PREGNANCY-BIRTH Messages for February, 1999: Re: Cytotec vs. Cervidil

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Re: Cytotec vs. Cervidil

From: Myra Hollifield, RN (anonymous@obgyn.net)
Mon, 15 Feb 1999 08:47:09 -0600 (CST)

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Next message: Amy: "Re: One more reference on Cytotec & Pit"
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In reply to: William D. McIntosh, MD: "Re: Cytotec vs. Cervidil"

At Fri, 12 Feb 1999, William D. McIntosh, MD wrote: >
>>Dr. McIntosh.
>>
>>I am not convinced that Cytotec is better than Cervidil. From what I
>>have been reading, the dosage of Cytotec that is applied to the cervix
>>is not as controllable as Cervidil, and may cause frequent, tetanic
>>contractions, which I believe is a contraindication, especially in a
>>woman with a uterine scar (though ruptures can occur in unscarred uteri
>>as well).
>>
>>I disagree that Pitocin is "the very same hormone that your own body
>>makes to have contractions." Pitocin is synthetic oxytocin and not the
>>same thing. Michel Odent is doing research on Pitocin and is finding
>>evidence that the pituitary gets "tricked" into thinking it has already
>>produced enough Pitocin and therefore stops making it... therefore
>>requiring more Pitocin to keep the labor going. He also says that
>>oxytocin (the natural stuff) is the "hormone of love" and is at the
>>highest levels it will ever be in both mother and baby in the first few
>>hours after birth. If Pitocin has been used continually, natural
>>oxytocin won't be present, which can hinder the bonding process in those
>>crucial first hours after birth.
>>
>>>Why do you need an induction? Maybe you will go into labor on your own.
>>That is the best way of all.
>>
>>Agreed!!
>>
>>--
>>Amy DeRuyscher
>>Provisional Birthworks CCE
>>Provisional Birthworks Doula
>>
>I appreciate your opinion, but I am afraid that I cannot share it.
>Cytotec can be used badly, but that is not a reflection on the drug, but
>rather the user. All ripening agents share that same concern, that the
>dose is variable, and the effects not always predictable. That is
>Cervidil's main claim to fame, that you can pull the string if there is
>hyperstimulation of the uterus. You can just sweep out the Cytotec
>tablet, one of its strengths. The use of cytotec outside of L&D is
>untested, and frankly dangerous. So would be the use of Cervidil in
>that fashion.
>
>As for Pitocin, oxytocin from a test tube and oxytocin made in vivo are
>chemically identical. Any arguement that Pitocin is somehow different
>is going to have to explain to me how identical molecules can behave
>differently. To use the example of sucrose (sugar), whether it comes
>from a sugar beet or sugar cane, it is still sucrose. Any
>contraindication to pitocin is a contraindication to labor in equal
>weight.
>
>Both cervidil and cytotec have been used in thousands of women safely. I
>have used cervidil for several years, and prostin gel before that. I
>started using Cytotec just in the past year. My experience is the same
>as the literature, it works quickly, safely, and more reliably than
>cervidil. I do not use medications for my convenience, certainly not
>one that might get me sued. I pick the best possible agent that I can
>find, and the only outcome variable that counts is a healthy baby and a
>healthy mother. I would use cytotec in preference to cervidil in my
>wife.
>
>--
>William D. McIntosh, MD
>Clarksville, TN
>
>This is for educational purposes only. It is not intended
> to replace consultation and examination by your physician
> or other health care provider.
>

-- I tend to agree with Dr. McIntosh. I am a labor and delivery nurse and our institution has used Cytotec for a couple of years now. I find it is an agent that allows the early latent labor to be more natural and then when in active labor, it seems to progress quickly. I find it produces a labor more like "spontaneous labor", therefore those that have to be induced seem to prefer it over Pitocin. Cervadil tends to be a good agent for ripening, however, many times we do not see patients go into active labor on Cervadil alone. All of our docs now, including those who refer to themselves as "dinosaurs", are using Cytotec with much success. I also agree with his opinion on Pitocin and oxytocin being the same so how could human response be different. I personally was induced with Pitocin and had no problems at all bonding with my infant. I had about a 6-7 hour labor and a wonderful delivery. I feel that sometimes when Pitocin is used on an unripened cervix, it causes labor to last longer. This makes the mother very tired. Maternal exhaustion is one of the major reasons I see for lack of maternal/infant bonding initially.

My biggest concern is that of laboring a patient who has had a previous cesarean without the use of continuous monitoring. I have seen many successful VBAC's but I was present when one patient, who was a successful VBAC already, suffer from uterine rupture. The first signs we saw were fetal heart rate decelerations on the monitor. The patient didn't really notice any difference in discomfort at first. Our nurses and physicians were ready for a repeat cesarean before the patient then become more uncomfortable and started to bleed heavily. A stat c-section was performed and luckily, Mom and infant were fine, although the infant was very sluggish and first and took some time to resuscitate. I used to think laboring without fetal monitoring was great, and still feel it's acceptable in some cases, but once you see something as scary as uterine rupture, I think it's certainly worth laboring with a couple of belts on the abdomen to insure maternal and fetal well being.

Karen, I wish you the best and I hope you labor is successful, however it comes about. I certainly don't mean to scare you but there are some important issues to think about when it comes to laboring as a VBAC.

Next message: Amy: "Re: One more reference on Cytotec & Pit"
Previous message: chris: "Re: One more reference on Cytotec & Pit"
In reply to: William D. McIntosh, MD: "Re: Cytotec vs. Cervidil"

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