Induction at 41 weeks

Taylorgabbitas

I went for my second BPP today because on Tuesday I will be a week overdue and my doctor likes to see you twice in your 40th week to make sure everything is ok. I've turned down cervical checks up until now but she checked me today and I wasn't even dilated to a one. Everything was ok on the BPP so they scheduled my induction for Monday night (ripening) and to start pitocin Tuesday morning. I know things can change quickly and it's not impossible to go into labor on my own before then but I'm not getting my hopes up. Just looking for others experiences with a similar situation. Obviously I know that everyone is different but I'm nervous and it just helps to hear other peoples stories.

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cMichelle0423

I was scheduled to be induced with DS1 at 41 weeks and I ended up going into labor on my own 2 days before my induction date.

cas889

My experience with my daughter is pretty much exactly what you described.  I was at 40w6d and was high and closed when my OB checked me, so we scheduled an induction for the following day.  I checked in around 5pm and probably had the cervadil put in sometime around 6.  In my case, it was enough to jump start things and I did not end up needing pitocin.  She was born at 10:02 the following morning.  

Good luck!  

mysticl

Why are you being induced?  Is there a medical reason for it?

ncbelle

There's good evidenced based information about induction here - https://www.childbirthconnection.org/article.asp?ClickedLink=1072&ck=10650&area=27 - that you might find helpful reading as you make decisions.

There's no rule that you must induce at 41 weeks either if you'd rather wait (my last baby came at 41 weeks 3 days) - as long as I was having good NSTs/BPPs, I'd personally be comfortable waiting until 42 weeks.

ElTrain5

My midwife group does not talk induction until 42 provided all is showing up ok on the tests.

jnnfrrose6

I'd be getting a prenatal massage and asking them to focus on induction points in the meantime. Worst case it doesn't start anything but you've had a nice relaxing massage.

jjones59

I'm with you. I'll be 41 weeks Monday, I'm scheduled to go in for induction Monday morning at 7. At my last appointment I was 2 cm, high and posterior. Well just have to see. Good luck to you. 

Justabean3

I has zero progression, closed and still hard

Induction was at 41.5 weeks. they started it at 6p the night before then broke my water at 6a. I dialated to 4cm in less than an hour...

He had his cord wrapped so I ended up in a C quickly but the first process was low stress

beccam1230

I was in a very similar situation. I made no progress in 4 weeks...I was stuck at 2 cm and he was still pretty high. My doctor scheduled me to go in on Sunday night (Monday was 41 weeks) and she ordered cytotec until the following morning, when they would start pitocin. Well my son did not react well to the cytotec and they ended up starting pitocin a couple hours later. The cord was wrapped around his neck and he gave us some good scares with his heart rate dropping into the 60's on occasion but the nurse was incredible and everything was fine! He was born at 11:12 the next morning... So sooner than expected but it all worked out. Good luck!!

Lynnja616

ElTrain5 said:

My midwife group does not talk induction until 42 provided all is showing up ok on the tests.

This.

Justabean3

beccam1230 said:

I was in a very similar situation. I made no progress in 4 weeks...I was stuck at 2 cm and he was still pretty high. My doctor scheduled me to go in on Sunday night (Monday was 41 weeks) and she ordered cytotec until the following morning, when they would start pitocin. Well my son did not react well to the cytotec and they ended up starting pitocin a couple hours later. The cord was wrapped around his neck and he gave us some good scares with his heart rate dropping into the 60's on occasion but the nurse was incredible and everything was fine! He was born at 11:12 the next morning... So sooner than expected but it all worked out. Good luck!!

Cytotec gave me massive contractions!!

Taylorgabbitas

These have all helped me, thanks! I'm not opposed to the induction at all, just was hoping my body could figure it out on its own. I have to be honest though and say I'm definitely ready to be done! Hopefully everything goes well

beccam1230

Justabean3 said:

beccam1230 said:

I was in a very similar situation. I made no progress in 4 weeks...I was stuck at 2 cm and he was still pretty high. My doctor scheduled me to go in on Sunday night (Monday was 41 weeks) and she ordered cytotec until the following morning, when they would start pitocin. Well my son did not react well to the cytotec and they ended up starting pitocin a couple hours later. The cord was wrapped around his neck and he gave us some good scares with his heart rate dropping into the 60's on occasion but the nurse was incredible and everything was fine! He was born at 11:12 the next morning... So sooner than expected but it all worked out. Good luck!!

