Cytotec

[flashy09]

Did anyone use this when induced? I was offered an induction Wednesday and if my cervix was not favorable they would use Cytotec. Googled it and now I am scared!

[SnuggleBuggles]

I would never allow it. I know people have easy, successful deliveries with it but I would opt for one of the safer meds. better yet, if baby and I were well (biophysical profile...) I would not go for an induction till as close to 42 weeks as possible. The fewer interventions you add into the birth, the better the chances of avoiding complications. (caveat- of course there are times the interventions make sense and are the right choice.)

If I had to be induced, I would opt for pitocin on the lightest dose to get things going then back off and see if your body gets the message and keeps things going. Or, at least once in active labor I'd ask for it to be gone. Pitocin can cause contractions that are stronger and longer than natural ones so that can be harder for you and more stressful for baby.

Option 2 if your cervix isn't ready is the foley bulb. No chemicals, can be stopped at any point, and one of the least invasive options out there. You can search on these boards for successes with it. It will go into your cervix and slowly expand as it is filled with water or air. Once your cervix is around 4-5cm it will come out or be taken out. At that point you can move on to pitocin if things haven't started. I'd chose this over Cervidil but I wouldn't freak about Cervidil or other prostaglandin gel.

But, I'd never allow Cytotec in my body. I don;t care how long they have safely and successfully used it. There are safer methods out there and those are what I would pick.

I was a serious birth junkie. I read every book I could get my hands on with ds1 and worked on my birth plan for like all of my last trimester. :) After he was born I hosted a labor site on Baby Center for a few years. I always planned to be a doula and/ or birth educator but my passion for it faded a bit. Still, I read all the required books, lurked on an OB forum, and tried to keep up with stuf from mainstream and non mainstream sites. So, I am not really qualified but I feel like I am a well researched mom. :) So much so that with ds2 I wrote 4 birth plans just so I could sit down and learn about almost every possibility. So, year, a birth junkie. And a mom to babies that come right around 42 weeks so I have had a lot of reason to research inductions!!

Good luck!!
Beth

[JTsMom]

I totally agree with Beth. I'd wait unless there was a true problem, and then I'd start with the most natural methods, then progress to Pit only if need be.

[JBaxter]

I cant remember what I had with Jack. I was 41 weeks and Jack was measuring big w/ the ultrasound ( yes some ultra sounds ARE correct) I was only 1-2 cm and 50% effaced? I went into the hospital the night before and they placed something in my cervix Looked like a barbie tampon LOL. I was contracting on my own after about 6 hrs I slept through much of it. My water broke the next morning. I did need pit later in the afternoon. Jack was born 24hrs after I first checked in and about 13 hr after my water broke. Now if I knew he wasn't going to be over 10lbs I would have waited another week until I hit 42weeks.

[flashy09]

Maybe I will just hold off on the induction. I am getting a NST on Tuesday and that will make the decision easier.

I actually think my water could be leaking now, but I am not sure!

[Multimama]

Cytotec was the standard method of starting an induction where I had my DS, but I refused it and they used cervidil instead. If you do decide to have an induction I would definitely refuse the cytotec. They have other options at their disposal.

[Green_Tea]

I was induced with Cytotec almost 9 years ago. I was not dilated AT ALL, and the OB had no business inducing me (a day before my due date, she was on call, it was convenient, blah, blah, blah). I started contracting every 1-2 minutes immediately (an unintended, but somewhat common side effect of the drug), but the Cytotec did nothing to dilate me. I had killer contractions for 18 hours, my water broke at hour 12, and by hour 16 I had a fever and the baby was in distress. I never got past a centimeter. I ended up with a c section.

Cytotec is an ulcer medication. It has a black box warning for pregnant women. Utilizing it for inductions is an off-label use. It is and has been the subject of multiple lawsuits. I am truly surprised that OBs still have the guts to use it.

Unless there is a very good reason that you need to be induced (you or the baby is in distress, you are past 42 weeks, etc.) and all other forms of induction have been exhausted, I would NOT consent to an induction with Cytotec.

