Is Cytotec still used for induction? - Mothering Forums

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#1 of 54 Old 04-30-2009, 07:11 PM - Thread Starter
 
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I am not a birth professional, but soon-to-be new mum. I was having a discussion with a nurse-friend of mine today about Cytotec. I saw a show on tv the other day, where it was used as a cervical ripener/ induction drug. After all I had read about it, I was suprised it is still used, now I am thinking it might have been a really old show, since my friend is pretty sure it is no longer used. So, do any of you know if it is still used? If it is, can anyone provide a balanced argument about why, since it seems to have serious complications. TIA!
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#2 of 54 Old 04-30-2009, 07:14 PM
 
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it was four years ago. Ask me how I know.
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#3 of 54 Old 04-30-2009, 07:18 PM - Thread Starter
 
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I'm gonna guess that you experienced the not-so-lovely contractions of it?
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#4 of 54 Old 04-30-2009, 07:19 PM
 
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Originally Posted by lisalu100 View Post
I'm gonna guess that you experienced the not-so-lovely contractions of it?
Yep. My doctor said it wasn't "a big deal." Thankfully nothing horrible happened and my baby was born safe and sound.
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#5 of 54 Old 04-30-2009, 07:28 PM
 
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Yes, it is still used. I've been present at a birth as a doula where it was presented by the L&D nurse as an option for induction. Fortunately I had discussed Cytotec in advance with my client and she declined it. The nurse made out like it wasn't that big a deal and they used it all the time.

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#6 of 54 Old 04-30-2009, 08:16 PM
 
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It's been offered and strongly recommended to every single client I've ever had facing an induction at my local hospital. All but one have read the information I've sent them on the drug and declined.

Megan- mama to 3, midwifery student , doula, , runner , knitter .
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#7 of 54 Old 04-30-2009, 08:18 PM
 
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I was at a birth this weekend where the mother decieded to accept a cytotec induction. It is absolutely still in use (but in much smaller doeses than initially).

Megan Davidson, Labor & Postpartum Doula, Breastfeeding Counselor, Anthropologist, Mom to August (9) and Clay (4), Partner to Shawn.

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#8 of 54 Old 04-30-2009, 08:23 PM
 
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Yes, my midwife tried to use it on me and I declined, much to her annoyance.

Mom to DD1 (10/07) and DD2 (3/11)
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#9 of 54 Old 04-30-2009, 08:39 PM
 
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Used all the time for full term birth and to carry out miscarriages as well. Shocking really!

.
Homeschooling, midwifery mom to 4 beautiful blessings(8,6,4,1)

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#10 of 54 Old 04-30-2009, 08:50 PM
 
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Originally Posted by lisalu100 View Post
If it is, can anyone provide a balanced argument about why, since it seems to have serious complications. TIA!
It's really, really cheap.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
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#11 of 54 Old 04-30-2009, 08:59 PM
 
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Originally Posted by completebeginnings View Post
Used all the time for full term birth and to carry out miscarriages as well. Shocking really!
I used it when I miscarried in December. I did so with a lot of thought and education. Everything went really well, and I'm glad it was an option for me. That being said, it's not something that should be used lightly.

~Manessa mama to one teenageer, one tweenager, and a toddler

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#12 of 54 Old 04-30-2009, 09:00 PM
 
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My OB uses it vaginally for cervical ripening and rectally for PPH, but not alone as a means of inducing labor.
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#13 of 54 Old 04-30-2009, 09:07 PM
 
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Moving this to main Birth and Beyond, per the new Birth Professionals guidelines.
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#14 of 54 Old 04-30-2009, 09:34 PM
 
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It was certaintly used last July when I had my son. Having had two previous vaginal deliveries (both did have to be augmented with pitocin as I was not contracting effectively (the second was at 45 weeks, so we're not talking about just not waiting long enough here- apparently the pitocin boost is a good thing for me..) I was induced following a very complicated pregnancy- I was so ill by that point that I really did not advocate well for myself, and I went along with the ob.

Cytotech!

Yeah. I had not needed analgesia of any sort previously (yes, pitocin ctx are uncomfortable, but tolerable) I did have to have an epidural (it was that or I would have become psychotic, the pain was completely overwhelming/unbearable.) I also stalled at 8 cm for umm- 11 hours.... The baby was having frequent cardiac decels and generally it was a miserable experience all around.

