Alternatives to Cytotec?

phq2011 · July 2012

So I just found out from my provider that the main med used for cervical ripening is Cytotec. I was not happy that my OB dismissed my concerns about the medication by comparing it to Pitocin in risk of uterine rupture, etc. Does anyone know of alternative suppositories that appropriately ripen the cervix in case of an induction?

punkrockabye · July 2012

It's usually a choice between Cervadil and Cytotec. My questions about Cytotec were also dismissed with "we use it all the time" when I mentioned it not being approved by the FDA for inductions. Granted, I was also told that if this is even necessary, I'd completely have a choice in what is used.

I think Cytotec works faster, but can't be controlled or removed once it's started, so if contractions get way out of hand they have to medicate you with other things to try to control the situation. Cervadil works more slowly but if things go crazy, it can be removed easily. So it's a decision between having something work faster, or having a bit more control over the situation.

I'd be really surprised if Cervadil wasn't an option for you, or if your doctor flat out did not feel comfortable with it at all, even if they prefer Cytotec (for whatever reason).

phq2011 · July 2012

punkrockabye:
It's usually a choice between Cervadil and Cytotec. My questions about Cytotec were also dismissed with "we use it all the time" when I mentioned it not being approved by the FDA for inductions. Granted, I was also told that if this is even necessary, I'd completely have a choice in what is used.
I think Cytotec works faster, but can't be controlled or removed once it's started, so if contractions get way out of hand they have to medicate you with other things to try to control the situation. Cervadil works more slowly but if things go crazy, it can be removed easily. So it's a decision between having something work faster, or having a bit more control over the situation.
I'd be really surprised if Cervadil wasn't an option for you, or if your doctor flat out did not feel comfortable with it at all, even if they prefer Cytotec (for whatever reason).

This is how I feel. I understand that an unfavorable cervix can make Pitocin useless, hence why I would understand the use of a ripening agent. However, due to the nature of Cytotec to overstimulate the uterus, I would rather have the control to prevent the stress on me and the baby caused by a hyperstimulated uterus. I also have found from studies and stories that Cytotec can be not working with 1-2 doses and by the 3rd or 4th it is out of control. Does Cervadil behave this way?

nosoup4u · July 2012

Cervadil can be removed if contractions get too crazy. Some providers do Foley bulb inductions, but you have to be somewhat dilated to place one. Tell your provider you want Cervadil, it's your right to refuse meds. hth

anonsouthernbell · July 2012

Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.

This the product insert (you can google it I am sure), even has a picture of a pregnant woman with a line through it. I would not use a provider that uses Cytotec, even if I had the choice b/n induction drugs and especially if my concerns were dismissed.

iris427 · July 2012

Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.

There are a bunch of studies finding that Cytotec is just as safe as Cervidil, and more effective. It also costs a fraction of what Cervidil costs. It has some downsides but so do all induction methods. The maker of Cytotec issued that warning probably as a CYA move--lawsuits are a huge problem in obstetrics. I think the NB community is wrong on the Cytotec issue, quite frankly. There is a lot of inaccurate fear-mongering and painting OBs who use it as evil.

OP, you can tell your doctor you prefer to try Cervidil but you should also think about what you will do if the Cervidil doesn't work. Would you be willing to try Cytotec then, or have a c/s?

phq2011 · July 2012

iris427:
Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.
There are a bunch of studies finding that Cytotec is just as safe as Cervidil, and more effective. It also costs a fraction of what Cervidil costs. It has some downsides but so do all induction methods. The maker of Cytotec issued that warning probably as a CYA move--lawsuits are a huge problem in obstetrics. I think the NB community is wrong on the Cytotec issue, quite frankly. There is a lot of inaccurate fear-mongering and painting OBs who use it as evil.
OP, you can tell your doctor you prefer to try Cervidil but you should also think about what you will do if the Cervidil doesn't work. Would you be willing to try Cytotec then, or have a c/s?

My biggest problem with Cytotec is the inability to reverse effects if something goes wrong. I do know that the risk goes up if you have previous uterine surgery or previous births, and though I have none, it is just not something I am willing to risk if there is an alternative. I will talk to my provider if induction becomes a necessary conversation about using alternative methods.

