What’s the Difference Between Cytotec and Cervidil?
When it comes to inductions, the first step is getting your cervix soft and squishy so it’s ready for labor. There are primarily two cervical ripeners used for this purpose. The first one is called Cytotec (it’s generic name is Misoprostol, or Miso). This medication is used very commonly, like most of the time. It’s not approved by the FDA for use in induction and in fact it is packaged in a black box labelled NOT to be used in pregnancy or labor. It’s actually a stomach ulcer medication, but it’s commonly used because it’s fast and it’s very inexpensive ($2.00 per pill). The side effects can be mild, like cramping. But they can also be devastating, like fetal distress, meconium stained fluid or even uterine rupture in rare instances. It is difficult to regulate the dosage and can make each dose a gamble.
The provider will break the pill into quarters as best they can since this pill is not scored. It’s very hard to calculate because they’re cutting it and then inserting it into your cervix or beside your cervix. The main benefit of using Cytotec is that it’s fast and they can usually administer it again in four hours if they need to. It absorbs quickly into your cervix and it usually starts the contractions. It is also a medication that has a cumulative effect. Cytotec does not work the same on each and every body: A quarter of a pill given every 4 to 6 hours under the tongue may create a fairly normal labor pattern, or conversely it can create a way too intense labor too quickly.
If your baby doesn’t tolerate it, or if your body does not like it, it is difficult to remove because it absorbs very quickly, and that can result in an emergency cesarean. Administering it to you underneath your tongue goes in pretty quickly but it’s slower to absorb and start contractions. However, studies show that under the tongue dosage has resulted in more cesarean deliveries than vaginal deliveries. So it’s important to discuss with your provider how and why they use Cytotec in an induction.
The other medication option is called Cervidil. It is more expensive than the alternative and takes longer to work, but it’s a good choice if the goal is a low and slow induction process. But your insurance is paying for it so why does the cost matter? Cervidil is an artificial prostaglandin that mimics the natural prostaglandins you have in your own body that helps soften the cervix to a buttery consistency. They administer this by putting it into a little tube, and then inserting it into your cervix, similar to a tampon. With this medication application, you will need to be lying in bed. This medicine can be easily removed. It has a 12-hour dosing period because Prostaglandins take longer to work. It will be resting in your cervix. They can pull it out if it’s not working for you or your baby. It can also be administered as a gel that is smeared onto your cervix and absorbed that way. It can also be wiped off your cervix if your baby or your body does not respond well to it, which does not happen often. About 12 hours after it is placed, they’re going to check your cervix and see if it’s soft and buttery. If not, they may do another dose (12 more hours) and then add Pitocin.
A Midwife friend of mine has started counseling her clients to insist on the second 12 hour dose, since often this is all it takes to allow the uterus, the baby and the cervix to get the message and labor ‘appears to start on its own’. However, usually after 12 hours they typically add the Pitocin and they may create an illusion of urgency that labor needs to start- this is not true. You’re there to have a baby, you can stay slow and deliberate. There is no rush. This is a circumstance where you can check in with yourself – am I ok? Is baby doing ok? Then we have time. While Cervidil is FDA approved for induction, it’s very expensive (about $200 to $300/dose), and so it’s not the medical model’s first choice. Cervical irritation, discomfort,temporary increased maternal heart rate are the most typical side effects of this medication.