After the birth, I was unable to function, and in horrific pain for another 12 hours. I didn't even care about breastfeeding or bonding, I just plain couldn't function. Considering that I'd literally skipped down the hall after my daughter's birth- this was not something I'd forseen. Luckily, my husband was there to step in, and remind me to nurse the baby as well as to hold him and love him.

I still have horrible nightmares about ds's delivery, and as I am currently pregnant, I'm desperately fearful of another experience that's remotely horrific.

I don't have enough space/distance/time from the birth yet to begin healing, and I know that my bond with was much harder to form than it was when I was able to establish an early relationship/nurse normally etc with my daughter.
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#15 of 54 Old 04-30-2009, 09:38 PM
 
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Originally Posted by DreamsInDigital View Post
My OB uses it vaginally for cervical ripening and rectally for PPH, but not alone as a means of inducing labor.
Can you provide me a bit more information, DiD? I tend to put cervical ripening as an induction method, especially one requiring a medication to do so? I have had clients who have been induced with misoprostal (Cytotec) either vaginally or orally, and it was always a documented induction.

How does your HCP see it?

Sharon

Birth doula, doula trainer, ican leader, lamaze childbirth educator, and most importantly, mom of 2 great girls!
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#16 of 54 Old 04-30-2009, 09:41 PM
 
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Still in use out here in California!

Stephanie-33 lucky mama of 5 precious ones: DD-12, DS-9 , DS-6 , and DD-3 and Bridget Alannah  SHE'S ONE NOW! loving wife to DH-38
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#17 of 54 Old 04-30-2009, 10:15 PM
 
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It's used here in Puerto Rico, much to my dismay.

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#18 of 54 Old 04-30-2009, 10:16 PM
 
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Still in use here. My OB saw that in my birth plan I said "absolutely no Cytotec" and she questioned it. Seven years ago I had it orally to induce my 4th baby... Within 45 minutes she was born, and I was at 0cm/-2 station when I went in for the induction (I'm a T1 diabetic and she was 3 days overdue, which means automatic induction).

My OB listened to the story and told me that couldn't be. So I ordered the records and brought them with me yesterday. She was in shock. I'd only gotten a half a 25mg pill.

I also had nursing issues. My baby lost her suck reflex due to the violent birth. It took almost two months to finally get her to latch and nurse. I pumped the entire first two months. That was also hard on bonding (of course, she was born on 9/10/01, so that may have been the bonding problem or at least not help it).
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#19 of 54 Old 04-30-2009, 11:13 PM
 
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Yes it is used, often!!!

Cristina - "If you find it in your heart to care for somebody else, you will have succeeded." Maya Angelou
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#20 of 54 Old 05-01-2009, 12:15 AM
 
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Off of the top of my head there is only one hospital in our area who doesn't routinely use it to begin an induction for an "unripe" mother. I talked to an OB whose practice I used to send clients to about it, and she was adament that she does use it, will always use it. She said, "It's cheap, it's fast, and it is efficient, it takes a hard, high, posterior cervix and turns into a cervix that is low and buttery in no time. We haven't had a problem with it yet. I will NOT consider using cervidil instead."

Mama to two awesome kids. Wife to a wonderful, attached, loving husband. I love my job-- I'm a Midwife, Doula and Childbirth Educator, Classes forming now!

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#21 of 54 Old 05-01-2009, 01:23 AM
 
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I'll be the voice of dissent here. I'm a home and hospital birth CNM. I've attended about 400 births in my career, with 200-250 of them being in the hospital. I would use cytotec in the hospital if my collaborating doctor would let me.

It's used, as is obvious from these postings. It's used because it's effective. The horrible things we hear are when excessive amounts are used, excessive doses are administered (in one study it was administed every four hours until active labor), administering cytotec and then adding pitocin on top of it, using it to augment labor, performing AROM during the labor, administering it to women with risk factors for uterine rupture, and not listening to or observing a woman closely enough during labor. (Thanks to loridjs! Want to give credit where it's due...)

Generally speaking, 25 mg of cytotec is unlikely to result in the effects everyone here is citing.

I recently did a literature review on the use of cytotec for outpatient preinduction cervical ripening. I found 7 articles, 2 of which were editorial/commentaries. I only have the abstracts, not the articles, but here are some of the findings:

1) A definite weakness is that all of the studies have a relatively small study group, anywhere from 49-270, usually divvied up into two groups.