TiffanyT85 · July 2012

I am going to suggest that you watch the "Pregnant in America" documentary, I found it on netflix. It looks at the issue with Cytotec, and speaks to a family that was affected by the adverse effects. There is alos a website for this doc, which should have more info as well. Being a FTM I don't have first hand experience with it, but if it is specifically stated by the manufacturer not to be used for induction of labour I would stay far away from it!

Also, Cervadil is designed for labour induction. You should definetly ensure that you do not allow Cytotec to be used, as it is very dangerous to both you and your baby.

StacieJane · July 2012

iris427:
Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.
There are a bunch of studies finding that Cytotec is just as safe as Cervidil, and more effective. It also costs a fraction of what Cervidil costs. It has some downsides but so do all induction methods. The maker of Cytotec issued that warning probably as a CYA move--lawsuits are a huge problem in obstetrics. I think the NB community is wrong on the Cytotec issue, quite frankly. There is a lot of inaccurate fear-mongering and painting OBs who use it as evil.
OP, you can tell your doctor you prefer to try Cervidil but you should also think about what you will do if the Cervidil doesn't work. Would you be willing to try Cytotec then, or have a c/s?

The makers of Cytotec, in order to have it be used for induction, would have to fund large studies of women to prove it's safe. It's cheaper for them to just say, "We don't recommend it for induction," knowing full well that OBs are going to continue using it for induction. It's cheap (because they haven't had to pay the big bucks to prove its safety) and effective in moving labor along. I've seen your posts on this issue before, and I think you make some good points about the "omg!" of Cytotec in the natural birth community (there are no truly "safe" drugs for pregnancy or induction), but the thing that scares me about Cytotec is that when it goes bad, it goes REALLY bad. Also, women are often left to labor unattended with Cytotec, so the nurses are not there to see the warning signs that immediate attention is needed, and with an unknown of how that drug will affect that woman (as there are no studies on why Cytotec affects some women so horribly), this is also frightening. I don't know what I'd do if faced with Cytotec v. c-sec, but outside of that situation, I think it's reasonable to at the very least avoid it up to that point or use it as a last resort.

phq2011 · July 2012

StacieJane:
The makers of Cytotec, in order to have it be used for induction, would have to fund large studies of women to prove it's safe. It's cheaper for them to just say, "We don't recommend it for induction," knowing full well that OBs are going to continue using it for induction. It's cheap (because they haven't had to pay the big bucks to prove its safety) and effective in moving labor along. I've seen your posts on this issue before, and I think you make some good points about the "omg!" of Cytotec in the natural birth community (there are no truly "safe" drugs for pregnancy or induction), but the thing that scares me about Cytotec is that when it goes bad, it goes REALLY bad. Also, women are often left to labor unattended with Cytotec, so the nurses are not there to see the warning signs that immediate attention is needed, and with an unknown of how that drug will affect that woman (as there are no studies on why Cytotec affects some women so horribly), this is also frightening. I don't know what I'd do if faced with Cytotec v. c-sec, but outside of that situation, I think it's reasonable to at the very least avoid it up to that point or use it as a last resort.

Thank you. I really needed words to say what I was actually feeling. I can't dismiss it's effectiveness, and I know doctors work off-label often, not just this case. I was introduced to the word Cytotec in Business of Being Born and really took it with a grain of salt, as I did with the rest of the documentary once I got over the scare factor (thanks to all you NB bumpies!). However, I really can't dismiss the fact that when it goes wrong, it hyper stimulates the uterus irreversibly. Pitocin is known to do this as well, but after 50+ years on the market, we have discovered better ways to regulate dose; and with a short span of effectiveness in the body, it leaves the system quickly once the IV pump is shut off.

zaramarie81 · July 2012

punkrockabye:
It's usually a choice between Cervadil and Cytotec. My questions about Cytotec were also dismissed with "we use it all the time" when I mentioned it not being approved by the FDA for inductions. Granted, I was also told that if this is even necessary, I'd completely have a choice in what is used.
I think Cytotec works faster, but can't be controlled or removed once it's started, so if contractions get way out of hand they have to medicate you with other things to try to control the situation. Cervadil works more slowly but if things go crazy, it can be removed easily. So it's a decision between having something work faster, or having a bit more control over the situation.
I'd be really surprised if Cervadil wasn't an option for you, or if your doctor flat out did not feel comfortable with it at all, even if they prefer Cytotec (for whatever reason).