[swissair81]

Cytotec is an ulcer medication. It has a black box warning for pregnant women. Utilizing it for inductions is an off-label use. It is and has been the subject of multiple lawsuits. I am truly surprised that OBs still have the guts to use it.

:yeahthat:

There are almost no good reasons for a Cytotec induction.

[rachelh]

Everything Beth said!!!

Would never allow that in my body! There are so many natural methods to try to get birth moving along. If all those fail and I was beyond 42 weeks, I would then move on to a medical induction with pitocin or cervidil.

[flashy09]

I am so scared! I don't know how to tell my Dr I don't want it without looking like a control freak I know better than you type patient. If my cervix is favorable enough they are just going to use pitocin the next day. Only getting induced if NST shows a problem. But if it does and my cervix is not ready, I just don't know what to say!

[Multimama]

I am so scared! I don't know how to tell my Dr I don't want it without looking like a control freak I know better than you type patient. If my cervix is favorable enough they are just going to use pitocin the next day. Only getting induced if NST shows a problem. But if it does and my cervix is not ready, I just don't know what to say!

Just say you won't use cytotec because you are not comfortable with its off label use. Plenty of *doctors* aren't comfortable with its off label use so your doctor shouldn't be surprised and should respect your wishes.

[Green_Tea]

I am so scared! I don't know how to tell my Dr I don't want it without looking like a control freak I know better than you type patient. If my cervix is favorable enough they are just going to use pitocin the next day. Only getting induced if NST shows a problem. But if it does and my cervix is not ready, I just don't know what to say!

Do you have reason to believe it *will* show a problem?

I would simply say that you are unwilling to be induced with Cytotec, and inquire about what other options are available. He/she would be foolish to push it. There are a ton of pending malpractice suits against doctors who have used Cytotec to induce.

[Multimama]

Do you have reason to believe it *will* show a problem?

:yeahthat: How far along are you? Sometimes doctors at this point go fishing for a reason to induce...

[SnuggleBuggles]

I got spoiled by my midwives, where I was expecting to be an informed partner in those types of decisions. But, with ds1 I was in a traditional practice and I did have one uncomfortable talk with an OB there. I was 41w1d and just had my NST and BPP; all was well. He was really pushing an induction even though all was well. I told him I'd really like a few more days (and tests again in a few days). I just made myself be that mom (and certainly not the last time I have had to advocate for my kid!!!!). At the end of the day it is *my* birth, body and baby, not the Dr.'s. kwim? It's really ok to have a discussion where you ask risks, benefits and options. They are supposed to do that automatically since that is informed consent. Really, don't worry! It;s ok to and often expected. It's all in how you have the discussion- respectful, nice but honest.

Beth

[daisymommy]

You calmly and firmly say to your doctor...


Cytotec is an ulcer medication. It has a black box warning for pregnant women. Utilizing it for inductions is an off-label use. It is and has been the subject of multiple lawsuits.

...and I am not at all comfortable using it. No thank-you. If I approach 41-42 weeks and am not in labor yet, or have an unfavorable NST, then I will consent to using a foley bulb or low dose pitocin to get things going."

And then you smile and wait for them to get the message that it is your baby, your body, your informed educated choice :)

[JBaxter]

FYI not all OB groups or hospitals do the foley inductions. The groups here do not and its not protocol at the hospital here.

[Multimama]

FYI not all OB groups or hospitals do the foley inductions. The groups here do not and its not protocol at the hospital here.

:yeahthat: This may not be an option. Also, pitocin may not do anything for you on its own. But even if neither of those work out, there is still no reason to go to cytotec.

[daisymommy]

Latia (essence) here on the BBB, was a doula and has a great natural castor oil regime that has a great success rate for jump starting labor. You might want to have her email it to you. You could always try that if you go past due, before trying an induction.

[BayGirl2]

For my first delivery I had cytotec, but I was not induced. I was in natural labor for about 12 hours before I went to the hospital. DS was posterior and I had horrible back labor that I could barely endure, but I was less than 4 cm dilated. I had been dealing with high blood pressure for the last month + of the pregnancy and at that point I wasn't comfortable going hom. My choice was go home and wait until I got to 4+ cm or have something to stimulate my cervix - I already had strong contractions so I don't think pitocin would have been a good option. I chose to have the cytotec (an oral pill) - I had done a lot of studying and wanted to go as natural as possible but it wasn't a drug I had learned much about.

