cytotec induction

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Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380
cytotec induction

So... my current doula client has a host of issues. The mw she is seeing is talking induction. She wasnts to induce with cytotec. I have heard horror stories, like uterus ripping in half and such from this drug. I have also read over on alldoulas.com that there is a new clinical trial on a gel form of vaginal cytotec that looks better. She said the mw is going to use the pill though. Ugh. I want to say run faster than the wind from that, but in the end this is her decision and the DONA terms of service doesn't allow us to give out medical advice. I sent her a bunch of links. So... what is your opinion on this. How would you proceed?

TyrantOfTheWeek's picture
Joined: 12/26/05
Posts: 1147

Unfortunately all you can do is support her as a doula. Especially if there has been money exchanged and/or contracts signed. It sucks, but you can lead a horse to water....

Joined: 11/23/07
Posts: 870

my last research (which was from books which were at least 5 years old) was that cytotec was CONTRAINDICATED in pregnant women and was NOT approved for induction because of the risks associated with hyperstimulation of the uterus.

which means that not only does the FDA say that its not approved for use but that their research says its dangerous and shouldnt be used.

of course, that could have changed recently. does the FDA have a website?

just the fact that it was contraindicated so strongly at any point makes me think that it is just a bad idea, even if further trials have found safe points in it.

Drugs.com still has cytotec listed as a cateragory X drug during pregnancy. but it also lists it as a possible drug used for cervical ripening and labor induction.

I would never choose pitocin over natural occuring labor, but at least pit has a long history of study, is a synthetic hormone that your body already uses, and is easily adjustable VS the cytotec that once it is in they can't do anything to stop it.

other than giving her the info in books such as "born in the USA" by marsden wagner.... i guess there isnt much you can do. She has to make this decision herself anyway.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

As far as I know it is still counterindicated for use in pregnant women. Apparently there is some loop-hole that the docs use to induce labor. If the gel is approved then this would be the first form of cytotec that IS approved for pregnant women. ugh! Anyway she found the same info, but was scared that is why she asked me. I told her if it was me and I had to be induced I would do pitocin and cervidil because both can be stopped/removed. I personally would never do any of it because of the risk of uterine rupture is far to great for someone like me. She is learly about induction at all because she wanted a natural birth with no epi. So... I am doing everything I can in terms of ideas for natural induction. She is 70% effaced, 1cm dialated and baby is at 0 station so her bishops score should be pretty high. If she could have some good contractions I bet she would dialate well. She really is a very very sweet girl and wanted a natural birth so bad. I really feel bad for her. I wish I could help in some way. Sad

Singfourever's picture
Joined: 08/26/06
Posts: 306

Is the midwife wanting to give it orally or vaginally? I believe if taken orally, it's not as dangerous.

Mom2ThreeKiddos's picture
Joined: 09/15/09
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vaginally

Joined: 02/20/09
Posts: 4

I recently attended the birth of my granddaughter, a VBAC, my daughter was induced due to diabetes and a couple of other reasons. She had a Foley catheter inserted into her vagina against her cervix, (she was 1cm dilated), the night before going into L&D. The catheter came out on it's own about 5 hours after insertion and when she was checked the following day she was 3-4 cm and very stretchy. She was somewhat augmented by oxytocin (following protocol) and went on to deliver a healthy 8lb. girl. So why use drugs to start the process...if induction is necessary perhaps this would be an alternative for your client.

krazykat's picture
Joined: 08/11/07
Posts: 1143

Show her this post... it's one I made a while back:

So now that we are getting pretty close, some of us will no doubt face inductions. I was induced with DD. They used Cytotec to ripen my cervix, and then pitocin. I just want to put a warning out there about Cytotec, because I wish I had been given ALL of the information before I agreed to it. I was led to believe that it is harmless, and that may not be the case. There ARE other (safer) ways to ripen the cervix if that is the way you choose to go... but please do your research on Cytotec before you agree to it.

Basically they use Cytotec because:
-It is extremely cheap
-It is fast and effective at ripening the cervix and producing extremely strong contractions
-It allows the hospital to insert the pill into your cervix in the morning, and have a baby by the time the doctor is ready to go home.

My warnings to you:
-It can cause such strong contractions that can put the baby under distress and cut off oxygen supply
-Once they insert the pill, if the contractions are too strong, or too much for the baby, it cannot be reversed
-It is believed to be linked to an increase in uterine rupture
-It can cause severe bleeding in the mother to the point that she must have a hysterectomy to stop it
-The manufacturer does not recommend it's use in pregnant women or to induce labor, and it is also NOT approved by the FDA for those purposes. There are even warning labels on the drug currently that say "not to be used in women who are pregnant" (http://www.cytoteccase.com/)
-The pill was not designed to be used in pregnant women or to induce labor, or vaginally; it was designed for gastric ulcers
-It was not tested in a laboratory before doctors began using it as a labor induction drug in pregnant women
-The pill is not made in a dose to be appropriate for induction, so it must be cut, which is impossible for the dose to be accurate
-It should never be used with a VBAC (it increases the risk of uterine rupture to a 1 in 20 chance)
-There are current lawsuits regarding the use of Cytotec as an induction agent

