what is used other than Pit for 3rd stage? - Mothering Forums

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Old 07-08-2009, 09:34 PM - Thread Starter
 
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Hi,

I was going over our birth plan with my OB today and one of the things we have on it is that I would prefer IM Pitocin over IV (and only if necessary). She said that when they do IM, they use something else instead of Pit, but I can't remember what it was. Can anyone help?

Amy, wife to Paul 5/20/01, SAHM to Daniel 5/23/07, Claire 7/15/09, and Elaine 9/4/12

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Old 07-08-2009, 10:33 PM
 
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methergine?

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Old 07-08-2009, 10:40 PM - Thread Starter
 
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Originally Posted by iemaja View Post
methergine?
That could be it, I'm pretty sure it started with an M. Any thoughts on this med?

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Old 07-09-2009, 12:18 AM
 
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methergin or they might use misprostol (cytotec) which works pretty well for hemorrhage
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Old 07-09-2009, 12:46 AM
 
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All hospital birthers here automatically get Cytotec (misoprostol) for third stage, unless they object. It's generally given orally here (for third stage), but can also be used rectally.
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Old 07-09-2009, 11:52 AM
 
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I use Methergine if the placenta has not delivered, Pitocin if it has. I'm hoping soon to be able to do away with both and just use Cytotec.
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Old 07-09-2009, 11:57 AM
 
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Cytotec has so many nasty side effects when used to induce labor. Are none of those a concern for use in 3rd stage?

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Old 07-09-2009, 02:24 PM
 
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What do you mean by "so many"? The risk of uterine rupture is for a distended pregnant uterus. And "nasty" contractions are what you want when dealing with a hemorrhage.
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Old 07-10-2009, 10:22 PM
 
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When I experienced severe hemmorrage I was given an injection of pitocin, next an injection of methergine, then an injection of a drug called hemabate. The next few hours and days I was given metheragine tablets every few hours. ((also did nipple stimulation, cold packs on uterus, exploration of uterus to "double check", manual compression of uterus... oy.. not a fun memory at all. HTH.

edited to add.. interesting link for hemmorrhage in a hospital setting. HTH
http://www.aafp.org/afp/20070315/875.html

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Old 07-10-2009, 10:30 PM
 
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I've seen Hemabate given ::shudder:: it gave the mom instant and intense diarrhea for the next few hours, and nausea. It was not very pleasant. I think the doc was just punishing her, because she'd written "no prophylactic pit" on her birth plan, and he said something like, "Oh, you don't want pit? Well you're bleeding, so I'm going to have to use something else."

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Old 07-10-2009, 10:47 PM
 
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First of all, pit can be given IM. I am assuming that your preference is not to have an IV... if so, pit can most certainly be given IM instead of IV. I wouldn't see why it would mean they'd have to use something else...

Where I work, we routinely give a bag of IV pit after the placenta delivers. If there is heavy bleeding, we will either give IM methergine, IM hemabate, or rectal cytotec. It is provider preference and sometimes we have to use more than one.
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Old 07-11-2009, 10:47 PM
 
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Not what you're asking, but there is some very interesting info in the placentophagia thread about putting a little bit of the placenta in your cheek to stop hemorrhage. Of course, that wouldn't work if you haven't delivered the placenta yet. I had an IM injection after DD's birth. I believe it was pitocin but can't be 100% sure.

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Old 07-11-2009, 11:26 PM
 
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Quote:
Originally Posted by nashvillemidwife View Post
What do you mean by "so many"? The risk of uterine rupture is for a distended pregnant uterus. And "nasty" contractions are what you want when dealing with a hemorrhage.
The orriginal poster wasn't asking about hemorrhaging, just use for third stage.

I'm just curious as to why it's even used at all, since it's not approved for any use except to treat ulcers and has a specific warning on the package and insert that it should not be used in pregnancy or labor, and third stage is a part of labor.

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Cytotec has been reported to cause the uterus to rupture (tear) when given after the eighth week of pregnancy.
That's a direct quote from the Cytotec packaging insert. 8wks pregnant is not a "distended pregnant uterus".

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This Patient Information Sheet is for pregnant women who may receive misoprostol to soften their cervix or induce contractions to begin labor. Misoprostol is sometimes used to decrease blood loss after delivery of a baby. These uses are not approved by the FDA. No company has sent the FDA scientific proof that misoprostol is safe and effective for these uses.
That one is from an FDA Alert that went out. (bolding mine)

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Old 07-12-2009, 07:52 AM
 
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Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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Old 07-12-2009, 03:21 PM
 
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Quote:
Originally Posted by DoulaVallere View Post
The orriginal poster wasn't asking about hemorrhaging, just use for third stage.
I was talking about hemorrhage.

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I'm just curious as to why it's even used at all, since it's not approved for any use except to treat ulcers
Because it's highly effective. We know it causes miscarriage in pregnancy and uterine rupture in labor so should obviously used with extreme caution, but the risk/benefit analysis in treating postpartum hemorrhage is extremely favorable.

