Misoprostol for induction... Had this last time, and had horrible experience - what do you know about it, please?

[designerbaby]

Hi all,

I'm due to have an appointment with a consultant regarding 'management' of the birth of my second, following a difficult birth with my first. I'm keen to be as informed as possible about what happened last time, so I can make my wishes and preferences both clear and well-researched.

In short, I went 2 weeks overdue, so was induced using Misoprostol in pill form.

I had, in fact, been having regular, but fairly mild contractions since the day before, but wasn't progressing and was given my first dose of Misoprostol in pill form at 10am. I was told it was currently 'unlicensed' but was told it "would be soon" and that it was a pleasanter experience than a vaginal gel. I was given no further information than this as far as I remember.

Nothing much happened, so was given another dose at about 8pm. About an hour later my waters broke, contractions got suddenly more powerful - managed on gas and air for about 3 hours until all hell broke lose and basically it seemed I ended up with a contraction which didn't stop for four hours...

Indescribable pain, (husband said I was screaming that I was going to die (but I don't really remember TBH)) but was making no progress and was only 1.5cm. The midwife on duty said I could be taken to labour ward for more pain relief or any other intervention until I was 4cm.

It was only until a change of consultant shift happened and the new guy took one look at me and said "get her down to labour ward ASAP for an epidural - she can't continue like this" that anything was done.

Was given an epidural (mercifully) and it's only at this point that I can start to remember stuff again (all rest was reported after the fact by somewhat traumatised DH).

Labour continued for another 18 hours with Sintocinon drip, made very slow progress, and finally delivered DD with forceps assistance... she'd passed a lot of Meconium, they suspected distress, so it was all done in theatre. Extended 3rd degree tear for me but DD was fine.

Keen, obviously, to avoid a repeat of this, so have been trying to do some research into Misoprostol - but all the stuff on the web is in 'medical speak' and I really can't make head nor tail of it. It does all seem a little alarming, and that really this isn't the best stuff...

But figured there's lots of knowledgeable people on here who might be able to give me some more info in a language I understand?

Many thanks in hope,

db
xx

I didn't know anything about it but I have also googled - most of what I found is not very current

It seems it's not clinically approved for use in induction in the UK or the USA but it does get used - apparently for cost reasons (it's cheaper than alternative drugs)
The manufacturers also don't want it used for induction
The RCOG seem to recommend it's only used in trials

Adverse affects are uterine hyperstimulation and lack of oxygen to the fetus

I think you need to ask serious questions about why you were given an unlicensed drug

Am no expert but I just happen to be reading the official NICE clinical guidelines for induction as will be induced next week

It says the following:
'Misoprostol should only be offered as a method of induction of labour to women who have intrauterine fetal death (see section 1.2.9) or in the context of a clinical trial.'

So it seems extremely strange/dodgy that you were given this drug (am assuming you're in the UK of course).

Hi
Sorry about your experience - that sounds truly awful. I've had two inductions with misoprostol (one stillbirth and one clinical trial). They used massive doses for my first delivery - I had no idea about this as the time as I was deeply in shock. Having said that, I had 2 straightforward and fairly quick (8 hours) deliveries. My third induction was with prostaglandin and also straightforward. It sounds like misoprostol doesn't agree with you and/or you're keen to avoid it again. Just tell them - they can use other drugs.
Btw - it's possible that your hospital was trialing the drug when you were given it - they often don't tell us humble patients these things!
good luck!

i would absolutely refuse misoprostol, if it is still offered, it is IMO and from what i have read, likely to increase risk of stillbirth and rupture and was never designed for labour

you could ask for prostin if you need to be induced again, but i personally would avoid it,unless there are compelling medical reasons for induction

so sorry you had such an awful time, have you considered a doula for extra support this time?

Your experience sounds horrific.
I was induced with DS1 with Prostin pessaries and had an absolutely fine labour (with epidural and subsequent syntocinon drip). Much as my spontaneous labour a few years later was nicer, I would not hesitate to have an induction with prostaglandins again if clinically necessary.

Can you discuss the reasons for your previous induction including the choice of drug and maybe consider expectant management this time if you go over dates again? This involves daily monitoring until you go into labour yourself.

Good luck to you.

crikey designerbaby, have you had a look at what is said about this drug?

are you going back to same hospital (which one was it?) same people?

i had a bad induction experience and would def have a doula in your position.

I just realised it's you, DB

Oh, thanks for all your responses... you're all so kind and well informed - but I knew that!

No, it's a different hospital - not due to anything other than a house move. We ended up at the first one after having been referred to their foetal medicine unit following an early scarem and they were so nice we decided to stay with them. I thought the midwives were excellent actually...

I was offered (somewhat grudgingly it has to be said) expectant management, but a combination of factors, not least that we were over an hour away from the hopital, and I was SO huge I couldn't face the trek on public transport daily, plus I was uncomfortable and fed up and plus I was really poorly informed about the pros and cons of induction...

I think what I'm trying to get a grip on is how much my poor induction experience (I'm very aware that most people's induction experiences are far, far better than mine) was due to induction per se, or just the way my body works, (or doesn't!?) and how much might be to do with the drug which was used...

With a view to having a sensible and informed discussion with my consultant about ways forward should I find myself in a similar situation again.

i.e.

1. Do I not want to be induced at all? (although, DD was already 9lbs 8oz, and at a slight 5ft 1" myself, I don't think pushing out an even bigger baby would be all that much fun if she'd have had some more time to grow even more)

2. Would I go through that again or go for the C-Section which, I'm told, will be offered to me as a matter of course after last time?