Very good news broadcast featuring Ina May Gaskin, but heart-braking as well, so *warning* (maternal loss and infant loss mentioned): http://www.wsmv.com/video/13210018/index.html

Some links:
http://www.midwiferytoday.com/articles/cytotec.asp
http://www.gentlebirth.org/archives/cytotec.html
http://www.natural-pregnancy-mentor.com/cytotec-induction.html

I'm sure you know all this stuff already anyways, but it helped me to outline it and look at it like that. There are so many other (safer) ways to induce, why not try one of them? But I guess as a doula, all you can do is give her all the options and the information and then let her make her own decisions. And she really should watch the Ina May Gaskin news broadcast linked above.

krazykat's picture
Joined: 08/11/07
Posts: 1143

Dangit, I can't get the link to pull the video up, but here is the article: http://www.wsmv.com/health/13206378/detail.html

Joined: 11/23/07
Posts: 870

Maybe just remind your client that she has the right to refuse that treatment and maybe give her some pointers for standing her ground on the topic since it is what she wants to do.

has she tried some "natural" induction methods? DTD etc....

Joined: 11/23/07
Posts: 870

i read that article.... "standard of care" is BULL.... because the "standard of care" is how people are treated not how they SHOULD be treated, and the standard of care is sub-standard in most obstetric situations......

LMCH's picture
Joined: 02/05/07
Posts: 2031

yeah everything i have heard/read in the past is that cytotec when used as a cervical ripener is used off label...it is not meant for that and FDA doesn't approve its use in that manner. as Ariel mentioned, it can't be removed if the contrax are too strong, whereas cervadil can be. So I guess just see if she wants to hear the pros/cons of the various options (cytotec, cervadil, pitocin) and tell her the facts so she can make her decision...maybe remind her that it is up to her and she can tell the doc "no" about something if she isn't comfortable.

abkinsey's picture
Joined: 07/13/06
Posts: 323

It can be so frustrating to be a doula and not be able to steer clients away from a cliff. You can share info, but ultimately the client will make her own decision. The allure of professional medical caregivers and their "info" can be very powerful and convincing. I hope she reads up on cytotec before agreeing to it.

Here's something from ICAN:

http://www.ican-online.org/pregnancy/misoprostol-cytotec-labor-induction-a-cautionary-tale

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

I had already given her tons of info before I posted this. I just was wondering if there was something I myself was missing or if something had changed. I am unsure what she will decide, but in the end I will support her no matter what.

Spacers's picture
Joined: 12/29/03
Posts: 4100

I would also encourage her to consider *why* the doctor wants to induce and whether there are other, better, things to do than induce. High blood pressure or other symptoms of pre-e? Brewer Diet. Diabetes? Not a problem if she's keeping her blood sugar levels steady. Low amniotic fluid? This is a tricky one, because the fluid level changes constantly throughout the day, but I would encourage her to have multiple screenings before accepting that "diagnosis," and even then, inducing with low fluid can be risky unless they make sure baby & cord are both in the right position.

abkinsey's picture
Joined: 07/13/06
Posts: 323

Christy, I don't think you are missing anything. This is one of the hardest parts of being a doula, IMO. It's hard when folk make decisions that seem so risky, yet for it to be an empowered choice, only that mama can make the call. It's just that it's difficult to tell when it's truly her making the choice and when it's her care provider putting on too much pressure. Hang in there and let us know what she decides.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

The unfortunate thing is that it is NOT illegal to prescribe a drug off-label. Once the FDA approves a drug for ANY purpose, a physician is legally permitted to prescribe it for any purpose. The Cytotec product insert (http://www.pfizer.com/files/products/uspi_cytotec.pdf) is very clear about the fact that induction is not the intended use, but there are care providers who continue to use it for the reasons Ariel exlained.

Part of the problem with Cytotec is that the doseage is not controlled. The whole pill is a high dose, so pills are usually cut up, which I have read is difficult to do accuratetly. I can see how there would be benefit to having it in a gel because you could control the dose better, but if it is approved and is more expensive than the pill form, I can see providers using approval of the gel as an excuse to use the pill. I'll be interested in finding out if the gel gets approved or not. The medication in Cytotec is a prostoglandin, but it is a different type than what is in Cervadil.

Cindy, if it is necessary for your client to be induced, I'd encourage her to ask about starting with the foley catheter option instead.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

I thought of the whole foley catheter thing too, but I am not sure if she brought that up with her midwife or not. I don't want to go into full details because of privacy, but I will say that if I were her I would do the induction as well and I am fairly against induction unless medically indicated.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

Well I talked with my ob yesterday about the use of cytotech. I just wanted to see what his opinion was. He said he never uses it. He said he would rather do cervedil or even use a foley catheter. After that appt I knew I had made the right choice to have him as my doctor. Smile

krazykat's picture
Joined: 08/11/07
Posts: 1143

"Mom2ThreeKiddos" wrote:

Well I talked with my ob yesterday about the use of cytotech. I just wanted to see what his opinion was. He said he never uses it. He said he would rather do cervedil or even use a foley catheter. After that appt I knew I had made the right choice to have him as my doctor. Smile

Your OB gets an A for the day!!! *Thumbs up*

mandora's picture
Joined: 07/16/07
Posts: 262

I'd question why they're looking at cytotec when she's already 70% effaced. It's (unfortunately) very widely used where I am, but only as a cervical ripener. Are they wanting to do the whole induction with cytotec? I agree with everyone else that it's still contraindicated for preg, and would RUN from any care provider suggesting it. Hopefully she makes the choice that's right for her, and that all turns out well.

