My midwife uses Cytotec!! - Mothering Forums

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Old 03-04-2009, 11:28 AM - Thread Starter
 
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Shouldn't I be concerned? I have heard such awful things about it and I know doctors still use it, although it's not FDA approved, but a midwife??

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Old 03-04-2009, 11:44 AM
 
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It's really disappointing, and frustrating!:
I see you're in NY, I'm in NYC and Cytotec is popular with some midwives who work in hospitals.

It's so beyond my comprehension why they choose such a controversial unsafe drug, they defend it when you ask them about it!

Does your Homebirth midwife use Cytotec at homebirths?
Change midwives if she does!
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Old 03-04-2009, 11:47 AM
 
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I'd personally be concerned. Doesn't mean that she will use it on you though...! Just make sure you dont let her.
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Old 03-04-2009, 11:57 AM
 
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Id ask why and how she uses cytotec before freaking out. My HB midwife gave me a cytotec after dd was born because my placenta only partially detatched and I was bleeding pretty heavily.

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Old 03-04-2009, 11:59 AM
 
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anyone want to add some of this info on cytotec? I just delivered at home and this was given to me b/c of bleeding.
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Old 03-04-2009, 12:50 PM
 
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A lot of HB midwives will carry it for PPH, usually as a last resort medication if Pitocin and Methergine still aren't stopping the blood loss. The potentially dangerous side of Cytotec (uterine hyperstimulation, rupture, fetal distress) is when it's used as an induction/ripening agent; it's a different issue when used for PPH. Now if your HB midwife were using it for induction/ripening, rather than just for PPH, I would be very concerned.
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Old 03-04-2009, 12:54 PM
 
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Originally Posted by rixafreeze View Post
A lot of HB midwives will carry it for PPH, usually as a last resort medication if Pitocin and Methergine still aren't stopping the blood loss. The potentially dangerous side of Cytotec (uterine hyperstimulation, rupture, fetal distress) is when it's used as an induction/ripening agent; it's a different issue when used for PPH. Now if your HB midwife were using it for induction/ripening, rather than just for PPH, I would be very concerned.
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Old 03-04-2009, 02:03 PM
 
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What is she using it for? I think it works really nicely for PPH if pitocin isn't doing the trick.

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Old 03-04-2009, 02:04 PM
 
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Yeah, I had cytotec in the hospital (homebirth transfer after 44 hours of non-progressing labor) but I had it because I hemoraged real bad. I could have died...literally. I lost so much blood they thought about transfusion. Anyways, my midwife does carry it but as a last resort option and only of PPH not for induction of any sort. I would check on that and see why yours carries it. If it will save your life and they would use it in the hospital if you were there, is there really cause for oppostion??? Everyone has different reservations about things so I think you need to investigate further!!!
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Old 03-04-2009, 02:05 PM - Thread Starter
 
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Originally Posted by dewi View Post
It's really disappointing, and frustrating!:
I see you're in NY, I'm in NYC and Cytotec is popular with some midwives who work in hospitals.

It's so beyond my comprehension why they choose such a controversial unsafe drug, they defend it when you ask them about it!

Does your Homebirth midwife use Cytotec at homebirths?
Change midwives if she does!
Yes, she's a homebirth midwife.

And yes, it's for PPH. But even so, the risks with Cytotec are still very awful. I suppose others look at it in a "well, it's that or bleeding to death" sort of way, but frankly I'm worried about that.

Partnered mama with DD (01/04) and DD (08/09) and 8 critters, including a !
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Old 03-04-2009, 02:22 PM
 
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Yes, she's a homebirth midwife.

And yes, it's for PPH. But even so, the risks with Cytotec are still very awful. I suppose others look at it in a "well, it's that or bleeding to death" sort of way, but frankly I'm worried about that.
I would have to say, a completely untreated severe PPH has even greater risks than Cytotec. I would imagine she isn't giving it to every client, correct? If so, then I would find a new care provider. However, I would find it reasonable if it was her last-resort type of medicine for a severe PPH.

Is there something else you would prefer she uses? If so, discuss that with her and see what she says.

Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

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Old 03-04-2009, 03:14 PM
 
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Originally Posted by Raene View Post
Yes, she's a homebirth midwife.

