Tell me about EPO and RRL

SLPmama · 10-25-2009, 05:43 PM

For those of you that used it how did you use it and do you think it helped? I'm 38 weeks today and my doula suggests using it 2 orally in the am and 2 vaginally in the pm. Is this how you took it? Did you find any adverse effects when researching it? I haven't been able to find any but on another forum I go to a mom said she has heard to only use it under "direct midwife/doc supervision" and only after 38 weeks and for no more than 3 days. I haven't found that info but maybe I don't know where to look. From what my doula told me it is just a cervical prep and won't do any real induction.
Anyone heard any contraindications for VBAC moms w/ it?

What about RRL tea, did you drink it? Think it helped or not? Any reason not to?

SLPmama · 10-25-2009, 06:18 PM

Eek, I just looked in the archives and saw that someone's midwife said the latest research says to NOT use it bc it can interfere w/ your body's natural production of the hormones. Anyone else hear this?

AlexisT · 10-26-2009, 07:40 AM

There isn't any good research.

Theoretically, EPO could be a problem, because it's a prostaglandin, and we know that prostaglandins soften scar tissue as well as the cervix--that's why Cervidil and Cytotec aren't used on VBACs. But that's only theoretical--we don't know if EPO is strong enough to really do anything to the scar tissue.

MNHall · 10-27-2009, 02:20 PM

I did both.

I started drinking the tea around 32 weeks, from my understanding is it's good for you to drink all throughout your pregnancy as it can strengthen your uterus. I just used the tea bags, one tea bag and made two cups of tea out of it. I've heard the bags aren't ideal because it's not as strong, but I'm not a fan of tea..so I just chugged it down to strengthen my uterus! And, I wasn't sure how else to find it!

As for EPO, well, I did it. I had read to start anywhere from 32, to 34, to 38 weeks. So, I believe I started at 33 weeks, maybe it was 35, sorry, I can't remember. Can't say if it helped or not, but I was induced (for no good reason) with DS at 39.5 weeks. I was only 1cm and about 60-70% effaced. With DD, I was 2.5-3cm dilated and 70% effaced by my 37 week appointment and had her at 37w4d. So, it appears to have helped, but that could just be coincidence! I did an oral pill that was 500 (mg?). Once a day. My "plan" was to increase to twice a day at 38 weeks (but I never made it there). And I hadn't decided if I'd get desperate or not, but I've also heard of inserting it vaginally.

**Drummer's Wife** · 10-27-2009, 02:26 PM

I drank RRL and took EPO both orally and vaginally from about 37 weeks on for my vba2c attempt per recommendation of my mom (who was also my midwife.)

It's really your call. There isn't much info out there, either way. I was comfortable with my mom's suggestion, but I can't say it helped - since I went on to have another section.

DocsNemesis · 10-27-2009, 03:28 PM

I've used EPO in all but my first pregnancy. I went overdue with him and my midwife with my 2nd suggested it.

For me, it works really well, but it completely varies from woman to woman. I've never found any negatives to it. I did 3 caps my mouth and 3 caps-punctured-near the cervix before bed. I started with my 2nd around 38 weeks, my 3rd around 36 weeks, my 4th at 39 weeks. My 5th was a preemie so yeah, I didn't use it with him. With the first 2 nothing happened until I had my membranes stripped and then I woke up in labor the next day. With my 4th however, I was trying to just let nature take its course, when I checked myself and realised my cervix was horribly swollen. No idea why but it was. I decided to see if I could find anything to help get the swelling to go down and-surprise-EPO was recommended for that. The only thing I wish I had done in her case was wait until evening. In my hurry, I went ahead and took a nap in the morning and used it then...my water broke that night, at 11 and she was born at 2AM. Bleh! lol Anyway, it worked wonders for the swelling. I checked later that night and the swelling was totally gone and I was a good 7cm's before anything even happened.

I am curious about this scar thing though. I really don't understand how it would be able to reach a cesarean scar since you're using it on the outside of the cervix, but I am curious.

I also drank RRL tea with all but the last one but I have no idea how much it helps. I just figure the extra vitamins and minerals can't be bad

AlexisT · 10-27-2009, 07:49 PM

Cervidil is also given as a vaginal insert, and Cytotec can be given that way (in a few countries it's specially manufactured as a 25mcg vaginal tablet). For that matter, Cytotec is given orally. I don't know how it works, exactly--I just know that's why prostaglandins increase the rupture rate and are contraindicated for VBACs.

