Cytotec for induction and waiting for baby to come naturally - Mothering Forums
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#1 of 50 Old 05-28-2008, 09:41 AM - Thread Starter
 
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I have an induction on the books for tomorrow as I'll be one week past my due date and my ob's protocol is to induce then. I am really torn about what to do because we went through ivf to achieve this pregnancy and I want to everything that's best for the baby.
On ultrasound yesterday they think she is 9lbs, 2oz. Her fluid is within the parameters but is less than last week, her nst did not show much movement but they said that's okay because she was okay on us.
I saw the last doc I haven't met yet in the practice and she zoomed in and out of the room so fast I couldn't hardly talk to her about the induction. I'm so sick of them acting like you have only 5 minutes to talk to them. Anyways I asked her about how they proceed with the induction and she told me they use cytotec. Then I asked her if we could hold off and see if the baby comes on her own and she said yes we can. My dilemna is if I hold off is that the best thing and we have an insurance change so we have to decide today and start paying for a different plan. I'm wondering if I should call them today and ask for something other than cytotec for the induction.
Should I ask them if they would sweep the membrane, I'm thinking they don't because they haven't already offered that. Also I'm 1 cm dilated, no effacement and the baby's head has dropped down. I'm did accupuncture yesterday and had some mild contractions showing up on the nst. My son who is now 12 was exactly one week late but they had to break my water at the hospital when I wasn't progressing. Any advice is so appreciated!
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#2 of 50 Old 05-28-2008, 09:53 AM
 
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you arent in the hospital yet so my advice to you is to research the horrible horrible things that can go wrong with Cytotec. Not only does it set you up for more pain, they cant turn it off (from what i understand) like they can Pitocin. so...if its bad for you, its really really bad and wont get better..and then you get teh epidural.....which leads to a lot of other problems, both for you and the baby.

dr's LOVE to induce b/c then you are on there time frame. 41 weeks is NOT overdue....past 42 weeks is over due if your history isnt such that you tend to cook them longer.

someone much more knowledgable than me will probably come along and point you in the direction you need for researching but from what you have siad, you are having a normal pregnancy and the hospital is trying to start w/ all teh interventions w/o any reason whatsoever (btw, you cant be dropped at this point...they can not abandon you). BUT, you can stand up for yourslef and say NO! You do not have to ask permission to receive teh medical care you want (they will make you think you do...but you don't).

if you dont want the induction, you are probably going to have to fight or lie (as in "im sick..i cant do it today" kind of thing).

GL!
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#3 of 50 Old 05-28-2008, 09:57 AM
 
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http://www.midwiferytoday.com/articles/cytotec.asp
about the "off label" use of cytotec

http://www.mothering.com/articles/pr.../cytotech.html
mothering magazine article (sine this is a spin off of the magazine)
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#4 of 50 Old 05-28-2008, 10:05 AM
 
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Mama, I really would not use cytotec. That is dangerous stuff. Seriously.

I would also rethink the whole induction route and wait for your baby to come on his/her own time. Really, you aren't overdue yet.

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#5 of 50 Old 05-28-2008, 10:45 AM
 
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There is absolutely no valid medical reason to induce right now. Your amniotic fluid is changing constantly and being "a little low" probably just means you need to drink more water. Cytotec is dangerous stuff. It has never been approved for childbirth. OBs use it "off label." Please do some research on induction. Inducing DOUBLES your chance of ending up with a c-section. Here are some resources.

Henci Goer wrote Obstetric Myths vs. Research Realities and The Thinking Woman's Guide to a Better Birth. She does an excellent job of explaining the reasoning behind obstetrical protocols (which often have to do with avoiding being sued rather than what's best for mom and baby) and also what the research says about various interventions.
http://www.hencigoer.com/articles/

You may want to especially check out the abstract about due dates on this site.
http://www.childbirth.org/articles/labor/induction.html

More on Cytotech and inductions in general:
http://www.icpa4kids.org/research/pr.../induction.htm

You will often see a lot of info about inducing after 42 weeks because the placenta supposedly breaks down. This is based on a particular research study, but it has some flaws. Read Henci Goer to understand the situation thoroughly and make your own choices. I had planned to refuse induction after 42 weeks with my first after examining the research (he ended up coming on his own at exactly 42 weeks).

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#6 of 50 Old 05-28-2008, 10:47 AM
 
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Don't use cytotec, please! It's so dangerous, and it will only lead to other interventions. Let the baby come when it is ready, THAT'S what's best. Late term ultrasounds are notoriously incorrect when predicting weight (I've heard they can be off as much as 2lbs), so don't let the weight be a concern.