This. I personally would want to avoid Cytotec. Cervadil is still widely used (just had a cousin induced with Cervadil).

iris427 · July 2012

StacieJane:
iris427:
Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.
There are a bunch of studies finding that Cytotec is just as safe as Cervidil, and more effective. It also costs a fraction of what Cervidil costs. It has some downsides but so do all induction methods. The maker of Cytotec issued that warning probably as a CYA move--lawsuits are a huge problem in obstetrics. I think the NB community is wrong on the Cytotec issue, quite frankly. There is a lot of inaccurate fear-mongering and painting OBs who use it as evil.
OP, you can tell your doctor you prefer to try Cervidil but you should also think about what you will do if the Cervidil doesn't work. Would you be willing to try Cytotec then, or have a c/s?
The makers of Cytotec, in order to have it be used for induction, would have to fund large studies of women to prove it's safe. It's cheaper for them to just say, "We don't recommend it for induction," knowing full well that OBs are going to continue using it for induction. It's cheap (because they haven't had to pay the big bucks to prove its safety) and effective in moving labor along. I've seen your posts on this issue before, and I think you make some good points about the "omg!" of Cytotec in the natural birth community (there are no truly "safe" drugs for pregnancy or induction), but the thing that scares me about Cytotec is that when it goes bad, it goes REALLY bad. Also, women are often left to labor unattended with Cytotec, so the nurses are not there to see the warning signs that immediate attention is needed, and with an unknown of how that drug will affect that woman (as there are no studies on why Cytotec affects some women so horribly), this is also frightening. I don't know what I'd do if faced with Cytotec v. c-sec, but outside of that situation, I think it's reasonable to at the very least avoid it up to that point or use it as a last resort.

LOL yes I am the devil's advocate on Cytotec (and I think flyer and nosoup too).

Women are left to labor unattended most of the time, Cytotec or not, in most L&D wards. A woman being induced should be monitored continuously and the information goes directly to the nurses's station where it is monitored. A woman on Cytotec is no more in danger of having nurses miss an emergency than any other woman in labor. There are studies on Cytotec safety so it is no more of an unknown than how any other drug will affect an individual (which you can never know ahead of time, unless you have a crystal ball). A lot of drugs can go "really bad." You can die from anaphylaxis from run of the mill antibiotics. People die of liver failure from taking Tylenol incorrectly every year. It doesn't mean we should tell people they are horrible drugs and should never be used.

Yes, it is reasonable to try Cervidil first or even proceed with a c/s. It is not reasonable for NBers to single out Cytotec when its safety and risks have been shown in numerous studies to be comparable to other induction methods and the risks of a c/s. NB advocates criticize doctors for not practicing evidence-based medicine, but they are ignoring the evidence on Cytotec. Furthermore, the risks of Cytotec are comparable to having a VBAC or vaginal breech birth. Are we going to start telling women they should never do those things and they should not go to a doctor who supports them? Or are those risks OK because they are "natural" and Cytotec is a product of the medical industry?

jennyann28 · July 2012

I had Cytotec, as my water had been broken for 16hours with no contractions. Baby and I were both fine. I was monitored continuously for the first four hours, and they had the pharmacy chop up a pill so I only received a quarter of a dose. I was ok with it in that small amount and never needed more (or Pitocin).

frlcb · July 2012

I also had cytotec (it was a different name as it was in the UK) and it is commonly used in the UK as an induction method, and this is a midwifery led, more natural birth friendly model of care. I had no issues with it at all.

meagan.pilkington · July 2012

Look for previous posts on Evening Primrose Oil, or google it if you have the time. Many midwives recommend taking it orally (500mg 3x/day) and also vaginally (insert a certain amount into the vagina at night) to help "melt" the cervix so it can get soft and open. Im not sure how much time you have before your induction, or if you have time to try it, but I'd think it would be worth a try to get things moving along before the doc checks you next time. GL and HTH!

meagan.pilkington · July 2012

meagan.pilkington:
Look for previous posts on Evening Primrose Oil, or google it if you have the time. Many midwives recommend taking it orally (500mg 3x/day) and also vaginally (insert a certain amount into the vagina at night) to help "melt" the cervix so it can get soft and open. Im not sure how much time you have before your induction, or if you have time to try it, but I'd think it would be worth a try to get things moving along before the doc checks you next time. GL and HTH!