Cytotec gave me massive contractions!!

That's crazy.. it immediately started giving me strong contractions to the point where they had to remove it and give me a shot to stop them! Not a huge fan of it...

Mizoo

beccam1230 said:

I was in a very similar situation. I made no progress in 4 weeks...I was stuck at 2 cm and he was still pretty high. My doctor scheduled me to go in on Sunday night (Monday was 41 weeks) and she ordered cytotec until the following morning, when they would start pitocin. Well my son did not react well to the cytotec and they ended up starting pitocin a couple hours later. The cord was wrapped around his neck and he gave us some good scares with his heart rate dropping into the 60's on occasion but the nurse was incredible and everything was fine! He was born at 11:12 the next morning... So sooner than expected but it all worked out. Good luck!!

Cytotec gave me massive contractions!!

That's crazy.. it immediately started giving me strong contractions to the point where they had to remove it and give me a shot to stop them! Not a huge fan of it...

Do you two remember what dose you were given?  Just curious, as my midwife prefers cytotec to cervidil and I will be getting another dose in the morning.  I had one 25 ug dose on Friday and around 4 hours later I started contracting regularly but they weren't painful at all - just close together.  But then they stopped an hour and a half later anyway.

ncbelle

I would run very far from any provider using cytotec to induce.  It's "off label" use and there's strong evidence to suggest it increases the risk of uterine rupture.

mysticl

tundrabunny said:

mysticl said:

Why are you being induced?  Is there a medical reason for it?

She'll be at 41+ weeks. The placenta starts to deteriorate.

ACOG (American Congress of Obstetricians and Gynecologists) does not consider a woman to be "post term" until she hits 42 weeks.  Being 41 weeks is not reason to induce on it's own if the NST is normal and there are no signs of problems.  Due dates can be off, just because the magic wheel says you are 41 weeks it doesn't mean you are.  

I was induced with Cytotec.  It was the worst, most painful experience of my life and I would not wish it on my worst enemy.  It is a stomach ulcer medication, it is not meant for the induction of labor.  It's FDA pregnancy category is X.  According to the package insert provided by the manufacturer when used to induce labor it can cause hyper stimulation of the uterus (I had that, basically the contractions were constant, no break between them), uterine rupture, amniotic fluid embolism, fetal and maternal death….just to list of few of the side effects.  Three different medical practitioners explained this drug to me.  None of them told me any of this.  They said it was the same as sperm and made it sound like a mild way to induce labor.  If I had known the truth I probably would have made different choices.  Some hospitals have banned it's use for the induction of labor because of the risks.  

Here is the link to the insert. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019268s041lbl.pdf

allrightmeow

ncbelle said:

I would run very far from any provider using cytotec to induce.  It's "off label" use and there's strong evidence to suggest it increases the risk of uterine rupture.

Yikes!  Im hoping baby comes on it's own.  I've made it clear to my DH that any talk of medically "helping" my labor along in the early stages of labor should be shut the eff down.  I don't even want to hear it.  With DD they started talking about CS before my body even made the bed warm.  I really love my doctors this time so I don't think we'll have the same problems. 

discohiker

Induction is no guarantee that you will go into labor on your own... definitely know all the possible options if induction doesn't "take".  The condition of your placenta does make an impact on when they will induce, but not everyone's is deteriorating at 41 weeks.... they might have your due date off anyways. 
Good luck!  I hope you have a better experience than I did... 40 hours after my induction started I held my little boy, but in the meantime I had every intervention and experienced pushing and eventually a c-section thanks to failure to descend.

mysticl

lissydee said:

here is ACOGs new definitions of term pregnancy (this was as of November 2013, so fairly recent).

https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Definition_of_Term_Pregnancy

so if you were wanting more time (OP or anyone else), then use this as your argument...its their own professional organization who came out with these definitions. 

True cytotec is a drug that was made for something other than labor induction, however many many many medications have off label use, and this is no exception.  In truth, it is effective and is cheap.  The risk of uterine rupture were more in cases where it was used in women who had a previous c/s...this medication is now contraindicated for those women now. 

