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Preparing For Labor

No Cytotec for me!

Cytotec is the only pill for labor induction. If you are having a pill then you are having this drug.

Cytotec (Misoprostol)- The only advantage to this drug is it is time and cost efficient. The drug comes in pill form and a portion if the pill is inserted into the vagina. This is usually used independent of pitocin. **If your Dr. suggests this drug, just say “no” because there are much safer alternatives**
Risks:
-Uterine hyperstimulation and possible uterine rupture. Unlike Cervidil it can not be stopped if the medicine is too much for you and baby.
-The medicine was formulated for the treatment of stomach ulcers. It is acknowledged by the medical community as a possible labor inducer but the drug manufacturers actually don’t support its use as a labor induction drug.
-The fact that labor is sometimes shorter with Cytotec is not worth the potential risk to mom or baby.

My thoughts:
Of all the induction methods out there, I would personally never use Cytotec. If my cervix was not ready for an induction and I had to be induced for the health and safety of myself or baby I would consent to only Cervidil (or another prostaglandin E2 gel) and or Cervidil/Pitocin combo. I wouldn't even go with having my water broken (maybe I would consider it if I had been stuck at 7cm and labor was active). Based on lots of research I think that these are the safest options.

Cytotec can NOT be stopped if you or the baby begins to have trouble. The uterus can be overstimulated with contractions that are too strong, too long or too frequent. This can diminsh the Oxygen supply to the baby. If you begin having trouble with the contractions then they can administer Terbutaline (or similair) to stop the contractions. Knowing that it can cause this, and much more, I would not take the chance when there are better alternatives.

There haven't been any studies that have proven it to be safe. No induction drug is 100% safe. Ask how he uses it and see if he uses it per the ACOG guidelines (go to their website, acog.org, and type "cytotec" in or do that on google). I really do think that Cervidil is safer. It was designed for ripening the cervix unlike Cytotec. Cytotec is still too new imo to be a good option. I don't really think I would be swayed with the logic of "I use it all the time with no trouble." They probably say the same thing about epidurals but 3 in 100 women will develop a spinal headache and slightly less than 1 in 100 will have a more sever problem. So,yes for the majority of moms they are safe but some moms won't have a good experience. I'd rather not be a statistic. (Yes, uterine hyperstimulation can happen with Cervidil but it is less likely).

If you do just a Google search for Cytotec you will pull up some very scary stuff. Not to make light of the possible serious consequences that can come from this drug but a lot of those stories are more frequently the rersult of the drug being used "improperly." (Remember, the drug has not been approved by it's manufacturer for inducing labor so there is no official way to use it). A wile back the American College og OB/Gyns had info on their website (acog.org) about how to use this drug "safely" for inducing labor. Your Dr. should follow these!

ACOG recommendations:-One quarter of a pill should be the initial dose
-Can be readmisitered every 3-6 hours
-Continuous monitoring is necessary
-Pitocin should not be given any sooner than 4 hours after the last dose of Cytotec has been given


Links:
Elective Inductions: This includes important information on how to have a safe induction- elective or not
http://www.hencigoer.com/articles/elective_induction/
http://sheknows.com/about/look/143.htm
http://dir.salon.com/health/feature/2000/07/11/cytotec/index.html

FDA's advisement that this drug should NOT be used on pregnant women:
http://www.fda.gov/cder/foi/label/2002/19268slr037.pdf
More FDA info:
http://www.fda.gov/medwatch/SAFETY/2002/cytotec_changes.PDF


Books:
The Thinking Woman’s Guide to a Better Birth by Henci Goer

Interesting thoughts:
"Those doctors and midwives using Cytotec for induction of labor off-label need to understand that they are taking very big chances with the safety of the women and babies they serve. Just about everyone in the world, after taking a careful look at the scientific evidence, has concluded we don't yet know enough about the risks to be willing to use it. This is illustrated in the following list of organizations that do and do not recommend Cytotec (misoprostol) for labor induction:

Recommends

American College of Obstetricians and Gynecologists (ACOG)

Does not recommend

U.S. Food and Drug Administration
Best scientific opinion—Cochrane Database
Searle (manufacturer of Cytotec)
Society of Obstetricians and Gynaecologists of Canada
British Royal College of Obstetricians and Gynecologists
All obstetric organizations in Scandinavia
FIGO (International Federation of Gynecology and Obstetrics)
World Health Organization
Obstetric organizations and drug regulatory agencies in many other countries
How can ACOG possibly be willing to stand alone in opposition to the best scientific opinion in the world? Because so many of ACOG's members already use Cytotec induction off-label for its incredible convenience, the organization needs to support its members by recommending this practice. This means ACOG must find a paper published in a prominent U.S. journal supporting Cytotec induction. In ACOG's recommendation on Cytotec induction, the organization leans heavily on a paper by A.B. Goldberg and other authors published in the New England Journal of Medicine (2). Let's take a careful look at the contents of this paper, as it is a superb example of torturing the data until it confesses to what the authors want it to say:

http://www.midwiferytoday.com/articles/cytotec.asp

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Like I said before, if it were me I would stick with Cervidil or another Prostaglandin E2. After that I would use Pitocin on the LOWEST setting and ask that it be turned off once labor was established.


Watch this. It is from CBS News this past November all about this drug. Maybe it will be more compelling than the articles and my thoughts.
http://www.cbsnews.com/stories/2004/11/30/eveningnews/main658388.shtml


Again, there are many moms that have had safe, easy Cytotec experiences. Same thing is true with pitocin, foley catheter, cervidil, prepidil and AROM. Just when you compare all of the methods Cytotec has the highest risks and that risk, to me, just doesn't seem worth taking. I don't know if I'll be that mom that doesn't have a good experience.

Use this info to research more on your own and coming up with q's to ask your Dr. or midwife.

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Preparing for Labor by Amber