I tried to edit my post but I don't think it worked... I went back and looked at your ticker and see that you're 32-ish weeks. EPO is recommended to start no earlier than 37 weeks I believe (maybe 36?). There were a few posts about this recently, and maybe in the archives of other boards if you search, you can find recommended dosages and info on it so that you can ask your OB/midwife if you can use it toward the end of your pregnancy. I've been using it since 38 weeks and I figure if nothing else, it can't hurt!

StacieJane · July 2012

iris427:
StacieJane:
iris427:
Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.
There are a bunch of studies finding that Cytotec is just as safe as Cervidil, and more effective. It also costs a fraction of what Cervidil costs. It has some downsides but so do all induction methods. The maker of Cytotec issued that warning probably as a CYA move--lawsuits are a huge problem in obstetrics. I think the NB community is wrong on the Cytotec issue, quite frankly. There is a lot of inaccurate fear-mongering and painting OBs who use it as evil.
OP, you can tell your doctor you prefer to try Cervidil but you should also think about what you will do if the Cervidil doesn't work. Would you be willing to try Cytotec then, or have a c/s?
The makers of Cytotec, in order to have it be used for induction, would have to fund large studies of women to prove it's safe. It's cheaper for them to just say, "We don't recommend it for induction," knowing full well that OBs are going to continue using it for induction. It's cheap (because they haven't had to pay the big bucks to prove its safety) and effective in moving labor along. I've seen your posts on this issue before, and I think you make some good points about the "omg!" of Cytotec in the natural birth community (there are no truly "safe" drugs for pregnancy or induction), but the thing that scares me about Cytotec is that when it goes bad, it goes REALLY bad. Also, women are often left to labor unattended with Cytotec, so the nurses are not there to see the warning signs that immediate attention is needed, and with an unknown of how that drug will affect that woman (as there are no studies on why Cytotec affects some women so horribly), this is also frightening. I don't know what I'd do if faced with Cytotec v. c-sec, but outside of that situation, I think it's reasonable to at the very least avoid it up to that point or use it as a last resort.
LOL yes I am the devil's advocate on Cytotec (and I think flyer and nosoup too).
Women are left to labor unattended most of the time, Cytotec or not, in most L&D wards. A woman being induced should be monitored continuously and the information goes directly to the nurses's station where it is monitored. A woman on Cytotec is no more in danger of having nurses miss an emergency than any other woman in labor. There are studies on Cytotec safety so it is no more of an unknown than how any other drug will affect an individual (which you can never know ahead of time, unless you have a crystal ball). A lot of drugs can go "really bad." You can die from anaphylaxis from run of the mill antibiotics. People die of liver failure from taking Tylenol incorrectly every year. It doesn't mean we should tell people they are horrible drugs and should never be used.
Yes, it is reasonable to try Cervidil first or even proceed with a c/s. It is not reasonable for NBers to single out Cytotec when its safety and risks have been shown in numerous studies to be comparable to other induction methods and the risks of a c/s. NB advocates criticize doctors for not practicing evidence-based medicine, but they are ignoring the evidence on Cytotec. Furthermore, the risks of Cytotec are comparable to having a VBAC or vaginal breech birth. Are we going to start telling women they should never do those things and they should not go to a doctor who supports them? Or are those risks OK because they are "natural" and Cytotec is a product of the medical industry?

Of course, as with all things, it's a risk/benefits analysis. Part of the "villainization" of Cytotec in the NB community has probably been somewhat due to the fact that women are not appraised of the risks of Cytotec (as with many induction methods) and then when tragedy strikes, there's a horrified backlash: "You induced my labor with an off-label drug that is not FDA approved for induction, and in fact is decried by the maker for induction too?" So there's a real sense of being tricked. And so I think the outcry is somewhat justified: this is making women question and understand exactly what is being done in their induction, and what they are comfortable with. If a woman knows the risks of a drug, and decides that the benefits of what that drug offers outweigh the risks, more power to her. And if all the "Cytotec is the devil" NBers bring attention to the risks, not just of Cytotec but of other induction methods as well (as through this conversation and others, you have pointed out!), then that can only really mean good things in the end for the health of women who are informed and appraised about their birth experience.

