Cytotec and FHR...what would you do

[IDeliverRN]

Would you give Cytotec if the fhr is elevated? Baseline 130s but then suddenly started having long accels in the 160-190 range that continued for over 30 minutes. FHR occasionally would drop back to baseline for 40-60 secs then go back to 160-190s for a few minutes.

[Elvish, BSN, DNP, RN, NP]

How do you do a foley if she's closed and thick?

Very carefully. In all seriousness, I have seen them manually separate the cervix just enough to insert the foley before inflating it, esp on stretchy multips...or sometimes they are able to snake the tip of the foley in without stirring anything up. Which means she isn't really closed.

Otherwise, I stand corrected, we do use Cervidil. Just not very often. We don't have a terribly high induction rate.

[NurseNora, BSN, RN]

You're all right, I misspoke. I meant to say "previous baseline."

[LibraSunCNM, BSN, MSN, CNM]

There are times when a closed, thick cervix still needs to be induced (severe pre-eclampsia or HELLP syndrome, IUGR with reverse end diastolic flow, as a few examples).

Kryptonite, all inductions are not of the debil. Sometimes they really ARE necessary. Sometimes they are life-saving to moms and/or babies. Once in a great while, science really does have a place in the natural process. Sometimes one knows "just enough to be dangerous" and doesn't know enough to know the full implications of being 100% hands-off, all the time. I get it. I was there once. I talked about "medwives" and "gOBlins".

And cytotec induction on an unripe cervix is still a lot less risky than a cesarean, which is usually the alternative when trying to deliver a baby over an unripe cervix.

Agree with klone, as usual!

Before I went to midwifery school, my sole knowledge of Cytotec was through "Ina May's Guide to Childbirth." I thought of it as this unbelievably dangerous drug and didn't understand why it hadn't been banned by the FDA for its off-label use in OB.

Of COURSE we all agree that the induction rate, as well as the rate of ALL OB interventions, is much too high in the U.S. But now that I've actually gone through school and become a midwife, I recognize how useful Cytotec can be both for cervical ripening in inductions that are medically necessary, as well as postpartum hemorrhage. We don't use prostaglandins on patients attempting trial of labor after cesarean, obviously---in that case we just do foley bulbs or Pit. Again, an induction will be much more likely to lead to a lady partsl delivery if the cervix is ripened first. Ideally no one would ever need to be induced, but in a country where women are having babies while they are statistically fatter, older, and sicker than they've ever been, that ain't gonna happen.

In the case the OP presents, however, I would not give it, because I agree that the baby is tachycardic according to EFM guidelines.

[cayenne06, MSN, CNM]

Maybe if she's closed and thick you should be leaving her alone?! Radical idea, I know.

As to cytotec, the fact that anyone still risks mothers' and babies' lives with that is disgusting.

This is just not true. Cytotec is a great option for many patients with a favorable safety profile when used appropriately. I do prefer cervidil for ripening because you can remove it if needed.