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Misoprostal induction at homebirth 
28th-Jun-2012 11:40 pm [cervidil/cytotec, induction, overdue]
glasseswoooo
So, I am 40w4d and at my prenatal appt today my naturopath and midwife mentioned induction by vaginal misoprostal insertion. They weren't too concerned by me going to 42wks but with my first baby I went 18 days "past due." They said they "would't let that happen" this time. I had a totally healthy son and normal homebirth so I really don't see what the big deal is. My bp is totally fine 90/50 today and urine is normal...no swelling, no "baby is too big" concerns being voiced...so. I don't get it. I am planning another homebirth and I feel like it totally defeats the purpose to have any augmentation. Plus, misoprostal does not sound like a party I want to attend AT ALL. I don't need anything that helps make the pain worse, thank you very much. This just sounds so odd, don't you think? Anyone here been induced with this drug outside of a hospital setting? Or in the hospital for that matter...I am curious as to the effects of the drug as far as increasing strength of contractions.
Comments 
29th-Jun-2012 08:31 am (UTC)
I didnt know what it is so i googled and with what i've read i wouldnt let them near me with it.
30th-Jun-2012 02:16 am (UTC)
ditto. hell to the no.
29th-Jun-2012 08:36 am (UTC)
Nothing in the world could get me to agree to an induction with vaginal application of Misoprostol. My understanding that it is not even labeled for use in that way and that vaginal use predisposes women to fatal infection.
29th-Jun-2012 10:03 am (UTC)
They use it as the second half of a medical abortion. It can cause very strong cramps and bleeding. I'm sure it would accomplish the same goal (uterine contractions) for a birth as well, but I still wouldn't want it used. The contractions it causes can be very severe with complications to match.
29th-Jun-2012 10:09 am (UTC)
My thoughts as someone being pressured to schedule an induction at 40 weeks (they have relented from 39):

1. That bp isn't "totally fine," but rather a bit low. BP normally climbs during pregnancy and that would be low for a normal person.

2. Induction makes any labor high risk. I don't think it should be done outside of a hospital setting.

3. Cervadil is a cervical ripening agent approved by the FDA. However, after reading about the risks of induction with even a mother with successful vaginal births, I wouldn't do it. If cervadil is indicated (because the cervix isn't ripe), then absent medical indication, I would be wondering why not to wait? Even with a multigravida, cervical ripening greatly increases your risk of c-section.
29th-Jun-2012 10:45 am (UTC)
Misoprostol is Cytotec, not Cervadil.
29th-Jun-2012 10:54 am (UTC)
Yes, I know that. Cervadil is the cervical ripening agent they should be mentioning, not Cytotec. Sorry if that wasn't clear. However, without medical indication, I wouldn't agree to using it either.
29th-Jun-2012 03:00 pm (UTC)
I just wasn't sure if you maybe mispoke since she didn't mention Cervadil in the post.
29th-Jun-2012 03:22 pm (UTC)
No, mentally I was jumping off from madelitty's comment above. However, the connection was not clear in my comment.
29th-Jun-2012 03:25 pm (UTC)
I know that bp seems low but that is what it has been the whole time i've been having it checked this pregnancy and my first.....my bp always runs about there so I guess that is why they deem it normal.
2nd-Jul-2012 12:51 pm (UTC)
That's about what my bp has been all my pregnancy and no one has said a word of concern to me about it.
9th-Jul-2012 12:15 am (UTC)
Yeah, my provider always said it was more deviations from my norm than overall numbers was what the looked at for BP. I think mine was pretty similar to yours my whole pregnancy.
29th-Jun-2012 10:45 am (UTC)
Uhm, no. No no no no no. Cytotec is CONTRAINDICATED for use in pregnant women over 20 weeks. It is dangerous to use, too dangerous to use in a hospital where they can rush you to emergency surgery to preform a crash C-section and possible hysterectomy for a ruptured uterus. Google "cytotec uterine rupture".

I would very very seriously reconsider allowing any midwife who suggested using Cytotec AT HOME, illegally, anywhere near me during birth. It goes against every single shred of evidence for having a safe birth. Anywhere.
29th-Jun-2012 01:30 pm (UTC)
I would never consent to an induction via Cytotec inside a hospital, much less outside one. With an induction agent like that, you should be on continuous fetal monitoring. There is a reason midwives that attend homebirths don't induce. It goes against the model of care a midwife is supposed to provide...being confident in nature taking its course. I would be very, very concerned about being in the care of a midwife that thinks it is okay to induce with Cytotec at home.

Edited at 2012-06-29 01:30 pm (UTC)
29th-Jun-2012 05:20 pm (UTC)
My thoughts, almost word for word.
1st-Jul-2012 01:27 am (UTC)
+2

Cytotec is scary business. I'm really appalled to hear that homebirth midwives would be pushing its use.
29th-Jun-2012 03:20 pm (UTC)
Guhhhhh, these comments are all echoing how I feel.I'm just so shocked they brought it up...i mean they advised me not to take otc cold medicine when I was sick a few months back and now they are mentioning a downright dangerous drug? I just should have questioned it more but I was so taken aback by it I went mute or something....i will def NOT consent to it. Now I feel like I'm on a big fat deadline though. Thanks for your help!
29th-Jun-2012 03:29 pm (UTC)
Oh my god, hell to the no. Not even in a hospital with continual monitoring, much less at home. And NOT because of the pain (although that probably sucks too) but because of the risks of uterine rupture and other similarly nasty consequences. As the mama of a happy healthy normal sized 42+2 girl, I say stick to your guns in any case, but that your MW was suggesting cytotec is totally crazy to me.
29th-Jun-2012 03:29 pm (UTC)
I may have to be induced (it's not what I want at all but I'm also 2 weeks overdue with a rock-solid conception date) in a hospital (with a midwife) and misoprostal is one thing I will not let them get anywhere near me with.