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#7 of 50 Old 05-28-2008, 10:49 AM
 
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The manufacturer of Cytotec recommends against using it as a uterine stimulant for purposes of inducing labor. That usage has not been approved by the FDA.

Your doctor is being very irresponsible and in combination with arbitrarily inducing all women at 41 weeks, especially with no mention of Bishop's scores, makes me believe that she should have gotten a job as an investment banker or another similar profession where one can make large sums of money without having to give consideration to other people.

As far as your induction, don't show up. Don't go anywhere near that doctor until you're about to give birth.

If you do have a very large baby, the worst thing you can do is be induced. That gives no time for the baby to get into a good position, no time for proper shaping of the head, no time to gently ease the baby through the birth canal. Inducing with a large baby is pretty much a guaranteed tear. And it's not good for the baby either, induced contractions are harder and faster and reduce the oxygen to the baby. Inductions CAUSE medical emergencies and the only reason to have an induction would be a worse medical emergency already occurring.
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#8 of 50 Old 05-28-2008, 11:01 AM - Thread Starter
 
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I have researched the induction and cytotec and I agree with all of you. My DH is going to have to give in to paying for the insurance which is not a big deal after all we've been through. I put a call into the ob we'll see if she gets back to me today, I'm going to tell her that I don't want to use the cytotec and see if she offers any other options. In the mean time I think she'll come on her own time just have to trust in myself that everything will be okay. Went for a nice long walk with the doggies, helped to clear my head. I'm gonna go do some food shopping at my favorite health food store. Now to convince big brother that he has to wait longer and it's okay if she doesn't fit into her clothes!
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#9 of 50 Old 05-28-2008, 11:18 AM
 
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While you're doing your research, Google the terms "induction" and "big baby." You may be surprised to learn that the American College of Obstetricians and Gynecologists recommends against it. There is not enough scientific evidence to support the practice, especially because ultrasound estimates of fetal weight are notoriously inaccurate.

I agree with PPs. No-show your induction. It's your body, your baby and (by the way) your money. They work for you. Not the other way around.

Good luck!

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#10 of 50 Old 05-28-2008, 11:34 AM
 
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yarnista, we have the same due date. I'm still pregnant too!

I'm under midwife care in the UK, so it's quite a different environment, but if I'm still pregnant next Monday I have to go see the back-up ob (I assume they will do a NST etc) & I can have a sweep. Nobody will induce me medically until 42 weeks.
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#11 of 50 Old 05-28-2008, 12:42 PM
 
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I agree with you and PPs - avoid the cytotec. There are other prostaglandins that are actually MADE for inductions that can be removed and the dosage can be better controlled. Docs like cytotec because it's cheap. No other reason. Seriously.

I'd try a membrane sweep and see what happens in a day or two. If you're still up for an induction see what other options you have. Pitocin is not fun, I've heard, and if your body isn't ready to go it can be not very effective, but I believe it's usually more effective when combined with some other "cervical ripening" agents (see above). The only reason docs want to induce at 41 weeks is that they've gotten so good at inductions that the risks to the baby associated w/ induction SLIGHTLY favor that, versus the risks of still birth. Still, I think they calculated that they'd have to induce something like 4000 babies to prevent one stillbirth. If your baby is doing fine, there's no reason to induce.

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#12 of 50 Old 05-28-2008, 12:52 PM
 
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Please do not use cytotec. It is very dangerous. Also, there is no way for them to tell how big your baby is on ultrasound. They tell mom's all the time they need a c/section for 9lb baby and baby ends up being 7lbs. Everything looks good, baby seems fine so there is no indication to induce. Due dates are not exact science. It is only an estimate. You have every right not to show up for your induction tomorrow. Just wait and relax and realize you are doing the best thing for your baby by letting it decide when it is ready to be born. I am a senior midwife student and we have mom's all the time go over 41 weeks and it is no big deal.

Good luck,
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#13 of 50 Old 05-28-2008, 12:53 PM
 
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Just to remind everyone, a membrane sweep is an irreversible attempt at induction. And, the doctor Yarnista would be asking to do the sweep is induction-happy: "oops! I slipped and broke your waters, well, you've got 24 hours and then we have to induce". I don't think she should let anyone near her cervix at this point.

At 42 weeks, then she can consider getting her membranes swept.
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#14 of 50 Old 05-28-2008, 01:05 PM
 
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Hi, we haven't heard an update yet, so I hope all is well with you!

I just wanted to weigh in that I went 42 weeks, 5 days and had a 9 lb. baby totally drug-free. I did have a 2nd degree tear but I believe that was more due to coached pushing than his size. I was scheduled for a hospital induction the following day and was seriously considering going unassisted at home at that point This time I am planning a homebirth to avoid the due date pressure, but for now I think you are doing the right thing to refuse an unecessary induction.

