely mistaken u/s, and a lot of fear mongering by her back up OB) via cytotec. She also had just 1, 25mcg dose of the stuff and tho she didn't rupture, she (a 3rd time mom, natural births before) described the labor as pretty awful.

there are those who believe that cytotec is 'safe enough' under 'controlled conditions of hospital'. It is in fact a highly unpredictable drug, NOT approved for induction by FDA and involved/responsible in countless uterine ruptures and various catastrophic events for moms and babies. The CNM-birth just described was in the hospital--so no one died. But one problem with cytotec is that it is extremely hard to control dosage, or have any idea when it will kick in. So--even such a tiny dose can cause a rupture. But if a woman's body doesn't respond to cytotec, or respond strongly enough, in the 'usual' timeframe, then she will be given more cytotec under the assumption that she 'needs' more--but what can occur is that *all* of the cytotec activates at once, finally--leading to at least agonizing labor, and at worst, uterine rupture or tetanic contractions that can harm the baby.

PLEASE have this mother read up on cytotec--and if she is really ready for induction (or there seems to be a medical indication), then she should be inquiring about safer methods for herself and baby.

[MsBlack]

Ok--I was writing my other post when you filled in a bit more.

She might get a more or less 'normal labor'. I already said that she might get an agonizing one. She might get a really awful case of the shakes...really, really awful, which can take quite awhile to subside.

It is almost certain to lead to other interventions. It could lead to a scarred uterus, or even to the entire loss of her uterus. It could kill the baby, or at least put the baby in NICU with issues relating to hypoxia from tetanic contrax.

Take it as it comes, but do be ready for the worst.

[Contented73]

aaahhhhhh....what do I do?!

This is happening in three hours. Up until now, the doctor had told her that if she induces this evening, it would be with cervidil tonight; pit tomorrow. Standard. This is what we've been expecting. At the appointment today, the doc said it would instead be cytotec -- apparantly b/c with baby #1, client didn't respond very much to cervidil (though did overall have a successful, reasonable-length induction).

The induction is for being 42 weeks.

HELP!

[blissful_maia]

The research is very scary, yes. But at the hospital where I have worked as an apprentice, it is standard for OBs to try this method of induction for women with a good Bishop's score and no previous uterine surgery. I've seen it work time and time again. If it doesn't, it's on to oxytocin.

A negative side effect I've personally seen is lots of nausea and/or vomiting. One woman on the ward when I was there catching a baby immediately started having late decels (like 10 minutes after first dose) and there was an emergency C/S and a healthy babe. They thought it was a coincidence. :

[Contented73]

Does anyone have any compelling information -- articles, studies, etc. -- that I might share with my client? This is really scaring me and I wish there was something I could do. Obviously she could refuse the cytotec and just ask for cervidil, if she were convinced that she should do that. But, as all you doulas know, I can't make this about MY opinion,or the stories I've heard.

Edited to add: Bishops score is bad in this case. I thought the whole point of cytotec was cervical ripening?

[MsBlack]

She can refuse the cytotec, and insist on a trial of cervidil. If she is really 42 wks, then even tho she's a primip the cervidil may work anyway. If she's really 42 wks, and baby is still ok (which I'm assuming it is, or they'd have done this sooner), then another day or 2 of trying safer things is NOT going to make a difference. I 'm sure your client is sick of being pregnant and may be worried about her baby. Still, she needs to understand the risks of cytotec and insist on safer options--letting the baby cook for another day or 2 while trying cervadil is FAR safer than using cytotec, IMO.

She can stay home tonite and take castor oil. Even if this does not bring on real labor, it is now known that castor oil has prostaglanding precursors in it--and it could at least ripen her cervix enough for the pitocin to work. But castor oil may just put her into active labor.

good luck!

[Contented73]

Just to clarify, this is a second time mom whose first cervidil/pit induction was successful. Though, the cervidil part apparantly didn't do too much. The pit got her there though, in about 8 hours I think. So the reason (I think) that doc wanted to try cytotec was because "the cervidil didn't work" the first time. The mom is not feeling that great about the induction to begin with. She'd rather wait but doc is putting on the pressure.

[mclisa]

Originally Posted by minkajane

Oral cytotec is even worse than vaginal cytotec! At least when the tablet is inserted vaginally, it can be removed if the contractions get too strong. Orally, it's in there for better or worse. Not to mention the fact that the manufacturer states that cytotec is contraindicated in pregnant women and should NOT be used to induce labor. Then there are all those women who had uterine ruptures after no previous uterine surgery...

Have you ever actually seen what cytotec looks like? It's extremely small. It's difficult to place in the first place and there would be no way you coulod remove it.

This person does not know their facts.

[SublimeBirthGirl]

I would show her this video.
http://www.wsmv.com/video/13210018/index.html?taf=nash

IMO any practitioner who uses Cytotec to induce has a reckless disregard for his or her patients, and should be avoided.

[chandasz]

Remind her that she can say no.... or easier yet-- "forget" to come to the induction. But she can tell him that she does not consent to cytotec. Ask her to tell him to give her the package insert. That will give her enough reason to say no. The package insert warns of the dangers of using cytotec in pregnancy.

If you type cytotec into google-- you will come up with a million websites with reasons that this drug should not be used.

[BeckiCNM]

Originally Posted by mclisa

Have you ever actually seen what cytotec looks like? It's extremely small. It's difficult to place in the first place and there would be no way you coulod remove it.

This person does not know their facts.

