client being induced and I have a question

motherwise · 01-13-2006, 06:47 PM

I have a client who is being induced due to suspected preeclampsia (I have questions on this as well as they did a blood test and told her that her 'toxemia levels were high...didn't know there was such a thing as a 'toxemia' level per se.). Her OB has been giving her misoprostal (sp?) at regular intervals since approximately 5:30 last night. It is currently almost 4:00 PM now, and she has not shown any signs of cervical change. I guess the OB is waiting untill her cervix is 'ready' before administering the pit. I am worried that she is on the fast track to a cesearean...I haven't had much experience with this particular form of medication. Is there any thing I can do or advise her to do to help things along? I am just waiting by the phone right now, as she wants to call me when things pick up. I haven't had a chance to work with her much prenatally, as she called me last week and we only have done the consult, hoping I can still help her

Thanks

Need2read · 01-13-2006, 07:25 PM

Pregnancy—Misoprostol must not be used during pregnancy when used to prevent stomach ulcers caused by anti-inflammatory medicines including aspirin. It has been shown to cause contractions and bleeding of the uterus. Misoprostol may also cause miscarriage.

Breast-feeding—It is not known whether misoprostol passes into breast milk. However, misoprostol is not recommended for use during breast-feeding because it may cause diarrhea in nursing babies.

found this info by doing a google search. Uh, this website says it is used to prevent stomach ulcers...and other things your doctor may prescribe. *uh, okay...* ha.

Another website said:

Studies on birth defects with the diclofenac and misoprostol combination have not been done. However, there is a chance that diclofenac may cause unwanted effects on the heart or blood flow of the fetus or newborn baby if taken regularly during the last few months of pregnancy. Also, studies in animals have shown that diclofenac, if taken late in pregnancy, may increase the length of pregnancy, prolong labor, or cause other problems during delivery. Diclofenac caused unwanted effects on the formation of bones in animals.

Misoprostol has been shown to cause contractions and bleeding of the uterus. It may also cause miscarriage.

*I do not have experience with preeclamsia nor with the medication but I will see what I can dig up.*

Tiffany · 01-13-2006, 07:33 PM

A lot of drugs docs use for labor have been originally developed for something else, and don't even usually have an FDA approval for the way they use them in pregnancy (to start labor, etc.). I believe that is the large controversy over cytotec and is probably largely the same for misoprostol--however docs have found on their own if they use it a certain way it has a desired effect.

I think it's really when physicians start misusing a drug grossly is where you get problems.

As far as the client, I mean I am no doc but I know cervadil is widely used to soften the cervix and get it ready for pitocin. I wonder why he chose not to use that one? It is true her cervix needs to be in good shape for pit, otherwise you're forcing something that really just isn't going to happen.

Need2read · 01-13-2006, 07:45 PM

You may need to sign up to view the forum but check out this thread on Mothering.com (it is on the discuss page)
http://www.mothering.com/discussions...d.php?t=221654

On the http://www.hellpsyndrome.com/ website they have some good information and stated "Vaginal delivery is possible if there is no fetal distress or if there are no other clotting issues. Otherwise a c-section will be performed."

I would suggest that you remind your client that although she does have preeclampsia this is still her birth, she is still in charge and that she should ask questions about procedures, drugs, and anything else they are doing to her.

Pre-eclampsia can be dangerous (what I have read) and is serious...the health of your client and her child are of course utmost...so she may end up needing to give birth via cesarean. I would suggest you just encourage her and remind her that she is in charge of HER birth. Goodluck to you, and mom...please let us know the outcome.

motherwise · 01-13-2006, 07:51 PM

Yea, Misoprostal is the same thing as cytotec. I know it's evil stuff

I am just bummed because I didn't get a chance to over this stuff with her yet (called last week) and now I feel like it's too late to go into all the dangers etc. I just feel like I don't know how to help her. Alsom it's really me thats disturbed about the cytotec...she thinks that her doc is doing this for her and baby's health...I would like to help her avoid a c/s if at all possible.

Thanks guys, let me know what else you find!

motherwise · 01-13-2006, 08:04 PM

good links, thanks!

Gentlebirthmama · 01-13-2006, 09:40 PM

Misoprostal (Cytotec) is used as an induction agent. Usually docs will use either Pit or Cytotec...I think rarely are they both used as they are both used for the same purpose. The difference being that Cytotec is supposed to get the cervix dilating quickly and Pit won't necessarily cause a cervix to open right away, it may take many hours if a moms body isn't ready for labor.

Cytotec is something to really steer clear of as I've read stories of it literally turning the cervix to mush.

I knew a homebirth midwife in the area I used to live that carried Cytotec with her and would use it to ensure that she never missed a birth if she was going out of town or whatever...I lost all respect for her when I found this out. My doula client that was seeing this midwife called to tell me that the midwife had offered her this little white pill that would guarantee her having the baby (the midwife was due to go out of town around her due date)...I explained what it was and she chose another midwife! I was shocked to say the least that a homebirth midwife would even be daring to use something that even the FDA has stated could cause maternal and fetal demise.

Anyway, your question was about how you can help her and honestly I don't there is much you can do except provide her emotional support and labor assistance once things have kicked in. It's past the point of educating her on what this drug is and the risks...just be there as you would any other client.

Let us know how it goes.
Amy

motherwise · 01-13-2006, 10:52 PM

Apparently the OB stopped the Cytotec and started the pit...nice little cocktail huh? They are giving her till tomorrow

and if no progress then a section. Big Surprise. I'll let you know how it goes. Thanks for the support.