I can't say for sure whether it helped me, I did dilate after taking it, but also eventually opted for pain relievers (fentynal and then an epidural) which helped me relax to dilate more. However, DS had trouble latching on when he was born and we read later that bfing problems can be a side effect. Had I know that I may have chosen differently. Its impossible to say they were related, just a correlation.

My situation was a bit different though in that I was already in labor and I did have a complicating condition (high BP). I would need to have very good reason to be induced, especially with cytotec. And I agree, that every intervention increases your chances of a csection, so starting out with something that only sometimes works raises your odds.

Don't be afraid to state your requests to your doctor. Its your body and your delivery. Ask them to tell you the medical reasons for the recommendation and then made your decision from there.

[essnce629]

I agree with everything Beth said and wouldn't touch Cytotec with a 10 feet pole.

If you want my castor oil regimen (100% success rate so far-- 11 out of 11) just PM me. :)

[flashy09]

:yeahthat: How far along are you? Sometimes doctors at this point go fishing for a reason to induce...

I am 40 + 1 today and would be 40 +3 for the Cytotec on Tuesday and then induced with Pitocin at 40 and 4. It's just been offered to me, not insisted on but the nurse did say if the cervix was unfavorable they would have me come in Tuesday for Cytotec. I kind of feel that if the cervix is not ready than the baby is not ready for whatever reason, but I don't want something bad to happen right at the end so I asked for a NST so I would feel more at ease continuing on.

No problems at all, blood pressure was 102/60 something on Wednesday, never had protein or sugar in urine, she is estimated to be 6 1/2 to 7 lbs so not overly big.

I read about amniotic fluid reducing, the placenta not working well, meconium.....it all scares me. Cytotec and Pitocin scare me too. Again, I wish she would just come out naturally before Tuesday and save me all these decisions.

[JBaxter]

With those "stats" even if you feel like a bloated whale. I'd go to 42 weeks. Heck you could even set something up for 42wks if you want 40 wks is an average If you push an unfavorable cervix you are MUCH more likely to have a c-section. If your body isnt ready it isnt ready.

[JTsMom]

Don't be scared- you sound like you're doing wonderfully! :) Another thing to ask about is your Bishop score. An induction with a low Bishop score is definitely something to avoid.

http://en.wikipedia.org/wiki/Bishop_score

[SnuggleBuggles]

Again, I went to 42 weeks and it was hard to balance out what the best thing to do was. I'm only going to share my thought process that I felt comfortable with, not meant to be medical advice (like that caveat? :)). Anyway, my thought was that bad stuff can happen at the end of pregnancy (or any time); there is just no way to know. I was nervous about the truly post date complications. But, 40-42 weeks isn't postdate; after 42 weeks is. 40-42 weeks is still normal term. Current US society is what is making people rush things and forget that due dates are just ranges with no magical expiration date or timer. Plenty of modern, industrialized countries in the world are more hands off than we are...and have lower c-section rates too. I do like to consider how things are done in Western Europe, for example, and would read about that, the World Health Organization recommendations and others for a better perspective on things. Our society is very litigious and feels like they have to do something, especially when the tools are available to intervene so easily.

Anyway, my thought process...postdate babies are more at risk to being stressed out. Compromised placenta, meconium,, all those things that can happen I fear are more of a concern if you add in an induction. The contractions from something like Pitocin and Cytotec cause contractions that last longer, come closer and are stronger than your body may do naturally. That adds stress to a baby. I didn't want to add any extra stress for the baby if there was reason to worry about them being stressed out from being postdate. The baby might have done better, had a safer delivery, if nature took it's course.

I hesitate to lay any of this on you since you are operating on hormones, discomfort and uncertainty. Discussing induction options, methods, risks, benefits, philosophies is an easier talk to have at 7m when those things aren't nudging you a direction you might not have chosen otherwise.