2) Of the five studies, the ONLY one that makes mention of low apgar scores, fetal intolerance to labor, and/or neonatal complications was the one that used 50 mg. (total study size 270)

3) From the 25 mg studies:

"No patient had hyperstimulation or required cesarean delivery for nonreassuring fetal assessment during the ripening period." (total study size 84)

"There were no adverse outcomes in either group." (Either group being placebo or 25 mg cytotec) (total study size 68)

"No adverse effects were encountered." (total study size 60)

4) One study brought women in the evening before an induction, gave 25 of cytotec OR prepidil gel, monitored for three hours, and sent them home if everything looked good. "Misoprostol induced labor during the ripening period in 19 of 41 of patients, compared with 6 of 42 after dinoprostone" (Prepidil gel) (For the mathematically challenged, that's 46% vs 14%)

5) One study used a single dose of 25 or 50 of cytotec every 3 days for a maximum of 3 doses. The 25 mg group delivered, on average, in 3.9 days; the 50 mg group delivered in an average of 2.4 days.

6) One randomized, double blind, placebo controlled trial (the gold standard in the world of research) used a single dose of 25 mg without subsequent induction. The medication to delivery interval was 4.2 days in the misoprostol group and 6.1 days in the placebo group. For first time mothers, the interval was 4.2 days in the misoprostol group and 7.2 days in the placebo group.

7) Another randomized placebo controlled trial used 25 mg of misoprostol, followed by another 25 mg 24 hours later if undelivered, followed by admission 24 hours later for pitocin induction if still undelivered. NINETY percent of the miso group delivered within 48 hours, compared with SEVENTEEN percent of the placebo group. Average dosing to delivery time was 37 hours for the miso group and 61 hours for the control group.

Given the choice, I would rather get the cytotec and go home than go through a pitocin induction, which requires an IV and continuous monitoring.

So-confustication-how many doses and in what intervals did you get the cytotec? I would be EXTREMELY surprised if your reaction was from one dose of 25 mg, and very NOT surprised if it were anything else.

Rikki-cytotec doesn't come in 25 mg pills. It comes in 100 mg. If you got half a pill, it was 50 mg. Administering 12.5 mg is impossible, because that would require cutting a pill into 8 pieces, and it's such a small pill it's not possible. Is it possible to have a 45 minute labor on 50 mg of cytotec? Yep. On 25? Possible, but not as likely. It's also possible for a woman to have uterine hyperstimulation and fetal distress on 2 units of pitocin.

Another interesting factoid: cytotec is used in a few birthing centers.

Bottom line-cytotec is not the devil. Irresponsible use of it is. If I were able to use it, I would present my patient with all of the above information and give her a day or two to do her own research. Depending on the urgency of the induction, the MAXIMUM dosing I would do is 25 mg every 6 hours. If we have time, I'd rather follow the every 24 hour dosing study.

My STRONGEST preference, of course, is not at all, but induction is sometimes needed.

Preparing for overripe fruit flying my way.....

Jennifer
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#22 of 54 Old 05-01-2009, 01:47 AM
 
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(not a BP)

I think this is the one time I'm thinking, "thank goodness I've a vbac." It is horrifying to me that stuff is still being misused in this fashion.

Stinkerton 12/10/01 9lbs8oz, induced to c/s; Little Man 5/20/03 7lbs11oz, r c/s, fear of another labor; Jillybean 11/18/07 10lbs8oz 37cm head, induced VBA2C; and the Wee Beastie, 9lbs8oz, 35cm head, rpt VBA2C
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#23 of 54 Old 05-01-2009, 09:33 AM
 
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Jengacnm,

I appreciate your perspective on this. Unfortunately many women have cytotec used on them in less than careful way. For instance, the mom on here whose doctor's notes say that she was given half a 25mg dose when you and I both know that it only comes in 100mg doses. Her doctor made a clear mistake then by either documenting it incorrectly or giving her the wrong dose.

I met a first time mom once who was planning a natural birth with a respected CNM practice which is known for being hands off. They induced her with cytotec because she reached 41 weeks and they had lost a baby once at 42 weeks. No pitocin, only two doses (I'm not sure the amount) of cytotec. Two hours after her induction began her son was born by emergency cesearean and she had to have a blood transfusion. I don't know all the details of her story but she was a bit shocked by her traumatic birth.