And yes, it's for PPH. But even so, the risks with Cytotec are still very awful. I suppose others look at it in a "well, it's that or bleeding to death" sort of way, but frankly I'm worried about that.
But the risks with cytotec are not very awful when used postpartum. Diarrhea, blood pressure changes, nausea, afterpains. About the same for other drugs used for PPH, like methergine. All of the really bad stuff, like uterine rupture, aren't an issue postpartum.

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Old 03-04-2009, 03:25 PM - Thread Starter
 
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Okay, this is good to know. Thank you!!

Partnered mama with DD (01/04) and DD (08/09) and 8 critters, including a !
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Old 03-04-2009, 03:33 PM
 
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I would generally run in the opposite direction. Pit is approved for those postpartum uses, why not just use that?

I am curious about why uterine rupture is not an issue postpartum. It was my understanding that you did not have to have a baby inside to have UR. They are supposed to be extremely violent, constant contractions. Also there is the issue that there is no correct dosing for Cytotec and doctors just give whatever they think is good. You can't turn it off once you've taken it, and I've read (admittedly very rare) stories of Cytotec contractions going on for days.

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Old 03-04-2009, 03:44 PM
 
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Because pit doesn't always work. I had a severe postpartum hemorrhage that was not responsive to pit, methergine or anything else.

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Old 03-04-2009, 03:50 PM
 
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All the homebirth midwives here in San Diego carry it. It is for severe emergency bleeding, not induction.
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Old 03-04-2009, 04:54 PM
 
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I would generally run in the opposite direction. Pit is approved for those postpartum uses, why not just use that?

I am curious about why uterine rupture is not an issue postpartum. It was my understanding that you did not have to have a baby inside to have UR. They are supposed to be extremely violent, constant contractions. Also there is the issue that there is no correct dosing for Cytotec and doctors just give whatever they think is good. You can't turn it off once you've taken it, and I've read (admittedly very rare) stories of Cytotec contractions going on for days.
Uterine rupture is very rare (if at all, I don't know if there are postpartum cases of it or not) because your uterus is no longer totally stretched out. Think of it as popping a balloon that is fully inflated versus one that just had a bit of air in it by squeezing. The one that is full will pop much easier than the one with just a tiny bit of air in it.

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Old 03-04-2009, 04:58 PM
 
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Originally Posted by Raene View Post
Yes, she's a homebirth midwife.

And yes, it's for PPH. But even so, the risks with Cytotec are still very awful. I suppose others look at it in a "well, it's that or bleeding to death" sort of way, but frankly I'm worried about that.
What risks? Once the uterus is no longer pregnant, there is no risk of UR. There have not been any documented cases of UR with misoprostol used postpartum. It's like turning off a frigging faucet most of the time. Miso is my go-to drug, over methergine, hands down for a PPH.

Fear is not a good place to make decisions from.

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Old 03-04-2009, 05:13 PM
 
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I would generally run in the opposite direction. Pit is approved for those postpartum uses, why not just use that?

I am curious about why uterine rupture is not an issue postpartum. It was my understanding that you did not have to have a baby inside to have UR. They are supposed to be extremely violent, constant contractions. Also there is the issue that there is no correct dosing for Cytotec and doctors just give whatever they think is good. You can't turn it off once you've taken it, and I've read (admittedly very rare) stories of Cytotec contractions going on for days.
Pitocin doesn't work everytime on every person. It also has a much shorter duration. That is fine for some people as they stop bleeding and that is the end of it. Some people though will stop bleeding and then as the pitocin wears off (about 30 minutes later), they begin gushing again. Cytotec lasts much longer, so it can be given in addition to pitocin, if needed. Yes, it can't be stopped once it has started, but IM pitocin can't be stopped either.... once the shot has been given, that is it, there is no getting it back. Absolutely the contractions with cytotec can be stronger and that is what stops the PPH. If a uterus isn't wanting to contract in order to stop bleeding and pitocin isn't working, then something needs to be used that will make the uterus contract.

As far as the uterine rupture goes... it is thicker after the baby is born. It shrinks up and the walls are thicker, so that also means they are stronger against a rupture.