Remember the average gestational length for first-time moms is 41 and a half weeks, about 10 days past your ESTIMATED due date.

People have already mentioned the inaccuracy of ultrasound. But remember, also, there is no way for your OB to determine how large of a baby you can deliver. Generally speaking, babies don't grow larger than their mamas can birth So there's no arbitrary, 9-lbs-is-too-big rule (I'm 5'4" and was about 150 lbs before pregnancy)

I would also be careful about having a more non-stress tests or US. They will just use those tests to try to pressure you into inductions. Listen to your baby's movements and most importantly, your instincts about your body and your baby. If they do want to induce, make sure you make them give you ALL the information (not just baby size but position, bishop's score, etc) There is no point inducing if you're not "inducable"

Finally, be cautious as well about more "natural" methods of induction. I had my membranes swept several times and it didn't really help things along, and it HURT a LOT! (nobody told me how uncomfortable that could be) I also tried black/blue cohosh under MW supervision, acupressure, castor oil. I think those things made me feel as though I was in control in the short term, like I needed to be "doing something", but nothing really seemed to "work" so it ended up making me feel worse (feelings of failure, why wasn't my body working, etc.) What I really should have done was take it easy until the baby was darn tootin' ready Which is the hardest thing in the world to do!!!!!

Best wishes

Also remember that
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#15 of 50 Old 05-28-2008, 01:23 PM - Thread Starter
 
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Just waiting for the ob to call sometime today which I'm willing to bet she won't. So then I'll be a no show tomorrow. My sister in law who is a pediatrician just told me I should be going because this baby needs to come out but she is also really excited about her coming and sees things differently than I do. My other sis in law is a nurse at a different hospital and they do not use cytotec there which makes me more of a believer not to let them use it on me here! DH and I both agreed that we will wait and let her come on her own, he is going to pay for the better insurance too. My mother in law went through an awful induction with him and told me this morning she thinks we should wait it out too.
People at work are apparently questioning why I'm not getting induced, I feel like going in there and telling them you know opinions are like a--holes everyone has one! I'm not happy with school because the personnel director secretary just informed me yesterday my unpaid child rearing leave has been denied, just to add to my stress a little. I can't worry about that for now, just focus on me and my family. Thank you so much for all your support.
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#16 of 50 Old 05-28-2008, 02:56 PM
 
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oh my god, don't use cytotec! I thought the word was out that this is a horrible drug and can cause women to lose their child and their uterus. I'm sure others can give you great information on the off-label use of this drug - do even a little research and I'm sure you will see how awful it is. Seriously...I can't believe any doctors are even using it anymore.
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#17 of 50 Old 05-28-2008, 05:50 PM
 
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make an appt. for a total spa treatment for next Monday. its a guarantee you will go into labor and miss the appt! lol!

sounds like you have re-evaluated and understand much more now than earlier. your baby will come when she is ready to..she needs to bake a bit more.
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#18 of 50 Old 05-28-2008, 06:12 PM
 
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WOW, I deifinitely did not know they were still using cytotec. After all the studies proving how dangerous it is and after the manufacturer issued a statement specifically warning against using it to induce labor, WOW how irresponsible!!

You are smart to wait it out and kudos to your mil for sharing her story. I was born from an induction gone wrong - my moms ob was going on vacation the next day so he induced her. Now I have the permanent i.v. scars commemorating my first weeks out of the womb (and into the nicu) because of it. And screw your co workers opinions! Just tell them the topic is not open to discussion and thats that.

Im glad you and your husband are willing to take charge of your body and your babies safety. Some women even go to 44 weeks with no problem.. We are all unique and so are our pregnancies.

Sending you good vibes!! :
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#19 of 50 Old 05-28-2008, 06:40 PM - Thread Starter
 
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Well I just finally talked to the doc and expressed my concerns. She told me that they use a really small dose and that it would be necessary to use it as my cervix is not thinned. I asked her at this point if it is really important to get her out and she said no we could wait a while longer. So I called DH and we decided the best thing for her is to wait it out. The doc called back and was fine with that. I feel so much better. Then to comfort big brother in tears because he was so excited. I explained thing to him and told him he can play hookie from school with me on Friday so all is better.
Now to deal with the phone calls is another matter. Maybe I'll just won't answer them! Thanks again!
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#20 of 50 Old 05-28-2008, 06:57 PM
 
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Originally Posted by Yarnista View Post
She told me that they use a really small dose and that it would be necessary to use it as my cervix is not thinned.
Is she claiming that cytotec has been approved for use in thinning cervixes? Is she claiming that cytotec is the best option for doing so?