I appreciate you all being the devil's advocate on Cytotec. It really made me consider and research (apart from Ina May, who I often take at her word!), and that's always the right thing. So say a first-time mom reads this thread and starts truly considering the risks of induction with any method ... it might open her mind to a new way of thinking. I know that happened to me! I was six months pregnant and not a NBer at all when someone mentioned to me that an epidural was a needle that went into your spine! I was horrified. Hey, the research and learning has to start somewhere! And that's why I appreciate these discussions, even though I'm more on the "terrified of Cytotec" side than you are.

Side note: I don't think ANY woman who's been induced should be left unattended for any length of time.

iris427 · July 2012

StacieJane:
iris427:
StacieJane:
iris427:
Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.
There are a bunch of studies finding that Cytotec is just as safe as Cervidil, and more effective. It also costs a fraction of what Cervidil costs. It has some downsides but so do all induction methods. The maker of Cytotec issued that warning probably as a CYA move--lawsuits are a huge problem in obstetrics. I think the NB community is wrong on the Cytotec issue, quite frankly. There is a lot of inaccurate fear-mongering and painting OBs who use it as evil.
OP, you can tell your doctor you prefer to try Cervidil but you should also think about what you will do if the Cervidil doesn't work. Would you be willing to try Cytotec then, or have a c/s?
The makers of Cytotec, in order to have it be used for induction, would have to fund large studies of women to prove it's safe. It's cheaper for them to just say, "We don't recommend it for induction," knowing full well that OBs are going to continue using it for induction. It's cheap (because they haven't had to pay the big bucks to prove its safety) and effective in moving labor along. I've seen your posts on this issue before, and I think you make some good points about the "omg!" of Cytotec in the natural birth community (there are no truly "safe" drugs for pregnancy or induction), but the thing that scares me about Cytotec is that when it goes bad, it goes REALLY bad. Also, women are often left to labor unattended with Cytotec, so the nurses are not there to see the warning signs that immediate attention is needed, and with an unknown of how that drug will affect that woman (as there are no studies on why Cytotec affects some women so horribly), this is also frightening. I don't know what I'd do if faced with Cytotec v. c-sec, but outside of that situation, I think it's reasonable to at the very least avoid it up to that point or use it as a last resort.
LOL yes I am the devil's advocate on Cytotec (and I think flyer and nosoup too).
Women are left to labor unattended most of the time, Cytotec or not, in most L&D wards. A woman being induced should be monitored continuously and the information goes directly to the nurses's station where it is monitored. A woman on Cytotec is no more in danger of having nurses miss an emergency than any other woman in labor. There are studies on Cytotec safety so it is no more of an unknown than how any other drug will affect an individual (which you can never know ahead of time, unless you have a crystal ball). A lot of drugs can go "really bad." You can die from anaphylaxis from run of the mill antibiotics. People die of liver failure from taking Tylenol incorrectly every year. It doesn't mean we should tell people they are horrible drugs and should never be used.
Yes, it is reasonable to try Cervidil first or even proceed with a c/s. It is not reasonable for NBers to single out Cytotec when its safety and risks have been shown in numerous studies to be comparable to other induction methods and the risks of a c/s. NB advocates criticize doctors for not practicing evidence-based medicine, but they are ignoring the evidence on Cytotec. Furthermore, the risks of Cytotec are comparable to having a VBAC or vaginal breech birth. Are we going to start telling women they should never do those things and they should not go to a doctor who supports them? Or are those risks OK because they are "natural" and Cytotec is a product of the medical industry?
Of course, as with all things, it's a risk/benefits analysis. Part of the "villainization" of Cytotec in the NB community has probably been somewhat due to the fact that women are not appraised of the risks of Cytotec (as with many induction methods) and then when tragedy strikes, there's a horrified backlash: "You induced my labor with an off-label drug that is not FDA approved for induction, and in fact is decried by the maker for induction too?" So there's a real sense of being tricked. And so I think the outcry is somewhat justified: this is making women question and understand exactly what is being done in their induction, and what they are comfortable with. If a woman knows the risks of a drug, and decides that the benefits of what that drug offers outweigh the risks, more power to her. And if all the "Cytotec is the devil" NBers bring attention to the risks, not just of Cytotec but of other induction methods as well (as through this conversation and others, you have pointed out!), then that can only really mean good things in the end for the health of women who are informed and appraised about their birth experience.
I appreciate you all being the devil's advocate on Cytotec. It really made me consider and research (apart from Ina May, who I often take at her word!), and that's always the right thing. So say a first-time mom reads this thread and starts truly considering the risks of induction with any method ... it might open her mind to a new way of thinking. I know that happened to me! I was six months pregnant and not a NBer at all when someone mentioned to me that an epidural was a needle that went into your spine! I was horrified. Hey, the research and learning has to start somewhere! And that's why I appreciate these discussions, even though I'm more on the "terrified of Cytotec" side than you are.
Side note: I don't think ANY woman who's been induced should be left unattended for any length of time.