Lots of medications are used or prescribed off-label, many of them leading to new labeling for new treatments. That's part of the process.
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Old 07-12-2009, 04:49 PM
 
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from the trials/studies the side effects are some increase in shivering and some women had their temp rise.
the thinking behind using a prostaglandin instead of just a utero tonic med like methergin or pitocin is that all/most of the oxytoxic receptors are already filled/used and so that class of drug won't work so using a prostaglandin would actually increase the effectiveness of natural and added drugs-
midwives found and started using ergot of rye many centuries ago (even though there can be some pretty horrific side effects) - which A Hoffman (of LSD fame) used as a basis of info to explore making a drug to control postpartum hemorrhage(without the side effects of ergot) and he came up with methergin (the very drug we use now) none of this was studied in the same way we study drugs now- they invented it started using it. In any case the only way to figure out how safe any of it is ultimately is by trial - and misoprostol in many forms and applications is begin studied now-
there is nothing quite like the feeling of a uterus that has no tone- I don't see a severe hemorrhage often, but when I do I want to be able to use what ever will work and fast- I am also trying to picture a uterus that has almost no form-because it is that soft and not contracting to go to beyond complete hard contraction to a level of contracting that would rupture it-
even in the 8 weeks pregnant example we are still talking about a firmly muscle toned uterus that is distended - and that is very different than an atonic non-contracting/poorly contracting postpartum uterus-
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Old 07-12-2009, 09:58 PM
 
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Originally Posted by nashvillemidwife View Post
I was talking about hemorrhage.
I know. I was just trying to get at the point that the orriginal question in the thread was about just assisting in third stage...just to get the placenta out faster, not a hemorrhage situation. And it sounded like some people were using it standard for third stage, with or without hemorrhage, which to me doesn't make sense. (of course, a managed third stage doesn't make sense to me anyway without a medical indication)



Quote:
Because it's highly effective. We know it causes miscarriage in pregnancy and uterine rupture in labor so should obviously used with extreme caution, but the risk/benefit analysis in treating postpartum hemorrhage is extremely favorable.

Lots of medications are used or prescribed off-label, many of them leading to new labeling for new treatments. That's part of the process.

And I agree with this. That's how Viagra came to be...someone was trying to make a (I believe) bp drug, and said "hey, this kinda sucks for treating high bp, but MAN will it give a man an erection!" and there ya go.

But to me there is a HUGE difference in finding out a drug has a side effect that can be exploited for positive use when used off lable, and using a drug off lable that both the MAKER of the drug AND the FDA have explicitly said "DO NOT USE THIS FOR ANYTHING BUT WHAT IT IS MADE FOR." There's just a huge difference there to me. I understand that it's a lot cheeper than the alternatives, but the side effects aren't just something like priapism, which, while uncomfortable, rarely causes long term damage...and having a woman's uterus literally explode, often killing her and her baby, which happens randomly among women - VBACs and vaginal birthers, first time birthers, etc - so no way to really determine who is at risk and who isn't.

I guess I'm just trying to understand why, when there are other safer options available, anyone would support using that drug off lable for anything at all. ACOG actually sent out a letter in response to Searle's letter warning them not to use the drug for induction or third stage of labor that pretty much said "we think Searle is fearmongering and we are going to make our own rules and keep using Cytotec no matter what they or the FDA says about it." So to me, using it off lable for third stage or induction says the same thing...that the users are ignoring Searle and the FDA's warnings and taking unnecessary risks.

I'm really just trying to wrap my head around the justification here, and I feel like we are going to have to agree to disagree. To me it's an obvious answer, and to you it's an obvious answer...just different answers.

Vallere: Blessed Wife, Doula, Homeschool Mom to Ian Gray(11/20/05), Zollie Isaac(10/14/07), Anna Zophia (8/14/09):, and a GIRL coming June 2010!
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Old 07-12-2009, 10:11 PM
 
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well after the makers made that statement they put some product together for drug trials-- so what they are saying is we don't want to be sued for you using this drug- but here why don't you try it under the auspices of a trial ...
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Old 07-12-2009, 11:20 PM
 
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Cytotec for postpartum hemorrhage is not only more effective than pitocin, but it's faster and easier to administer, and does not require refrigeration. I shudder when I think about how many homebirth midwives carry their drugs around in their birth bags when they need to be in the fridge! But logistically, what are you going to do?

In a true emergency, the alternatives really don't compare.
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Old 07-13-2009, 01:36 AM
 
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http://www.gentlebirth.org/archives/...g.html#Cytotec

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Old 07-13-2009, 05:45 PM - Thread Starter
 
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Wow, thanks for all the info, it's been very helpful. To clarify, I told my OB that I didn't want routine Pitocin for the placenta, but that if I had a PPH and needed it, I preferred IM to IV (she really wants me to have an IV and I don't, for various reasons). So that was when she said that they don't do Pitocin IM, they use something else (I do think it was Methergine). She didn't say why, and I hadn't heard of this other drug, so I wasn't sure if it had any advantages or disadvantages versus pit.

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