Good luck to her (and to you! I know first hand how hard it is to support someone in making decisions you yourself might not make.... but that's all part of the job, right?) Wink

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

Baby is here and both are doing great. I wish I could say it was a fabulous labor, but it was not. Sad Learned a lot with this client.

momW's picture
Joined: 09/29/09
Posts: 5634

"Mom2ThreeKiddos" wrote:

Baby is here and both are doing great. I wish I could say it was a fabulous labor, but it was not. SadLearned a lot with this client.

Things that will be useful with future clients or things that you cannot do anything about but at least now you know?

Very glad to hear her and baby are doing well. Do you think she learned anything from this?

krazykat's picture
Joined: 08/11/07
Posts: 1143

I'm also glad to hear that both are well, and curious as to what went down?

Mom2ThreeKiddos's picture
Joined: 09/15/09
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rethinking sharing specifics.

Mom2ThreeKiddos's picture
Joined: 09/15/09
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"momW" wrote:

Things that will be useful with future clients or things that you cannot do anything about but at least now you know?

Very glad to hear her and baby are doing well. Do you think she learned anything from this?

I think both actually. I might be a little more diligent on trying to sway a client from cytotec or an induction period actually. I don't know this is so hard. As a doula I am just supposed to give information and let the client decide, but I am unsure how much of that would be telling them flat out what I would personally do. This is where I am struglling and I think I need to do better.

abkinsey's picture
Joined: 07/13/06
Posts: 323

"Mom2ThreeKiddos" wrote:

I think both actually. I might be a little more diligent on trying to sway a client from cytotec or an induction period actually. I don't know this is so hard. As a doula I am just supposed to give information and let the client decide, but I am unsure how much of that would be telling them flat out what I would personally do. This is where I am struglling and I think I need to do better.

When I work with women, I first give them all the stats on paper and then walk them through what they mean. Then, I will let them know if I have had any personal experiences that pertain. Sometimes when people see stats, it just doesn't compute into "that could happen to me" or the emotional impact of the possibility isn't clear to them. They don't know how it could impact them later. I'll just say something like, "This is what the stats say and I just need to disclose my own experience because it impacts how I process this. When I was in labor...abc." Or, "A friend...abc." I'm clear with them and encourage them to make their own decisions, but I do want them to understand my bias (even when keeping things very professional), while still understanding that I'll provide support even if her choices are very different. Sometimes hearing personal experiences helps clients to make more informed choices and sometimes clients choose to just bear them in mind when talking with me and then do something completely different. But, I do find that sharing those stories has been helpful, no matter what the mama decides to do. Also, I don't take on very many clients and the ones that I do take on, I ask that they attend a birth circle meeting and two ICAN meetings prior to the birth. I want them to hear stories from people other than me so that they can come to their own conclusions.

Hang in there. This is the part of doula work that is so hard. :bighug:

Do you have a doula support network near you where you can share and get feedback?

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

Kind of. The women tend to be kind of gossipy though, so I don't feel very comfortable with them quite yet.

abkinsey's picture
Joined: 07/13/06
Posts: 323

Oh man, that is unfortunate. The support network here has been invaluable to me. Maybe if there are one or two other doulas that you connect with better than the rest (that aren't gossipy), y'all could do lunch or something. That helps me sometimes when I need to decompress after a birth. There's nothing quite like seeing the whites of the eyes of another woman who truly understands...

abkinsey's picture
Joined: 07/13/06
Posts: 323

Another thought....if you have an ICAN chapter near you, call up the ICAN chapter leader and see if you can do lunch or something. Chapter leaders are also used to working with women and many have had similar experiences to what you are describing.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

Thanks. The ICAN leader we have is very nice. I just never have a chance to go to meetings.

abkinsey's picture
Joined: 07/13/06
Posts: 323

Totally call her up. Most of the other ICAN leaders I know (I'm an ICAN leader, too) have lunch with people all the time just as a support kind of thing. I bet she'd be more than willing to meet with you at a time that's convenient for both of your schedules. That way you also don't have to share in a group setting for confidentiality reasons, etc.

krazykat's picture
Joined: 08/11/07
Posts: 1143

Christy, what a hard situation. Just remember that you did everything that you thought was best given what you had to work with at the time, so don't beat yourself up. Poor mama! But again, I am glad they are both well.

Anne, that is such a great way of putting things. I'm going to have to file that away for a later date!