If your cervix isn't thinned that means that an induction is likely to fail. If you talk to her again before going into labor, try commenting "if my cervix isn't thinned, doesn't that mean my Bishop's Score will be really low and that a c-section is more likely?"

Glad to see that she's okay with waiting. (Still baffling why you'd have to argue for it.)
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#21 of 50 Old 05-28-2008, 06:59 PM
 
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i woudl venture to say that cytotec is never NECESSARY..at least teh manufactuer doesnt believe so.
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#22 of 50 Old 05-28-2008, 07:07 PM
 
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First of all, women are not technically "overdue" until 42 weeks. Secondly, the SOGC (here in Canada) has a policy that NO CLINICAL DECISIONS should be made on the basis of baby's suspected size. I'm sure ACOG has similar.

I am so glad you are feeling patient and well, your cervix will thin (and dilate) soon. It's not uncommon for first babies to bake a little while, mama. You are doing an excellent job. Hang in there.

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#23 of 50 Old 05-28-2008, 08:08 PM
 
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make an appt. for a total spa treatment for next Monday. its a guarantee you will go into labor and miss the appt! lol!
I LOVE this idea! I think I will use it, though I pray I don't have to.

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#24 of 50 Old 05-28-2008, 08:17 PM
 
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Good for you! I'm glad to hear you've turned down the induction! Especially the cytotec. I didn't know OBs still used that stuff!

Also, since I don't think anyone has mentioned this yet, 1 cm dilated doesn't really mean much right now. My labor started 3 days after an appointment where I was 1 cm dilated and barely effaced.

And I agree with the PP who said don't let the OB anywhere near your cervix for sweeping the membranes. If you really want to kick things off naturally, there are other things you can try. You're already taking good walks, it sounds like. I know there are pressure points on the feet/ankles that can help labor along. I don't know exactly where, but what pregnant woman DOESN'T need a good foot massage? And there's doing exactly what you were doing to start your little girl in the first place. I'm sure other posters here also have great suggestions.

Good luck and hang in there!

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#25 of 50 Old 05-28-2008, 09:30 PM
 
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I don't know exactly where, but what pregnant woman DOESN'T need a good foot massage?
Around the ankle bones. Be sure to tell the person giving the massage that you want labor to start because otherwise good practitioners will avoid that area entirely when you're pregnant.

You probably can't work them yourself because bending is such a nuisance, but a friend or family member can do it if a massage isn't in your budget. Just gentle circular motions around the ankle bones (as well as all the other nice massaging they give you--rubbing the calves is such a happy thing for swollen legs and feet!)
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#26 of 50 Old 05-29-2008, 08:19 AM - Thread Starter
 
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I had reflexology the week before last and it was pure heaven. Now if I only had enough cashola to do that for myself more often.
My sis in law who is the pediatrician called last night and is not happy with my decision but I can't worry about that. No one else but DH and I could make it for us.
I know she's probably annoyed because I asked for her opinion and then didn't listen to her.
Not sure what I should do with myself today. Maybe some work in the garden, knitting and chatting on the phone. Will keep you all updated on our progress!
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#27 of 50 Old 05-29-2008, 10:00 AM
 
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its amazing to me that a pediatrician would want you to be induced, which puts so much stress on the baby, before you are officially "past due date". Babies get to chose their birth days in these neck of the woods at least.
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#28 of 50 Old 05-29-2008, 12:25 PM
 
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mama, just out of curiousity, where in CT are you? I'm in northeastern (the oh-so Quiet Corner).

Keep us posted!
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#29 of 50 Old 05-29-2008, 02:24 PM
 
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It sounds like you've already made the right decision, but just in case you need some more reinforcement, I would NOT agree to an induction before 42 weeks unless it was medically necessary. It's a c-section waiting to happen.

However, I would feel like a total hypocrite if I didn't mention that I agreed to be induced with a 1/4 tab of Cytotec at 39.5 weeks due to PROM and borderline high blood pressure. Everything turned out fine- I was already 1-2 cm dilated and totally thinned out, and I ended up with a lovely natural birth and a perfect baby- but it was a bad decision and it's not one I would make again.
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#30 of 50 Old 05-29-2008, 02:26 PM - Thread Starter
 
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We live in Newtown near Danbury. Must be nice to live up North, not quite as hectic as down around here I would think. Everyone is in such a hurry around here they drive like maniacs on our small roads. I'm originally from Ontario where life is a different pace in my mum's small village where she lives now. Maybe someday I'll get my wish and live up there.
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