But it is not ok to inflate risks and scare people in the interest of "informing" people about the risks--that is the opposite of informed consent ethics. It is no different than the doctors who scare women into c/s by misrepresenting the risks of VBAC or shoulder dystocia. Scaring people into seeing only one side of complex medical issues is not informing them and it is not benefitting anyone. We can talk about inductions without mispresenting them. Otherwise we NB advocates make ourselves look scientifically illiterate and that is not doing us any favors.

I mean, forget for a minute that we have a lot of unnecessary inductions. What if a woman really does need to deliver soon? If she refuses Cytotec and nothing else works for her, she is going to have a c/s. So she has a 3x risk of dying, she has increased risk of infection, damage to her internal organs, rehospitalization, not to mention that every single pregnancy she has in the future will have increased odds of life-threatening conditions like uterine rupture, placenta previa and placenta accreta. And given that 92% of births after a prior cesarean are RCS, there is a good chance all those risks will be compounded by having yet another c/s for all future deliveries. That is the context in which we need to look at Cytotec risks when we say it is dangerous and shouldn't be used.

I am glad my rambling on this topic is appreciated haha.

StacieJane · July 2012

iris427:
But it is not ok to inflate risks and scare people in the interest of "informing" people about the risks--that is the opposite of informed consent ethics. It is no different than the doctors who scare women into c/s by misrepresenting the risks of VBAC or shoulder dystocia. Scaring people into seeing only one side of complex medical issues is not informing them and it is not benefitting anyone. We can talk about inductions without mispresenting them. Otherwise we NB advocates make ourselves look scientifically illiterate and that is not doing us any favors.
I mean, forget for a minute that we have a lot of unnecessary inductions. What if a woman really does need to deliver soon? If she refuses Cytotec and nothing else works for her, she is going to have a c/s. So she has a 3x risk of dying, she has increased risk of infection, damage to her internal organs, rehospitalization, not to mention that every single pregnancy she has in the future will have increased odds of life-threatening conditions like uterine rupture, placenta previa and placenta accreta. And given that 92% of births after a prior cesarean are RCS, there is a good chance all those risks will be compounded by having yet another c/s for all future deliveries. That is the context in which we need to look at Cytotec risks when we say it is dangerous and shouldn't be used.
I am glad my rambling on this topic is appreciated haha.

Honestly, I agree with what you're saying. You're just ahead of your time as the voice logic while the scare tactics bring attention to the issue. I've researched it as you have, and have come to a different conclusion about Cytotec. Part of that is just because I trust Ina May and her opinion sways mine, so I don't claim to be the unbiased voice of reason. But at the same time, it is a complex medical issue that isn't as black and white as looking at the printed risks of a method. There's so much that's undocumented and unstudied about Cytotec, and I think that has to play into the fear and confusion about it.

And I've actually never heard of a situation where it was "c-sec or Cytotec" (though of course it must exist). I think it's typical use as a go-to induction method is the bigger problem, and the fact that it's not approved for induction (regardless of why), and that women are not informed of this before it's shoved up next to the cervix (or behind the cervix, or taken orally, since there's not even a "way" to do it). We can disagree; I'm just glad people are talking about it.

Hyaline · July 2012

First--I love this whole discussion.

Second, the part that gets me about the OP's post (and the first reply) isn't whether or not Cytotec is used, but that concerns are being dismissed. And they aren't being dismissed with "Here's the research, here are the potential issues, and the statistics on those risks. Your other option is X, which carries these risks. If you want to know more, I recommend you look up this study." Nope, it's "we do it all the time."