I don't think EPO is remotely near as strong, since it can't induce labor the way Cervidil or especially Cytotec can. But theoretically, if you used enough of it, maybe. It would be really nice to have some actual data on it. Right now, anyone who makes a decision either way is guessing.

DocsNemesis · 10-27-2009, 09:54 PM

I was under the impression that cervadil and cytotec were risky due to strong, uncontrollable contractions. Pitocin they can turn down if it gets too strong; cytotec they can't undo once its been done (or can they? Maybe theres some counter pill? lol) and it can produce extremely strong contractions. Mix that with a uterine scar and rut roh-same reason why pit isn't recommended.

EPO doesn't actually cause any contractions. All it does is ripen the cervix, and in some cases, reduce swelling. Now I suppose if it somehow migrated through the cervix and up to where the uterine scar is, it could in theory soften the scar tissue...but is that really a bad thing? I dunno...it might actually make it slightly more flexible, but since scar tissue is generally lacking in collagen to begin with, I don't know.

Anyway, the only way I could even see it migrating up is if you've lost your mucous plug and are already dilating/thinned out a reasonable amount.

OP, its up to you what you are comfortable with. I for one am using it again, since it obviously works well for me-even though I now have a cesarean scar. But its all what you feel is ok and what isn't. Like I said, it may not even help you at all. Or it might make all the difference. Theres just no way to know.

MsBlack · 10-28-2009, 08:16 AM

RRL tea is completely safe for healthy pregnant women. It's active ingredient, fragrine, acts specifically on uterine muscle to produce mild 'toning contrax' much like Braxton Hicks. This is just a general tightening of the uterus, 'hard belly', not going to implicate the somewhat different cells of the cervix, won't cause 'labor contrax' that is. Some sources say that RRL also has 'hormone balancing' effects, but I've not seen any evidence on this as yet.

EPO is not a prostaglandin per se--it contains compounds that our bodies can use to create prostaglandins necessary for softening ('ripening') the cervix. THe cervix must soften for uterine contractions to have the desired effect of opening the cervix by pulling it back (if that makes sense). Because I have seen adverse affects with EPO used in excess, I think it is wise to be cautious about it's use. Labor occurs a) in the presence of both prostaglandins and oxytocin--the first soften the cervix, the second creates uterine contractions that shorten the uterus, pulling the cervix up/away/open. And b) labor occurs when baby is ready, as signified by biochemical signals passed to mom (as far as I know, this biochemical dance btwn mom and baby is not entirely understood yet).

You don't want to disrupt the balance of prostaglandins and oxytocin, which can be trouble for some moms. EPO can cause too much cervical softening before mom has enough oxytocin flowing--which can bring baby down too far, too soon, onto a fairly closed cervix. I saw this in a first time mom whose baby was fairly far descended into the vagina, causing an almost unbearable, irresistible urge to push from 1cm dilation onward. Another mw I know saw a mom who used a lot of EPO--and the mw could actually see the baby's head a little, with the cervix still wrapped around it, only a few cms dilated! In both cases, labor is very painful because the cervix is stretched so tightly around baby's head that the uterine contrax can't open the cervix--the cervix just cannot relax. Knee chest, to bring baby up toward mom's heart and off the cervix, was the only thing that helped cervix open--and knee chest is not a comfy way to labor, let me tell you!

I would not recommend EPO for any first time mom; and only for 2nd or beyond births if the first birth went pretty far post dates (at least 42wks) and/or mom had a lot of strong labor without good progress in dilation. Of course, many women who've had a primary csec had just this occur--BUT! They also were laboring in bed, not allowed to move and position freely, not fed or allowed to drink, had epidurals and/or pitocin inductions....so I would still be cautious about using EPO for such a mom.

THe amount noted by the OP sounds like a lot to me as a 'preventive measure'. I think even half that amt would be plenty....if it's needed at all.

Semen also contains prostaglandins....and it would be hard to go wrong with making love as often as desired in the last weeks! Orgasm also produces oxytocin in women....as well as simply 'love itself'....so go ahead and love on your partner, be loved-on....but do try not to make it chore designed mainly to get some prostaglandin deposits!