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Old 03-04-2009, 05:16 PM
 
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If she's using it for PPH, I would not be concerned. I would perhaps talk to her about what her PPH protocol is, and see about getting a shot of pit first if you would prefer that (I would expect she'd try pit first anyway). But IMO cytotec is OK for PPH and can be lifesaving if necessary.
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Old 03-04-2009, 05:21 PM
 
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A lot of HB midwives will carry it for PPH, usually as a last resort medication if Pitocin and Methergine still aren't stopping the blood loss
Ahh, this is what I had it used for. They gave me the pitocin, then the methergine orally, then the Cytotec and then the Methergine shot. I had never heard of these meds until I needed them.
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Old 03-04-2009, 05:32 PM
 
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When my sister did a homebirth transfer her CPM and her transfer-CNM convinced her to get Cytotec. @@ I don't get it.

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Old 03-04-2009, 05:58 PM
 
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When my sister did a homebirth transfer her CPM and her transfer-CNM convinced her to get Cytotec. @@ I don't get it.
What don't you get?

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Old 03-04-2009, 07:34 PM
 
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Raene
I thought you were concerned your HBmidwife would induce your labor at home with cytotec.

Use for PPH is very different then induction.
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Old 03-04-2009, 09:18 PM - Thread Starter
 
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Raene
I thought you were concerned your HBmidwife would induce your labor at home with cytotec.

Use for PPH is very different then induction.
So I've learned from this thread...interesting. I just assumed it was horrible no matter what. Who knew? I'd still avoid it...even if it works and is safer, it's still not FDA approved, and they approve just about EVERYTHING...

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Old 03-04-2009, 09:55 PM
 
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So I've learned from this thread...interesting. I just assumed it was horrible no matter what. Who knew? I'd still avoid it...even if it works and is safer, it's still not FDA approved, and they approve just about EVERYTHING...
FDA un-approved means nothing. No one is going to conduct the trials for misoprostol to be approved, because it's off-patent and dirt cheap. The issue is not evidence of harm when used appropriately.

Again, fear is a poor place to start from when making decisions, as is a lack of information.

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Old 03-04-2009, 10:11 PM
 
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my biggest concern would be the overuse of it. for instance we could say "it's for rare and big emergencies only!" but... it's kinda like the elephant in the room thing. try not to think about it and it becomes bigger.

I guess I mean to say PPH isn't normal. it doesn't "just happen". it's either retained placenta, someone with clotting problems in general or uterine rupture ECT... or b/c someone was pulling on a placenta before it dettached is now is in a bad situation! all extenuating circumstances...

I would greatly clarify with this mdiwife exactly when, how and why she uses cytotec. making sure she doesn't pull on placentas... AT ALL. b/c if she carries Cytotec b/c she's needed it plenty of times - well that's just plain concerning. but if it's one of those things she carries and NEVER uses... well I might be okay with it.

then again I doubt she'd be like "oh yeah I always pull on placentas and they tend to retain so I just gotta carry this stuff to fix my booboos I create" lol... but sometimes you can read between the lines by how someone answers a question ykwim?

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Old 03-04-2009, 10:24 PM
 
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Well that's funny. I had a severe pph. I did not have retained placenta. I did not and do not have clotting problems. No one pulled on the placenta.

There are more reasons for pph than that. In my case, it was uterine atony from a long labour.

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Old 03-04-2009, 10:27 PM
 
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Well that's funny. I had a severe pph. I did not have retained placenta. I did not and do not have clotting problems. No one pulled on the placenta.

There are more reasons for pph than that. In my case, it was uterine atony from a long labour.
Yep. Some common reasons for PPH: large baby, polyhydramnios, long labor, rapid labor, being a grand multip, infection.

You'll note that none of them have anything to do with having a bad midwife.

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Old 03-04-2009, 10:33 PM
 
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Well that's funny. I had a severe pph. I did not have retained placenta. I did not and do not have clotting problems. No one pulled on the placenta.

There are more reasons for pph than that. In my case, it was uterine atony from a long labour.

ok but I didn't say those were the "only" reasons for PPH... I gave a handful off examples... as to say it's not just some thing that happens all of the time.

my POINT was that a PPH isn't just there for no reason... it happens for A reason. the uterus isn't contracting and closing properly for A reason. not just because some people PPH hemorrhage randomly.

nor did I accuse any midwife of causing it all of the time (only that it *can* be caused by someone pulling (including the mother) on the placenta)

a lot of people PPH after medical interventions and bad pushing instructions etc... and some people even PPH b/c of undetected cysts and what not. I'm well aware there are MANY reason for PPH, but it's also entirely NOT the "norm".... not even close. the most common PPH reason is retained placenta from pulling on it, and bleeding out b/c of side effect to medical intervention.

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