What? "We do it all the time?" That is not evidence-based medicine, any more than the scare tactics are--that's the logical equivalent of 18th century surgeons bleeding people for sore throats.

That's probably off-topic. Sorry. But it got me a little riled up.

In case anyone's interested, the Wikipedia entry on Cytotec has some citations to medical journal articles on the subject that might be interesting: https://en.wikipedia.org/wiki/Misoprostol#cite_note-5

Blackrose1918 · July 2012

Cervadil and Prepadil. They're the same drug (dinoprostone) but delivered in different forms.

chicagojackie · July 2012

Let's not forget about Laminaria Sticks (made from kelp, inserted in cervix...)

Just a thought.

Tampasomedaybride · July 2012

My initial response upon reading this was to literally say "Oh hell no." Cytotec is dangerous. It is dangerous for you and for your baby. I would be all over the internet collecting articles and information to provide my OB for why I would AT ALL COSTS refuse cytotec. I honestly might go with a c-section before I go with that crap. It is NOT made or endorsed by the FDA or even the manufacturer for labor purposes.

You can ripen the cervix with evening primrose oil or lots of sex too. I would be trying both of those things before entertaining any other methods. Cervadil was used for my sister, and I havent heard too much negative about it. So that might be another option.

Here is the FDA's opinion on this drug. And trust me I dont place a lot of value on the FDA's opinion on anything since they are basically run by the drug companies. And you would think that if they COULD endorse this drug as a safe way to induce labor then they certainly would (think of all the $ to be made). The fact that even the FDA has refused to label it as safe for labor is a huge red flag for me. This is the same organization that gave Gardasil the go-ahead and look how that turned out.

https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111315.htm

Tampasomedaybride · July 2012

iris427:
Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.
There are a bunch of studies finding that Cytotec is just as safe as Cervidil, and more effective. It also costs a fraction of what Cervidil costs. It has some downsides but so do all induction methods. The maker of Cytotec issued that warning probably as a CYA move--lawsuits are a huge problem in obstetrics. I think the NB community is wrong on the Cytotec issue, quite frankly. There is a lot of inaccurate fear-mongering and painting OBs who use it as evil.
OP, you can tell your doctor you prefer to try Cervidil but you should also think about what you will do if the Cervidil doesn't work. Would you be willing to try Cytotec then, or have a c/s?

If there are so many studies showing that Cytotec is safe for inductions, then why wont the FDA or even the manufacturer approve it for that use?

phq2011 · July 2012

Tampasomedaybride:
iris427:
Starbuck128:
From what I understand, even the makers of Cytotec say that using as a means of inducing labor is dangerous and advise not to use it that way. I would use that as a way to approach a doctor who wanted to use it. Cervidil is much safer, but also much more expensive. Some hospitals don't even have it.
There are a bunch of studies finding that Cytotec is just as safe as Cervidil, and more effective. It also costs a fraction of what Cervidil costs. It has some downsides but so do all induction methods. The maker of Cytotec issued that warning probably as a CYA move--lawsuits are a huge problem in obstetrics. I think the NB community is wrong on the Cytotec issue, quite frankly. There is a lot of inaccurate fear-mongering and painting OBs who use it as evil.
OP, you can tell your doctor you prefer to try Cervidil but you should also think about what you will do if the Cervidil doesn't work. Would you be willing to try Cytotec then, or have a c/s?
If there are so many studies showing that Cytotec is safe for inductions, then why wont the FDA or even the manufacturer approve it for that use?

To play devil's advocate on my own post, as a pp said, Pfizer (manufacturer of Cytotec) would have to fund thousands of dollars into research, since it is their medication, to deem it safe for pregnant/laboring women. It is currently okay in the US to prescribe medication off label (which is not evil, believe it or not), so Pfizer still makes money from the off-label use of Cytotec to induce labor. The fact continues that studies are showing better control of Cytotec. Pitocin went through similar issues of uterine tearing which was found to be because of high doses administered too quickly or prolonged use of the medication (over 24 hours). It is also known now that Cytotec's risk of uterine tearing increases with previous uterine operations.

This all being said, I would still consider alternatives before using Cytotec because the less medication I need the better. (See my update post about using terbetuline to slow hyperstimulation).

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Alternatives to Cytotec?

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