Science and Sensibility’s Blog has done it again. They have explained why the ACOGs approval of using Cytotec to induce labors is NOT evidence based.
In Hypnobabies class we teach moms the risks associated with cytotec/misoprostol/miso and I encourage my moms to ask NOW if their care providers use it, after I had a mom who didn’t find out until the day an induction was necessary it was the ONLY cervical ripener available from her care provider. That is a tight spot to be in. Knowing a drug isn’t always safe, but finding it is the only option.
Some care providers are now saying, “ACOG says it is ok.”
This blog post explains why even though ACOG says it is safe, the research and peoples experiences show that it isn’t ALWAYS safe.
Moms should be informed of the possible risks and given a choice of cervidil or foley bulb which are proven safer.
What is frustrating is that some OBs refuse to let a mother choose to have a VBAC because of the increased risk of complications, but find it acceptable to subject other mothers to the increased risk of Cytotec.
Is it because of time and money?
It takes more time for the OB to attend a VBAC then do a repeat cesarean. They make more money with the cesarean too.
It takes less time for an OB to use cytotec than other cervical ripeners and it costs much less money.
Cervidil is not always available (we don’t stock it in my hospital). Foley bulbs only work if the cervix is already 1-1.5 cm dilated, so that the foley tip can be inserted.
If you eliminate cytotec, cervidil isn’t available, and a foley bulb cannot be inserted, there are very limited choices left: pitocin on an unripe cervix (not a good idea), hospital prepared PG gel (we have that), or not inducing.
Facebook has a mommies group for those who have lost babies or have injured babies from cytotec use. it’s so so sad.
Why wouldn’t a hospital stock cervidil? I guess that is why some moms are told cytotec is their only option. A GREAT reason to find that out early in your pregnancy, so you could choose a different hospital if you wanted.
What is hospital prepared PG gel?
So, in most cases, what’s wrong with the “not inducing” option? Obviously, there’s some cases when it is absolutely necessary, just like in some cases of Cesarean, but why is induction seen as such a “normal” thing? Not counting time and money concerns (which should *not* be the deciding factors for healthcare that they are in the US).
In my community we have a couple of hospitals that claim they ‘don’t stock cervidil’ either. Yet the hospital down the road always has it available. I believe it is an issue of cost. Cytotec is pennies on the dollar compared to Cervidil. The hospitals want to cut costs. Cytotec probably also works faster which is also in the interest of the hospital. If they lose a few patients along the way… oh well, its part of the risk of doing business I suppose. What a sad world we’ve created for birthing women and their babies. I was at another traumatic birth last night. I’m beginning to come around to the idea of elective c/s. Maybe it is less traumatic than a typical hospital birth where there’s a 1 in three chance you’ll end up in surgery anyways.
**Sad Doula in Southern California
Hugs to you. It is hard to see some births. Sometimes I think it is more traumatic for us watching then the moms. Sometimes not, it depends on the situation of course.
Hey there! I am a staunch activist against Cytotec use vaginally for cervical ripening.
I, personally, almost died from the iatrogenic complications caused by my OBs backup dosing me with Cytotec. When my doc found out, he stomped out of my room incensed. Later, after my emergency D&C to remove retained placenta and a pph, he basically said “and this is why I don’t use Cytotec”.
I am right there with Lisa RM – most times, we don’t need to induce, we just do. If you have to ripen a cervix, then obviously their Bishops Score is at the low end, so we shouldn’t be forcing something that nature is not ready to allow. And besides… in those cases when we DO have to induce…
My safety in healthcare shouldn’t be dependent on what a hospital chooses to stock. If cervadil is the safer option (which it is) then they SHOULD be REQUIRED to stock my option of cervical ripener.
Safer birth options people. Safer birth options.
Sorry for the harshness of this post.
It is my belief that a hospital may not stock Cervidil due to the cost. Cervidil costs $175 for one dose. Misoprostil (100 mcg tablet) costs about $0.60. So, a dose of Misoprostil 25 mcg would be about $0.15. A hospital prepared PGE2 gel costs just pennies (probably about the same financial cost as Misoprostil).
My hospital, and most providers I work with, will usually opt to use the hospital prepared PGE2 gel. It actually works very nicely! It’s a prostaglandin gel (4mg in 4ml), is placed in the posterior fornix of the vagina (outside of the cervix), and works well to help soften the cervix. It can be given every 4 hours, and usually only take on average 2 doses to soften the cervix enough to move on to pitocin for continuing the induction – or it sometimes works so well that one dose puts the woman into labor!
Unfortunately, I don’t see a lot of women who would choose to not induce. They seem accepting of whatever the doc wants to induce them with. I do my best to educate them about the pros and cons about their induction method(s) BEFORE the induction starts. However, it sometimes feels like too little, too late. I don’t know how to educate more women before they walk in the doors of L&D – they come in, thinking “oh great! No more pregnancy! They’re inducing me today!”
Please don’t be sad! YOU make a difference to the women you work with! Don’t ever forget that.
I totally agree. Cervidil is also easier to control than cytotec or other prostaglandin gels. You can simply pull the string on the cervidil and remove it if the uterus is hyperstimulated/hypertonic. You cannot remove the cytotec or gel once it’s placed.