That said, its a drug that is absorbed systemically, so you can't just stop it (like pitocin) or remove it (like cervidil) if there is uterine hyperstimulation, fetal or maternal distress.  You have to wait it out and in the mean time try other measures (IV fluid boluses, tocolytics) to stop adverse effects.  Thats what make me most nervous about it.

The package insert does not state that.  It simply states that it has caused uterine rupture.  

The fact that it is an off label use is the one thing they told me about it.  That didn't bother me because I have had great success with off label usage before and the drug ended up being approved for the use I was taking it for.  I sincerely doubt Cytotec will ever be approved for induction of labor.  The rest of the information was kept from me.  Which means I did not give informed consent when I agreed to the induction.  Which means my rights as a patient were violated.  

If a woman has all the information and decides to use cytotec that is her right.  But it should not be presented as some mild drug to get things started.  That's how it was presented to me.  I found out the truth about the drug months later by accident.  I cannot explain the level of betrayal I felt as I sat there and read those words.  I trusted the doctors, nurses, and midwives to be honest with me and they lied.  When you find out your care providers lied to you it makes you question every single aspect of your care.

No effort was made to counteract my adverse affects.  They wanted those contractions to keep going.  And I didn't know until later it was an adverse affect.

As for it being effective and cheap.  It wasn't effective for me.  I still ended up in the OR so all of that was for nothing.  And cheap should never be the deciding factor in health care.  

cookieinva

I was induced at 41 weeks with DS. I went in the night before for cervical ripening (which didn't really do anything for me) and I was 0%, 0cm when I checked in as well as the next morning. Once they started the pitocin though, that really worked for me. I had DS later that afternoon with no problems or ocmplications, vaginal delivery. I had a very good experience. Induction does not necessarily doom you to hours of labor only to end up in a c-section even though some people have that experience. Good luck! Eat before you check in and don't expect to sleep very well there.

mysticl

lissydee said:

@mysticl, here are some research articles on uterine rupture from ctyotec.  The vast majority of them cite its occurrence in women who have a previously scared uterus (i.e. c/s).  I wasn't just saying that earlier to be flippant...its what the research shows.  Another risk of uterine rupture with cytotec is being multigravid (i.e. having had more than one pregnancy & delivery). 

https://www.ajog.org/article/S0002-9378(99)70049-9/abstract?cc=y=?cc=y=

https://journals.lww.com/greenjournal/Abstract/1998/05001/Disruption_of_Prior_Uterine_Incision_Following.15.aspx

https://europepmc.org/abstract/MED/11077631

https://www.karger.com/Article/Abstract/10303

Cytotec is cheaper than pitocin and cervidil.  Here is an article that not only discusses the cost differences, but also does a good job out outlining the risks and benefits involved with each type of agent:

https://www.aafp.org/afp/1999/0801/p477.html

I do absolutely agree though with you on the aspect of informed consent.  I do not think that when women agree to an induction, that they are fully aware of how potent and serious each of these induction agents are.  I think women are more scared into it because of their baby being "post dates" (and please everyone, see my ACOG link about about the new definition of term and post term) that the risks of each inducing agent are not fully discussed--they all present some potential concerns to maternal and fetal well being.  Patients not receiving proper informed consent is a huge issue in health care in general.

I am sorry about your experience.  I would be angry too.

I also wasn't informed that cervidil even existed because they don't use it at the hospital I delivered at.  I was told cytotec or pitocin.  I knew I didn't want pitocin (though I ended up with in anyhow).  So I went with what I thought the milder option was.

I get the whole thing that most of the ruptures occurred in VBAC patients.  But that fact that the package insert does not specify that makes me have to believe the manufacturer has a fair amount of concern that it could happen to anyone.  

I was induced for a medical reason.  Gestational hypertension.  Though not a single thing was done about it other than testing me for pre-e twice (negative both times) and inducing me.  That takes me to the part of questioning all of my care.  

All of that, plus the fact that the hospital has a VBAC ban has lead me to find a new practice and new hospital for this birth.  Though I'm going to have to find yet another one because we are moving.  But that's a whole other issue.   

