Cytotec and Childbirth

Yesterday we discussed the use and overuse of Pitocin, a name-brand oxytocin used to stimulate contractions.

Today, we have in our sights: Cytotec.

If anyone read the birth story of my second son, you may remember that I was overdue with him. He was measuring "small" near the end of the pregnancy, but as our due date neared and then passed, I was pushed to pick an induction date.
That in itself was frustrating. I didn't want to pick my child's birth date....essentially his birthday. I knew that once we were induced, I'd give birth not long after. I trusted that my body would respond to the chosen induction method pretty well. After all (and don't hate me), my labor with my older son was about 5 ½ hours. I was hoping to be so blessed again.
Then again, my midwife for my older son, Debbie, wasn't interested in inducing. Once we neared 40 weeks, she said we'd only start discussing induction at almost 42 weeks. Neither of us had been entirely sure of my Little L's date of conception (I was on hormonal birth control when I conceived him, and my cycle was really erratic), but our guesstimation proved to be on point. He was born one day before my due date.

So when I started feeling the arm-twisting during my second pregnancy, I acquiesced. Surely I'd go into labor before the day I was set to be induced.
Mark and I worked for last couple of weeks to get Baby E out naturally. And though all that lovin' didn't directly get that baby out, I don't feel like we wasted our time. *wink* (sorry, Mom.)

I was set to be induced on March 12. When I saw my "medwife" the day before my due date, she asked if I wanted her to strip my membranes. It wasn't a medical intervention, she explained, and since I was already a bit effaced, it may kick me into labor. I had been holding at 2-3 cm dilated for a week. So "stripping" simply means letting the practioner sweep in and push the amniotic sac away from the bottom of the uterus. It releases prostaglandins, which ripens the cervix.
I let her do it.
The next appointment, a few days after my due date, I was still pregnant (gasp!) and not much more dilated: 3 cm. That's when I was pushed to pick and induction date. So I settled on the following Wednesday, the 12th.

Within the next week, I began hearing from friends to avoid Cytotec. It's an ulcer medicine and has occasionally been known to cause uterine rupture.
On the 11th, while dropping off the kids with my sister, making plans to head to the hospital for a 7 a.m. appointment, I e-mailed my midwife. She assured me that we'd just use 25mg of Cytotec as a vaginal suppository and that I could still be perfectly mobile.
It still didn't sound like a joyous labor. I don't even like hospitals.
We e-mailed back and forth a few times and when the conversation was "done", I was resolved to show up at the hospital and refuse the drug. I hoped I could stand my ground.
You might remember from my birth story of Baby E that we went into labor not long before I was set to be induced, and the medical professionals only got to participate in about 10 minutes of my labor. Lucky us!
However, I still worry about the overuse of Cytotec.
Before I was ordered to take the med, I hadn't even heard of it. And I considered myself relatively well-informed. So I bring both my story and some Cytotec facts to you, friends. I hope that you can avoid an unneccessary medical intervention, if at all possible.

What is Cytotec?
It's the brand name of Misoprostol, made by the drug developer Searle. It's a synthetic prostaglandin. And it's approved by the FDA to ease or stop drug-induced gastric ulcers.
What's that you say, Cate? It's for ulcers?
Ah, yes. We hit another point. It's not even specifically for the induction of labor. And in 2000, Searle contacted physicians reminding them of the intended use. But according to the Birth Naturally site,

However, once a medication is approved by the FDA doctors can prescribe it for other things as well.

So my medwife was totally within the bounds to designate this as my induction drug. After all, she said,

Cytotec is not FDA approved, but has been approved for use by the American College of OB-GYN's for use in induction and has been in use for over 10 years. The risk of uterine rupture with 25-50 mg of cytotec is extremely low, and I have never seen it myself. I don't think there is another option at [the hospital] for induction other than pitocin. I don't believe the pharmacy even carries anything else. I'll check on that. I'd be willing to break your water and see if that works (using your own prostaglandins) but if it doesn't, the only option left at that point is pitocin, as once your membranes are ruptured you can't use cytotec.

Wow, really putting a woman at ease, there.

But there are risks, especially for women who have had a C-section previously. Even the American College of Obstetrics and Gynecology (ACOG), which I don't often agree with, chimes in:

There have been reports of uterine rupture following misoprostol use for cervical ripening in patients with prior uterine surgery. Thus, until reassuring studies are available, misoprostol is not recommended for cervical ripening in patients who have had prior cesarean delivery or major uterine surgery.

If it's an approved medicine, what are the risks to pregnant women?

• Extra strong contractions
• Uterine hyperstimulation
• Uterine Rupture
• Amniotic fluid embolism
• Severe genital bleeding
• Retained placenta

And some other problems:

• Once it's given, the dose can't be controlled. At least Pitocin is through an IV and can be gently increased.
• Baby's heart rate must be monitored, which limits mobility.
• There's a risk of the passage of meconium into the amniotic fluid, and then may cause a certain type of infant pneumonia.

And guess what else? Cytotec comes in 100mg pills. That means that if you were to be given a 25mg dosage (as I was to be), the hospital would have to cut it into pieces. Indeed, on the Gentle Birth site, some care practitioners give firsthand accounts of doing this!

So what is it, ladies? Shouldn't we expect better?
If you're looking for a much more exciting and yet more peaceful way to induce labor, check out the blog on Gentle Labor Induction.


Images: Daquella Manera on Flickr under a Creative Commons License.
The second is from the Drugs.com image database.

p.s. Some of the information here was from handouts from MotherFriendly.org, but was mixed with my own research. But check out their site for good natural birthing resources.