Cytotec?!? (x-posted in my ddc)

[muttix2]

Mods: x-posting for maximum responses as this issue is very important.

At my last appointment my midwife and I talked about what will happen if I go past 42 weeks. She only delivers up to that point.

A little background information: I'm not sure on my dates. I could only remember the week that my period started, not the day. My cycles had been very irregular due to very high stress and had just begun to resume a semi-normal cycle. I didn't get a positive pregnancy test until about six days after my period "should" have shown up if it was operating on a normal schedule. I told my midwife all of this and also reminded her repeatedly throughout my pregnancy.

She said that because of that we can likely slide a few more days before having to go to the hospital to be induced. The thought of having to have a hospital birth affected me badly so I wasn't paying attention to what she said next. She told me that we'd likely start it off with Cytotec if my cervix needed it (she mentioned some exact circumstances, I don't remember if she said not dilated and effaced or just one of those) and then we'd move on to Pitocin.

It didn't hit me until later... Cytotec?!? I've heard/read so many bad things about inducing with Cytotec, especially if you have already had several births (as I have). I never thought that I'd have to deal with this and I'm at a loss. I know that she can't force me to do anything but I need to know my options.

Basically I'm looking for support. What are my options other than Cytotec? Can the hospital refuse to induce me if I refuse the drug (which I'm not so sure would be a bad thing)? And has anyone had to deal with their caregiver suddenly dropping this bomb on them?

[Nan'sMom]

First thought is does she know anyone who can do a homebirth? I found out that around here if you have a CNM and ask them for a referral to a DEM for something like this they will often oblige. Is she talking a biophysical then induction if "necessary" or just an induction based on dates? What an awful position to be in...I'd really check out other area midwives...induction based on dates, particularly on possibly faulty dates, doesn't sound like a good idea to me.

NO WAY I would use cytotec. I even have it in my emergency transfer plan to do a c-section instead if that is the choice.

Good luck!

[mwherbs]

there is a different prostaglandin that is not the man-made stuff that is not as strong or dangerous as cytotec-- the stuff is in an applicator that can be pulled out if it over stimulates the uterus-- it is a milder way to induce than pit and you usually don't have to stay at the hospital the entire time--
castor oil is also a consideration if you are looking at an induction- the evidence shows that castor oil increased the vaginal delivery rate either by starting labor or by improving induction success--

[turtlewomyn]

cervadil is less dangerous than cytotec, they can remove it if it works "too well" I believe. Cytotec is cheaper so they like to use it more, it is also deadlier.

Have you thought of using some evening primrose oil to get things going?

[danotoyou2]

nak

http://www.truebirth.com/?p=17

[fairejour]

Cytotec nearly killed my baby.
Refuse it!

[maxmama]

Okay, calm down. Cytotec (misoprostol) is a drug. Drugs can be misused. They are not inherently evil. I'm assuming you have no uterine scar, which is a contraindication for any prostaglandin.

I've seen just as much uterine hyperstim with cervidil as with miso, if not more. Yes, the cervidil can be pulled, but honestly, it doesn't seem to work as well.

With either method, you do need to be monitored continuously. It is not appropriate (even in ACOG's mind) to not monitor a prostaglandin induction. If you feel strongly about not being monitored, a Foley catheter is a possibility, but it just doesn't work as well as a prostaglandin.

[etoilech]

Yeah, but why be induced in the first place? There are less dangerous drugs to use than Cytotec, but they all carry a risk of hyper stimulation and the standard risks of induction. Is there a medical need to get the baby out? Are you and the baby not doing well? You're not sure of your dates, and even if you were some babies need longer than others.

You can refuse to be induced.

We're not allowed to use Cytotec, it's contraindicated in pregnancy. It would mean my license.

[maxmama]

Originally Posted by etoilech

We're not allowed to use Cytotec, it's contraindicated in pregnancy. It would mean my license.

A lot of things are contraindicated in pregnancy. Pretty much, oh, everything. But they are still used for some indications. It's not financially viable for the manufacturer to do testing on miso for induction or for PPH, because it's been off-patent forever. Who's going to do a trial involving pregnant women and the IRB review that would require for a medication that retails for 25 cents? That doesn't mean off-label use automatically is bad.

[mwherbs]

there has been a multi-center study on cytotec but I have yet to read the results-- there is a difference in the type of prostaglandin that cytotec is compared to cervadil-- good articles on prostaglandins in general on wiki --

so the money has been spent on studies - and the newer study was on a different type of application so that it too can be removed the same way cervadil can be removed-- but no go- ahead by anyone yet so why not play it safe with something that has been studied- and is ok'd for use

[amymaew]

Cytotec isn't just used off label in pregnancy, it's used AGAINST label. The manufacturers even say do NOT use this in pregnant women, and the label has a pic of a preggo woman with a big old X through it. I'd run away from cytotec, and probably someone who thought it was a good idea to use to induce me. There are other options, including cervadil, castor oil, evening primrose oil, a foley bulb induction, patience lol. Good luck!

[kltroy]

I'm going to be the dissenter in the group I guess...
IF you decide there's a good reason to be induced, and you're not a VBAC, I personally don't think a prostaglandin (either with or without pitocin) is terrible if used judiciously. From what I understand, if your cervix is truly not ripe and you are given pit, it can be unproductive and painful, and using some sort of prostaglandin can help it get you into labor. That said, I would sweep membranes and give a foley catheter a shot before I used any drugs.