Marilyn

~Tranquility~Doula · 01-14-2006, 10:24 AM

I'm hoping things start going for your client! Cytotec is some really nasty stuff so at least he's not giving it to her anymore. Hopefully what she has been given doesn't pose a huge problem for her.
Good luck to your client! Sending labor vibes her way!

Gentlebirthmama · 01-14-2006, 11:24 AM

How far along is your client? Things probably aren't working if she's being induced before her due date because her body isn't ready for labor yet.

The one positive thing about Cytotec is that once it's stopped it stops working, whereas with Pit. it remains in the body for a while once stopped.

I pray

that all goes well for you and that this doesn't end in a section.
Amy

Kalamazoo Doula · 01-14-2006, 01:14 PM

This has given my chills! I can't believe that Cytotec was being used on a momma that was already having preeclamcia symtoms! Dangers of preeclampsia is the BP going up so high that the mom could stroke out or have sezures (sp?). One of the possible side effects of Cytotec is that it can cause strokes and seizures! So why give it to a preeclamptic mom who is already at risk of getting these? When I was being induced with my first b/c of preeclampsia, they were going to be giving me Cytotec, I'm just glad that I was having more than 4 contractions in a hour! That was the protocol at the hospital, that Cyototec can not be used if there are more than 4 contractions happening in a hours time.

Cytotec can also cause hyperstimulation of the uterus! Which can cause uterine abrubtion, even in first time moms, and moms with no history of a cersarean! This risk goes up with the more babies a mom has, especially grand multips! In my area Cytotec is being doled out like candy! Even with my last delivery, I was given it as a postpartum mangement of bleeding, since I have a history of hemmorage. But I've seen it being used on first time moms postpartum to get the uterus to clamp down! I just hope that everyone gets a clue! I don't know if it is being used so much b/c it is made by Pizer, and they are in our home town? Maybe the docs feel the need to support the drug company in our town that has threated to leave on many occations?

okay, I'll get off my

and settle down! This is one of the only things that really gets me to open my big mouth! LOL Okay, I'm done!

I wish good luck to your client, and I hope she has a healthy and happy delivery! Keep us updated!

Luv2bemommy · 01-14-2006, 01:18 PM

Quote:

Originally Posted by Kalamazoo Doula

This has given my chills! I can't believe that Cytotec was being used on a momma that was already having preeclamcia symtoms! Dangers of preeclampsia is the BP going up so high that the mom could stroke out or have sezures (sp?). One of the possible side effects of Cytotec is that it can cause strokes and seizures! So why give it to a preeclamptic mom who is already at risk of getting these? When I was being induced with my first b/c of preeclampsia, they were going to be giving me Cytotec, I'm just glad that I was having more than 4 contractions in a hour! That was the protocol at the hospital, that Cyototec can not be used if there are more than 4 contractions happening in a hours time.

Cytotec can also cause hyperstimulation of the uterus! Which can cause uterine abrubtion, even in first time moms, and moms with no history of a cersarean! This risk goes up with the more babies a mom has, especially grand multips! In my area Cytotec is being doled out like candy! Even with my last delivery, I was given it as a postpartum mangement of bleeding, since I have a history of hemmorage. But I've seen it being used on first time moms postpartum to get the uterus to clamp down! I just hope that everyone gets a clue! I don't know if it is being used so much b/c it is made by Pizer, and they are in our home town? Maybe the docs feel the need to support the drug company in our town that has threated to leave on many occations?

okay, I'll get off my

and settle down! This is one of the only things that really gets me to open my big mouth! LOL Okay, I'm done!

I wish good luck to your client, and I hope she has a healthy and happy delivery! Keep us updated!

I totally agree!!

With my first they had told me they wanted to induced me with cytotec, and I came home and started my research.. After all the horrible things I read there was NO way in h*ll was that going into my body.. Plus it isn't even FDA approved for inductions!

What are they thinking?

Anyways, I hope your client has a safe delivery!!

Kalamazoo Doula · 01-14-2006, 01:32 PM

Well the ironic thing is that there has been postings from both the FDA AND the company that makes Cytotec, asking to please STOP using the drug for off label purposes! Which includes Labor Inductions!

The darn maker wants them to stop! funny hugh? But not funny HA HA!

motherwise · 01-15-2006, 12:46 AM

Well, I just got back from the birth and it ended in c-section just as I suspected

I am so bummed. She never dilated past 3. She was 38 wks, and her cervix was high and firm to start with so that counts for my sense of foreboding, I guess. It was really hard for me because I felt like if I would have had a little time with her prenatally, things would have maybe turned out differently. Also, every time I have a client that ends up with a section, it takes me back to my own very traumatic, very unecessary c/s. I try my best to leave my 'birth baggage' at the door, but....

Thanks for everything, girls. I think I will go have a glass of wine

Gentlebirthmama · 01-15-2006, 01:16 AM

Thank you for sharing the birth experience with us...I'm sorry, but not surprised at the outcome.

Right now my nephew and his girlfriend are scheduled for an induction on Monday if she doesn't start labor...apparently her cervix is still posterior so they told her they will put something into her vagina that will bring the cervix forward ??? and will then break her water, and then start Pitocin!
I can only guess how that labor will turn out.

Where are we going with birth in this country??

Makes me so sad.

Amy