I also would not do any sort of chemical induction as a home birth. Either stick to your guns and wait it out for a natural home birth, or transfer to a hospital birth for induction. Chemical induction is dangerous and depending on your Bishop's Score, you may have a 50/50 chance of needing c-section. I wouldn't risk it.
29th-Jun-2012 03:35 pm (UTC)
The c-section rate for a multigravida who is induced with a cervical ripening agent is around 14 percent for the only study I came across on the subject. There are other risks too, such as requiring operative delivery (forceps or vacuum). Much higher than the 3.9% with spontaneous labor for a multigravida, but not a 50/50 chance. The risk of c-section from a pitocin induction is around 7%.
29th-Jun-2012 03:40 pm (UTC)
I personally would find a new care provider if mine were suggesting going against a black box warning, especially outside of a hospital setting. There is a serious risk of uterine rupture. Personally based on my reading, I feel as though an elective csection is safer than a misoprostal induction.
29th-Jun-2012 03:48 pm (UTC)
what's the plan if you refuse? unassisted home birth? walk in to an ER in labor and pushing? there's no way I would consent to this, but I also wouldn't hire anyone who thinks 18 days past due dates is alarming.
29th-Jun-2012 04:01 pm (UTC)
I was prescribed this after a d&c for an early pregnancy loss last year. It hurt, but it wasn't so bad. BUT there is absolutely no possible way I'd take it to induce labor and I'd run if my care provider suggested it.
29th-Jun-2012 04:12 pm (UTC)
I loved my cytotec induction in hospital. It was awesome. I liked it much better than the pitocin and cervidil that I also tried (stubborn kid.) We did low dose and it took a few rounds but not more painful or more challenging than my regular labors. It actually felt like I was having my regular labor instead of an induction. My impression was that it was very gentle and very manageable, and because it wasn't IV I was able to move around.

That said, no induction should be taking place outside a hospital.
29th-Jun-2012 04:26 pm (UTC)
I had a cytotec followed by pitocin induction at 41 weeks +3 days. The cytotec really didn't do a whole lot for me. I was only on the pitocin long enough to get the contractions rolling and for my water to break. After that, the pit was turned off an I was on my own. I had a beautiful baby boy via a waterbirth.

But, all of this was done at a hospital. I agree. I wouldn't do an induction at home.

Edited at 2012-06-29 04:26 pm (UTC)
29th-Jun-2012 06:07 pm (UTC)
I'm having a hard time reconciling why any provider would consider it safe outside of the hospital (or inside)... but a NATUROPATH?!?! I'd be reporting that to her licensing agency!
29th-Jun-2012 10:41 pm (UTC)
I would seriously consider firing my midwife if she EVER suggested a homebirth induction with misoprostol. What a completely stupid, dangerous and irresponsible thing for a care provider to do!! I would be LIVID.

If you went to 18 days past your "due date" with your first, maybe you just have a slightly longer gestation time for your babies. I sure as hell would not risk MY life and my baby's life by taking a drug that shouldn't even be given in a hospital, where deaths have occurred in pregnant women using this drug.

I am perfectly serious is suggesting that you fire your midwife right now. She is dangerous for you and your baby. I fired my first set of midwives at 37 weeks, which I know is not the same at being 40w4d but the dangerous suggestion from your midwife, to me, warrants a firing.

I took misoprostol to complete a missed miscarriage and it was the most horrific experience I have ever had. It was HARDER than my labour with my son. As well as being beyond painful, I also started hemorrhaging and had to go to the hospital. Thankfully, it was not too serious but this was for a missed miscarriage at 7 weeks, not a full term baby that needed to survive the birth.

Is it possible for you to find another homebirth midwife? Is it possible for you to have a natural hospital birth *without this dangerous midwife* present? Would you consider an UC? I'm not saying you should do one or the other but, whatever you do, DON'T LET THIS DANGEROUS MIDWIFE NEAR YOU AGAIN!
30th-Jun-2012 01:23 am (UTC)
All of this. Plus, who's to say that she wouldn't try to use it without your knowledge and consent? Especially since she had the idiotic idea to even suggest using it already.
2nd-Jul-2012 06:26 pm (UTC)
i had cytotec at a freestanding birth center in idaho in 2005. i was 37 weeks. it was a disaster. a big fat disaster. NICU time and everything. i would not have consented if i knew anything about anything back then.

the only thing i would consider doing at home would be a water break, and i'd rather be contracting first. and if i did it, i would do it with the full knowledge and understanding that it could mean a hospital transfer if it didn't work.

i'm thinking waiting is your best bet though.
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