3. Would I consider an induction using different drugs, and would it make any difference?

4. If I go the expectant management route, how accurately would they be able to keep track of the size of the baby, and at what point would the risks of continuing become too great?

Of course, this might all be a moot point, you never know, I may end up going into labour spontaneously bang on schedule and pop this one out in a few hours in the water (like I planned with DD!). But I have to say I'm not so hopeful, really...

Am considering a doula, but not sure we can justify the added expense at the moment...

I hadn't really looked into the Misoprostol stuff before now, although a friend of my FIL who is an ObGyn in the US was pretty horrified at the time that I'd been given it. I have to say the stuff I'm seeing online - even though I only understand about 10% of it ? doesn't make for comfortable reading... I'm seeing things like "Exaggerated uterine response ? Hypertonic or tachysystolic contractions" and thinking "check", increased instances of babies passing significant Meconium, "check" and that's before you get to the really scary stuff about uterine rupture and the like.

And no, as far as I'm aware I wasn't told it was a trial - I think I'd have asked for more information if that had been mentioned. I was basically led to believe it was the same stuff as the standard prostin gel, only in pill form.

The more I look into it, the more cross I start to feel. I mean, all's well that end well and all that, but still, this isn't stuff to be taken lightly...

Anyone want to volunteer to give birth to this one for me? I'm already the size of a house... .

thanks again for all your help - anyone who has any further experience, I'd love to know what you think...

db
xx

hi designerbaby

sounds like you had a horrendous time last time, you poor thing. Am also about them using misoprostil for an induced labour, everythig I've read about it seems to indicate that this is a BAD idea.

I've had both misoprostil (for a late termination at 20 weeks ) and prostaglandin/Syntocinon drip (for DS1's birth). I also had morphine with the misoprostil which blurred a lot of it, but towards the end when things really started happening and the morphine had worn off I truly thought I was dying and was screaming the place down

Although prostaglandin/Syntocinon was pretty painful, it was nowhere near the same level of fear and pain as the misoprostil.

If you were to be induced again I would say it would probably be a very different experience with prostin and Syntocinon - also because sometimes all you need is one dose to get things going, so depending on how ready you were to labour it might be very close to natural labour anyway.

Not sure how much this helps, but thought it might be of interest. Good luck!

WFHIT - no it wasn't much fun, I grant you, but ultimately DD was fine, I was ok after a few weeks so no harm done - but I'm beginning to think we were both quite lucky.

Judging by what I've read it looks very much like I had some kind of "exaggerated uterine response" in which case it seems fortunate (to say the least) that DD didn't suffer any problems as a result...

None of this was looked into at the time - as far as I'm aware... but the consultant who finally got me down to the labour ward clearly thought something was amiss, as things happened (as in transferral, pain relief, lots more monitoring and different drugs) very quickly once he got involved, and from what DH told me he was quite about the situation at the time.

I'm not sure why I was given it TBH... as far as I'm aware it wasn't part of a trial, and I don't know why I wasn't just given the normal prostin pessary...?

Oh and hi PacificDogwood [waves back] must get back on my proper thread and say hi soon. Just a bit preoccupied by this at the moment...

Still undecided about whether to take the CS or go for a standard prostin induction if I find myself in that situation again... wait and see what consultant says, I suppose.

db
xx

And... "increased cervical lacerations (check) and increases in significant pernieal tearing (3rd degree, so CHECK)"

Bloody hell. What the F* is this stuff?

Is anyone in the UK looking into this in more detail? Or is it still being blithely prescribed unlicenced across hospitals in the UK?

Suddenly feeling quite cross.

db
xx

Ask your consultant for a thorough explanation of the options and weigh them up. In case i wasn't clear, my stillbirth happened in utero not as a result of an induction.

Thanks Rosebud... I did understand that your stillbirth wasn't caused by the induction. I'm sorry it happened to you at all though.

I'm suddenly quite cross that so many of the complications I had during labour may well have been a reaction to the Misoprostol and that given that I had been given an unlicensed drug with known side effects like these that I was left without help with what I was experiencing for so long, and the damage that might have been done to my DD (but thankfully wasn't) during this time.

The midwives obviously didn't have any idea of these side-effects or I can't help but think they'd have intervened earlier. This is dangerous, IMHO. You can't just prescribe stuff with side effects like this, and then bugger off without making your patient's primary carers aware of what they might be... surely?

It'll be an interesting conversation with my consultant I'd warrant...

db
xx

Rosebud, including patient in trials without full, informed consent is highly dodgy and would very likely get you struck off GMC/NMC register. I would be SHOCKED if it happened nowadays.

So sorry to hear about your awful experience OP. If you are angry - and I would be furious, maybe a letter is in order? Might help you process it and deal with it constructively.

Hope next birth goes well for you.

LS, I take your point, but unfortunately saying 'okay' when you're told that a drug is unlicensed but will be soon as OP did can be (and was) taken as 'full, informed consent'. I've always been shocked at how difficult it is to get info about side effects, risk factors, alternatives etc at all stages of health care from GPs to more specialist services.

P.S. I had no idea that it was an unlicensed drug or that my hospital was running a clinical trial the first time I was prescribed it. It was a 'this is what we use for inductions' approach, and I was too deeply traumatised by what was happening to ask any questions.