Justabean3

lissydee said:

here is ACOGs new definitions of term pregnancy (this was as of November 2013, so fairly recent).

https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Definition_of_Term_Pregnancy

so if you were wanting more time (OP or anyone else), then use this as your argument...its their own professional organization who came out with these definitions. 

True cytotec is a drug that was made for something other than labor induction, however many many many medications have off label use, and this is no exception.  In truth, it is effective and is cheap.  The risk of uterine rupture were more in cases where it was used in women who had a previous c/s...this medication is now contraindicated for those women now. 

That said, its a drug that is absorbed systemically, so you can't just stop it (like pitocin) or remove it (like cervidil) if there is uterine hyperstimulation, fetal or maternal distress.  You have to wait it out and in the mean time try other measures (IV fluid boluses, tocolytics) to stop adverse effects.  Thats what makes me most nervous about it.

They flushed my line several times... Is what they ended up doing. I was having back to back less than 1 min apart contractions for 12 hours. It was painful but I didn't know any different.

I think it has a lot to do with if you are ready. My son was stuck and had the cord wrapped so he came section anyway.

Id still do it again

Justabean3

Just to specify... Mine was a vaginal insert and I was on monitors the whole time.

I read rupture usually only takes place when taken orally

mysticl

Justabean3 said:

They flushed my line several times... Is what they ended up doing. I was having back to back less than 1 min apart contractions for 12 hours. It was painful but I didn't know any different. I think it has a lot to do with if you are ready. My son was stuck and had the cord wrapped so he came section anyway. Id still do it again

There was no time between mine. The next one would begin before the previous one stopped.  The "answer" was to give me a second epidural since the first one failed to work. Prior to that one finally kicking in there was much screaming and crying.

WhoCanItBeNow said:

It's fine when it's used properly- meaning partial pills applied to the cervix while you are on continuous monitoring.

The problem is people swallowing it and then going home with no monitoring. My hospital doesn't even carry Cervidi. They have solely used Cytotec for inductions since it came out and have never had a single issue. But they administer it properly.

I had minimal contractions on it. 1/4 pill did a perfect job of ripening my cervix. I had light but good contractions on it and they pushed back my Pit a couple hours because it did such a good job. Not that it mattered because his shoulders were too big for him to engage for labor to progress.

Mizoo said:

Do you two remember what dose you were given?  Just curious, as my midwife prefers cytotec to cervidil and I will be getting another dose in the morning.  I had one 25 ug dose on Friday and around 4 hours later I started contracting regularly but they weren't painful at all - just close together.  But then they stopped an hour and a half later anyway.

I hope to high hell you are currently in the hospital being monitored. Your midwife is a moron and is risking the health (and possibly life) of both you and your baby if you are not.

That's how they did mine.  It wasn't fine.  It wasn't anywhere close to fine.  I suffered hyper stimulation of the uterus and in 24 hours didn't dilate beyond 4 or 6 depending on who was doing the check.  And I had Pit on top of that.  

Justabean3

It isn't meant to dilate you just soften and efface.. That is what pit is for

But ya some have trouble

jess9802

I had a LENGTHY discussion with my OB - who has over 25 years as an OB and has conducted clinical research trials involving Cytotec. We talked about =Cytotec vs. Cervadil and in the end I consented to use of the former in my induction for chronic hypertension. Blanket statements that one should "run" from a provider who offers it are ridiculous.

Cytotec is associated with a reduced risk of C-section compared to Cervadil. It is extremely affordable and has been widely used in obstetrics for more than 20 years. Although its manufacturers are not willing to incur the cost of clinical research trials for the purpose of FDA approval for use in inductions, there are CRTs dealing with dosage and administration. It is the drug of choice at my hospital and has been for more than 20 years without incident. It is not a risk-free drug; it requires careful monitoring and it is not appropriate in all patients. But it is not an evil drug.

ElTrain5

I'm surprised at how often the comment is made that since a baby had the cord wrapped, a section was needed. (Or was found during a section, indicating the section would've have been "needed anyway"). A Nuchal Cord is actually incredibly common (one study finding up to 25% of newborns presenting with one) and typically does not cause any complications. Of course, like anything else, it's possible that given specific circumstances it could cause problems, but it's presence alone is certainly not an indication for a c section.