[maxmama]

Originally Posted by amymaew

Cytotec isn't just used off label in pregnancy, it's used AGAINST label. The manufacturers even say do NOT use this in pregnant women, and the label has a pic of a preggo woman with a big old X through it. I'd run away from cytotec, and probably someone who thought it was a good idea to use to induce me. There are other options, including cervadil, castor oil, evening primrose oil, a foley bulb induction, patience lol. Good luck!

The manufacturers say this to CTA. It's contraindicated in pregnancy because it will create contractions -- well, isn't that the whole point of an induction?

PGE1 (miso) works better than PGE2 (cervidil) for some women. I've seen it used many, many times with excellent results. It isn't a bogeyman. It's just a medication.

[georgia]

It's just a medication.

And any medication has the potential for abuse and has potentially dangerous side effects. I'd rather a mother be informed and know the risks rather than think, well, they use it many, many times so I guess it's safe.

[muttix2]

Thanks for the responses.

I've decided that at my next appointment I'm going to tell my midwife that I won't be using the cytotec to start labor. Because I feel I'm running out of options and all the natural things I'm trying to do aren't working, I'm going to have her strip my membranes. Hopefully I'll be able to avoid a hospital birth that way. Anyway, thanks again, your responses helped me form my decision.

[mwherbs]

Originally Posted by maxmama

The manufacturers say this to CTA. It's contraindicated in pregnancy because it will create contractions -- well, isn't that the whole point of an induction?

PGE1 (miso) works better than PGE2 (cervidil) for some women. I've seen it used many, many times with excellent results. It isn't a bogeyman. It's just a medication.

differences- I have not denied that it works-- what I say is there is virtually no way to remove a cytotec- tablet or part of a tablet - if there is hyperstimulation which is a risk -- cheap cost --

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cervadil comes in a made for vaginal application easy to remove if there is any concern application -- it has been studied and ok'd $200+ partly you are paying for studies and experience on safey---

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[georgia]

A Mothering article about Cytotech can be read here

[maxmama]

Originally Posted by georgia

And any medication has the potential for abuse and has potentially dangerous side effects. I'd rather a mother be informed and know the risks rather than think, well, they use it many, many times so I guess it's safe.

Actually, ACOG requires informed consent before using miso, because of the off-label use. And I find it hard to get involved in this misoprostol paranoia, especially when I would guess that few if any of the posters have actually ever seen it used.

[georgia]

especially when I would guess that few if any of the posters have actually ever seen it used.

I find this comforting

[Turquesa]

With all due respect to OP, we appear to have gotten off track. Cytotec certainly has its cheerleaders, (and OP's midwife may well be one of them), but this thread should not have erupted into a debate about its merits v. dangers in using it to induce labor.

You don’t have to have experienced Cytotec to have researched it. And if I understand both of your posts, the decision is pretty much made that you will NOT use Cytotec. You are now concerned about your care providers honoring that decision.

Originally Posted by muttix2

Basically I'm looking for support. What are my options other than Cytotec?

The research I have read on membrane stripping seems to question its effectiveness. I recommend searching for abstracts on it at www.thecochranelibrary.com or scholar.google.com. That being said, you may as well try it if you feel it beats the Cytotec alternative.

PP's have already gone over other options such as prostaglandin, and there are always the old (mid)wives tales (some of which hold some validity) of nipple stimulation, sexual intercourse (specifically semen on the cervix), spicy foods, etc.

You other option is simply not to comply with induction. No-Show your appointment. No kidding. This comes straight from Marsden Wagner’s book (http://www.amazon.com/Born-USA-Broke...15462&sr=1-1):

"Women are rarely told that every day the baby remains in the uterus, it grows bigger and stronger and becomes less likely to develop complications during the birth. They are rarely told that a woman’s body knows when the baby is ready. Women are not told that only 3 percent of pregnancies, if left alone, will go beyond forty-two weeks and that only 10 percent of those babies past forty-three weeks will get into trouble—10 percent of 3 percent = 0.3 percent of babies will get into trouble."

That’s not to say that your baby won’t be one of those 0.3%, and you may have some high-risk factors that I don’t know about. But in the almighty name of Informed Consent, it’s only fair that you know all of this.

[/QUOTE] Can the hospital refuse to induce me if I refuse the drug (which I'm not so sure would be a bad thing)? [/QUOTE]

Call the hospital. I honestly doubt that they would. Express your wishes, and then—here’s the important part—get a hold of the admission paperwork BEFORE you go in for your induction. You can and should tinker around with the boilerplate consent-to-treat form, which normally gives docs the go-ahead to do anything they deem necessary.

You are not legally required to sign any hospital paperwork that you find unacceptable, and you have every right to change it to reflect your wish to refuse certain treatments.

I wrote my birth plan in plain text, except I put the following in bold, red letters: ABSOLUTELY NO MISOPROSTOL! Then I hired a darn good doula to make sure that they followed through. I recommend that you do the same.

I’m probably going to get in big trouble for writing all of this, so I’ll go duck under a table now. (Shelter from the flying tomatoes. I’m sure you understand )