I have seen cytotec. Placed it, too. : (Not since I was a student). Yes, it is very tiny. Theoretically, you could try to fish it out with your fingers or take a big syringe with saline and try to flush it out of the vagina. I wouldn't say there is no way to remove it. It's not easy, for sure.

The research I've read seems to indicate that oral cytotec may have fewer complications - i.e. less hyperstimulation of the uterus or bad fetal heart tone patterns - than vaginal cytotec. FWIW. Most of the docs at my hospital will do oral cytotec if they do cytotec.

[NavelgazingMidwife]

It's so hard to counter scaremongering when lack of experience and TRUE stories is the standard. I have seen cytotec used many times and haven't *ever* seen it have negative effects. I *have* seen pitocin rupture two uteruses that hadn't even ever been cut into previously! Sure, there are statistical likelihoods and all, but when you have *judicious* care providers who have *experience*... women can do really well with cytotec.

A woman with a crappy Bishop score isn't going to do squat with Cervidil in a one day application and it is setting her up for a cesarean. Cytotec makes butter cervixes very rapidly, allowing pitocin to do its thing and giving women a shot in hell to deliver vaginally.

Do I think all women need cytotec? Of course not? I believe it is 100% contraindicated in VBACs, too. But I think blanketly demonizing ANYTHING in obstetrics is just as wrong as what obstetrics does to demonize the natural birth world.

Barbara E. Herrera, LM, CPM
San Diego, CA

[MsBlack]

I will say again: cytotec is too unpredictable to be safe. The risks it poses are too much.

I see no reason to be moderate or reasonable on certain topics.

Of course, I think it's fairly awful that this woman is being pushed to induce at all.

[gemasita]

Cytotec that is vaginally inserted can often be removed. Sometimes it doesn't dissolve all that much and can be fished out looking almost like it did when inserted, even when it's been in overnight.

NOT that I think it is safe!

[pamamidwife]

Originally Posted by MsBlack

I will say again: cytotec is too unpredictable to be safe. The risks it poses are too much.

I see no reason to be moderate or reasonable on certain topics.

Of course, I think it's fairly awful that this woman is being pushed to induce at all.

I agree. And the biggest issue here is the prevalence of induction for superficial reasons (dates, 'low amniotic fluid at term', big baby, etc).

Cytotec orally has a very different absorption rate than vaginally or rectally. It's slower because it has to go through the gastrointestinal system...and it's unknown how much/little needs to occur to start labor contractions. It would be easy to administer too much. Vaginally speaking, unless the hyperstim starts immediately, the chance of fishing out that little quarter of a small tab is virtually nil - not to mention the amount that has already been absorbed.

Induction in our country is abhorrent - at least with Pitocin the drip can be stopped and effects removed within 15 minutes or so (and terb can be administered) - though the worst cases of hyperstim and rupture with Pitocin have been with higher than recommended doses given to women. With Cytotec, the results are unpredictable for each woman.

Cytotec can also 'build up' in a woman's system, where you can have a 'judicious' administration of a quarter of a tab every four to six hours and after the third insertion, have serious effects on baby.

My view is that we have to stop inducing women because of these ridiculous reasons. Pitocin, prostaglandin gel, cytotec - all the catastrophes are usually because of superficial, non-evidence-based reasoning. And that, to me, is the tragedy.

[MsBlack]

Thank you, Pam--

I agree completely.

Barbara--

Reading your post, I saw a lot to....unpack. The main thing I'm going to address is this, bolded words my touch:

"Cytotec makes butter cervixes very rapidly, allowing pitocin to do its thing and giving women a shot in hell to deliver vaginally.

This is considered very much in the context of all you wrote, especially including your assertion of having seen numerous cytotec inductions and your wish that we not demonize obstetrics lest we be guilty of obstetrics' sin of the demonization of natural birth.

I have to ask--is it CYTOTEC that is 'giving women a shot in hell to deliver vaginally'? Or is it the very profession of obstetrics--whom we must not irrationally 'demonize'--that is the agency 'giving' women a 'shot' at vaginal delivery? You would not have me demonize obstetrics...and I would not have YOU forgive obstetrics for it's violent appropriation of WOMEN's power and permissions of birthing...an appropriation that now puts obstetrics in the position of deciding who is to be 'given' that shot at vaginal birth, and how that shot will be delivered. If even through means potentially causing catastrophes that no obstetrician will ever suffer personally.

You also assert that the lack of experience with cytotec by some, indicates a lack of ability to make sound judgement in this matter...that this lack of professional experience equates with a lack of authority in making reasoned decisions about cytotec. I can only assert in return--*some* of us would go a long way to avoid 'experience' with such things as cytotec, out of self-respect and out of a love for women that drives us toward supportive, healthy, respectful birthing ways --and drives us away from all that we know could bring about damage and terrible losses to women and families FOR NO GOOD REASON.

Some of us try really hard to avoid treating with obstetricians and the world of obstetrics, understanding it as a thoroughly misguided and viciously misogynist system of thought and actions that has wreaked far more harm than good on women and babies.

And I'm sorry, but this does not make us 'too inexperienced to desrve a vote' or 'too inclined to demonize, to be considered rational and fair'. It makes us committed to something other than what you apparently have committed yourself to. A difference of opinions and choices in play--nothing more, despite your attempt to make it seem otherwise.

[BirthFree]

Once again, MsBlack and Pamamamidwife said exactly what I would have said and then some.

Cytotec should not be administered to women for ripening or induction, period. There is no gray area to that at all... in my mind as a consumer, doula or apprenticing student midwife.