Dr wants to induce at 38 weeks, please tell me what you know about cytotec!!!!

StuNurseUP · Dec 1, 2005

I saw an article about it a few years back that painted cytotec in a VERY bad light. :chair: There was a pretty high percentage of complications. Personally I have been induced with pictocin and the secon time I had natural labor. Natural labor sure felt a heck of alot better. Induced labor is a lot harder on the body.

I wish you luck with your labor and new babay!

SmilingBluEyes · Dec 1, 2005

I would like to know how ripe is your cervix? If it's not effaced or not dilated, I would not want to proceed with induction. If it's effaced (more than 50%) and at least somewhat dilated, that is a different story. Inductions tend to go better with people who have favorable cervices, after 38 weeks.

Inductions ARE fairly safe, if medically indicated. And it is true, large babies can cause problems for "some" people---the doctor is also considering the larger the baby, the more likely he/she will have problems with blood sugar stabilization after birth. So, I can see why he/she want to induce your labor.

But I would only personally want to proceed with induction IF my cervix were favorable and ripe. The chances of failure are a lot less this way.

Good luck to you----let us know how things go, ok???!

mandana · Dec 1, 2005

I recommend a web search on Cytotec for labor induction. While I know its been used extensively for that purpose, it is worth noting that its an off label use for the drug.

Personally, I would refuse it. If induction is favorable for you at that time, and it may very well be, Pitocin will do just fine. Just for the record, my first son was the same size as your - 9lbs4oz to be exact, and my second child arrived two weeks early weighing only 7lbs2oz - everyone thought she was going to be the same size and at 38w the u/s measurement "clocked" her at 8lbs8oz.

The great news is that my first delivery was unbearably long (29 hours) wiht 4 hours of pushing and a 4th degree tear. My second labor lasted 4 hours total, and I think it was about 20 seconds of pushing - it was bliss.

Congrats and best of luck to you!

Amanda

SmilingBluEyes · Dec 1, 2005

I should amend my post to say:

Cytotec induction is generally done on unripe cervices. Personally I would not want to do this myself. But that is my opinion. I would rather be induced with a ripe cervix.....

I realize too, this is a medical question you are asking and generally, that is not allowed here at allnurses.com

Let me just say------If I were you, I would talk to my doctor specifically about the risks versus benefits of cytotec induction and be clear about what you are getting into BEFORE you allow this. It's done all the time, but it's up to you whether you want to do this.

GOOD LUCK!

mitchsmom · Dec 1, 2005

Here is the FDA page on Cytotec for induction as of May 2005:

http://www.fda.gov/cder/drug/infopage/misoprostol/default.htm

Here's an article about it by Henci Goer with references:

http://parenting.ivillage.com/pregnancy/plabor/0,,6xr4,00.html

BabyRN2Be · Dec 2, 2005

As SmilingBluEyes mentioned, this is not a medical board and you really need to do some research about cytotec. Also, I'm not a nurse (as my name implies) but I am a labor doula with 8 years experience.

Please take this just as information from someone who, repeat, is not a nurse but who has worked with many, many moms in the past several years.

I, personally, am not a big fan of cytotec. I've heard of problems with uterine rupture with cytotec as opposed to other medications. As Mandana mentioned, cytotec is being used in labor and delivery off-label, meaning, it is not specifically approved for ripening cervices. It was originally meant to be a drug for the treatment of ulcers, I believe. They discovered (unfortunately for some women) that it would cause the cervix to ripen and it lead to a few miscarriages. It is FDA approved for ulcers, but it's not specifically approved for ripening cervices.

Cytotec is introduced to the cervix via a string, sort of like a tampon. Once you have it in place, you can't get out of bed for a while (8 hours, I believe? Someone please correct me if I'm wrong). Also, once they start using cytotec, it can't be stopped or controlled.

I'm a bigger fan of Cervidil, which accomplished the same thing yet doesn't have the same problems of cytotec. Cervidil is a gel that is placed on the cervix. You can't get out of bed with Cervidil either, but if you start having problems, it can be controlled better.

I've seen LOTS of good results from Cervidil. It would be great if your cervix would ripen on it's own but it sounds like your doctor has some concerns about your baby's size and your cervix may or may not ripen by 38 weeks, especially with a second baby.

This is just anedoctal information. Please, I do encourage you to do some research on cytotec as well as Cervidil. Ask your doctor, most importantly, and have an open dialogue/communication with him. This is most important. If you have any concerns, please be sure to let your doctor know.

Mississippi_RN · Dec 2, 2005

I agree with SmilingBlueEyes in that 1) you need to do some more independent research as our advice here is not medically bound, 2) I would rather be induced (if it was me) if my cervix was dilated at least 1-2 and effaced at least 40-50 (things tend to flow more smoothly with those conditions, but things still happen). I have seen people be induced at our hospital with Cervidil (not Cytotec usually) and take one for 12 hours and maybe even repeat another Cervidil in 12 hours. Then, if their cervix was more dilated, more effaced (they had made progress) and they were having some contraction activity, they would start on Pitocin at the lowest setting and slowly weaned up every 30 minutes until they are maxed (usually 20 mu/ml). At this point, the contractions would usually be popping and they would be making great progress.

However, I have seen many inductions go wrong. For example, we have one OB who likes to bring people in when HE wants them to (meaning they might not be but about 1 cm dilated and not effaced hardly at all with no contractions to talk about. Nature tends to go against those people. As with me, I was severly pre-eclamptic (in risk of being eclamptic) and was induced when my son was 34 4/7 gestation. I went through 2 cervidils and about 12 hours on Pitocin with back labor before actually getting to push (while I was on Mag which probably fought against me). And I know, that when it came down to it, it was mostly because he KNEW he was not supposed to come then.

:chuckle

JentheRN05, RN · Dec 2, 2005

personally - we used cytotec quite alot when I was working in OB, rarely had complications, but we rarely had deliveries either lol (small hospital)

I would, as others have suggested, do some independant research on this to make up your mind :)

Good luck

JaneyW · Dec 2, 2005

Cytotec is not introduced by a string. It is a tiny pill (a quarter of a regular small pill) that is either placed by hand into the lady partsl fornix or taken orally. It is true that once it is in it is nearly impossible to remove and if your uterus contracts too much it can be trouble. You can still get up and move around after about an hour, but you have to be tethered to the monitor in most places. It can be repeated every 4-6 hours.

Cervidil is on a pessary like a tampon and can be removed if it causes trouble. In the last place I worked that used it, people were still allowed to walk the halls with it in place. It can be repeated every 12 hours.

The big issue here is to have as much knowledge as possible and not blindly follow your doc if you have doubts. Make sure you have true informed consent and an US at 38 weeks. Like a previous poster said, this one may not be as large as the last. Good luck to you!

mitchsmom · Dec 3, 2005

... Make sure you have true informed consent and an US at 38 weeks. Like a previous poster said, this one may not be as large as the last. ...

...remembering that late ultrasound is not very accurate... like everyone said... research...

VeryPlainJane · Dec 3, 2005

I was induce at 34 weeks I had GD, with a HUGE baby...she weighed 10.5. The OB used Cervidil. He said I was high and hard, but only after 5 hours i was at 3 and my water broke on it's own. I have to say it was very uncomfortable and I had to be in a prone position the whole time. It probably wouldn't have been so painful if I was able to get up and move around.