There is not a standard on how to use this drug. It is used in varying does and protocols.

Quote:
Given the choice, I would rather get the cytotec and go home than go through a pitocin induction, which requires an IV and continuous monitoring...Another interesting factoid: cytotec is used in a few birthing centers.
These statements just chill me to the bone. Why should cytotec not require continuous monitoring? Especially since it can't be turned off like pitocin once its started. I for one would not go to any birth center where it was used for cervical ripening.

Please understand I'm not sending any fruit your way, but enjoy discussing this with you. You said that your collaborating doctor will not let you use cytotec. Why is this? Its obvious that you've done a lot of research on this topic but do you have any personal experience administering this drug? Please share, I appreciate your perspective.

Heather Mike Married 8/1/99 Mom to Charlotte Aug 04, Nov 06, and Katherine Oct 07
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#24 of 54 Old 05-01-2009, 11:47 AM
 
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OP, what country are you in? (I ask because you use "mum")? Cytotec is not used on the NHS AFAIK--all inductions are done with prostin (Cervidil). There were phase III trials for misoprostol for induction of labor, using a 25mcg vaginal tablet, but it hasn't been approved yet.

In some countries, there are 25mcg vaginal tablets available, and a few countries have specifically licensed misoprostol for OB/GYN use. http://www.misoprostol.org has a map.

DD 01/2007, DS 09/2011

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#25 of 54 Old 05-01-2009, 11:50 AM
 
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Originally Posted by jengacnm View Post
I'll be the voice of dissent here. I'm a home and hospital birth CNM. I've attended about 400 births in my career, with 200-250 of them being in the hospital. I would use cytotec in the hospital if my collaborating doctor would let me.
One question. Would you tell your patients that there are warnings about it, and that use for induction is off-label...or would you just give it to them?

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#26 of 54 Old 05-01-2009, 01:53 PM
 
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Well then the nurse or doctor wrote the dosage incorrectly. I've got my record right here and it says "1030 1/2 25mg misoprostol". Was it ever made in 25mg dosages? This was 7 years ago.

Also, I have quick births naturally. My prior pregnancy to the one that was induced via Cytotec was 1hr23min, I was not induced and was pushing in the elevator at the hospital.

The one after that was induced with cervadil. It was in place for 12 hours with no change, they took it out and I was at 0cm. 23 minutes later she was born.

So while I can't say that the Cytotec caused hyperstim of my uterus, it was a *ton* more violent than the other two surrounding it.
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#27 of 54 Old 05-01-2009, 02:03 PM
 
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One question. Would you tell your patients that there are warnings about it, and that use for induction is off-label...or would you just give it to them?
Actually, it's not off-label, it is contraindicated, right on the label, by Searle. They have also send "Dear Doctor" letters to discourage the use of cytotec in pregnant women.

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#28 of 54 Old 05-01-2009, 02:22 PM
 
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Actually, it's not off-label, it is contraindicated, right on the label, by Searle. They have also send "Dear Doctor" letters to discourage the use of cytotec in pregnant women.
Yes, I know. I was just wondering if the poster who wants to use it would inform her patients that it's not actually an approved use of the drug.

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#29 of 54 Old 05-01-2009, 06:16 PM
 
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I didn't read through all the responses, but in my recent experience my midwife gave me Cytotec because i had a retained placenta. she tried Pitocin before that. I would never use either of these drugs BEFORE the baby comes out, but administering them for issues occuring AFTER the birth is a completely different story--- I don't see anything wrong with using these drugs if there's no baby involved. They certainly didn't hurt me.
Unfortunatley, neither drug worked on me. I had to transfer to the stupid hospital after my perfect and amazing homebirth because my stupid placenta refused to come out
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#30 of 54 Old 05-01-2009, 07:53 PM
 
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I haven't read all of the responses, but I induced using Cytotec 2 years ago with my daughter. I knew the risks ahead of time and did NOT want to use it. My doula even recommended against it. But, I got to a point where I didn't have a choice. I had to be induced, no other option and it was used.

I was terrified and extremely unhappy that it came to that as my only option. I still chose to go unmedicated and had a good birth (for the most part). My baby was born a few weeks early but incredibly healthy and I am grateful things worked out the way they did.
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