Don't psyche yourself up about postdate babies. You aren't even close to postdate at 1 day after your EDD. A wise mom told me, when I was pg with ds1, that I should mentally move my EDD back to 42 weeks. That is your due date. You can just hope for a little sooner. :)

Beth

[flashy09]

Thank you so much everyone for the pep talks and information. I really don't like the idea of being induced without a reason especially if my cervix isn't ready either. It did go from closed to 1 cm during the week between appointments so at least something happened. She is very strong with her movement so I "think" she is ok and I hate messing with the process and having unnatural contractions,etc. I feel much stronger to stand up against the Cytotec for sure and maybe the whole induction on Wednesday.....it seems like if my cervix isn't ready than she isn't ready to come and if it is favorable than labor shouldn't be too far off naturally. Thank you for the advice!!

[Multimama]

In France they consider pregnancy to last 41 weeks because the average time for a first time mother to go into labor is 40 weeks + 5 days. You are just fine!

I know (from experience!) this is a very stressful point in the pregnancy. But take a deep breath and trust your body and your baby. Of course, there are very valid reasons to induce and you may not want to wait forever, but I waited it out until 42 weeks and I would do it again.

[shawnandangel]

The black box warning reads:
"administration of misoprostol (the generic name of Cytotec, don't let them fool you with this name) to women who are pregnant can cause. . . uterine rupture. . . reported when misoprostol was administered in pregmant women to induce labor or to induce abortion beyond the 8th week of pregnancy"

My doctor used Cervadil to ripen my cervix. I was induced at 39 weeks because my amniotic fluid level was below 4. Anyway, even with the Cervadil I did not go past 1cm. They started me on a pitocin drip and still nothing. I was manually dilated to 3cm then progressed naturally to 4.5 before swelling down to 3 again. My labor ended in c-section.

My body was just not ready at 39 weeks to have baby leave.

I wouldn't let a doctor use Cytotec on me while pregnant for any reason.

The other thing I wanted to say to you is that if you think you are leaking amniotic fluid they can do a test at the dr.'s office to see if it really is the fluid or just a little leaking of urine.

It's important to get this checked b/c if your fluid is leaking it is giving an opening for opportunistic organisms to come in and increases your risk of infection past a certain number of hours. Call your doc in the AM and get an appointment to check your fluid.

[niccig]

I was just over 41 weeks and thankfully my OB at the time would not induce. I wanted to as DS ended up being born on Christmas Day, but she told me there was no medical reason. I had a very easy labour as baby was ready. I did have meconium in the amniotic fluid, they were aware of it and had staff to suction DS. He was fine. There was never any fetal stress.

Since then, my OB retired and when I saw someone else, I was told they wouldn't let anyone go past 40 weeks because of issues like this. Firstly, I knew my EDD was off by one week. DH and I had one chance that month, so even though 41 weeks by Dr., I knew I was 40 weeks. Yes, there was meconium, but it turned out to be fine, and I think that is less risk than a c-section. I might be wrong on that, but it's how I feel.

Just letting you know that some of the risks of going later, can still be less than inducing. By all accounts I've heard, my labour was much easier than friends who were induced, so I am thankful my first OB would only do induce for medical reasons and being 41 weeks wasn't a good enough reason in my case.

[flashy09]

I had the "bloody show" this morning and a lot of watery liquid that I am still confused whether is my water or not....it only seems to happen when I sit up from laying down, it's not dripping constantly. Going into my Dr this morning to figure it out.....but at least it looks like I won't have to be induced!!

[SnuggleBuggles]

Could be. :) Since labor hasn't kicked in they might bring up inducing (really augmenting) so you still need to think about your choices. If it is leaking, I'd personally ask them to strip/ sweep the membranes and give you a few hours to see if things get going on their own vs running right over to the hospital for pitocin. Every Dr. and midwife has a different clock when it comes to amniotic fluid leaks and some are really, really gung ho and intervention heavy. Most give you about 24 hours though, assuming you and baby are well, some give a lot more and avoid doing exams so the risk of infection is way, way down.

GL!!!! It could just be good old increased discharge but I'll cross my fingers for you!
Beth