Having an induction of labor can be confusing. Your friends may have had their medicine through the IV but misoprostol (marketed a cytotec — like Tylenol is also called acetaminophen) is given in a variety of ways. We’ll talk about each of the ways, their pro’s and con’s so you can make the best choice for your cervical ripening.
Hi — I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of labor and delivery nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I’ve given thousands of doses of Cytotec in that time. I’ve seen how we use it change over those years, and I’m excited to share what my favorite methods are with you guys!
How is Cytotec administered for labor?
Cytotec can be given orally, buckle, sublingual, rectal or vaginal. Each method have pro’s and con’s including absorption and things that can be problematic. Cytotec is a prostaglandin that is given to induce cervical ripening.
Let’s dive deeper into each of these methods so you can pick the right one for you.
First off, I love that you’re getting ready for your birth! You probably have lots of questions about your induction. Let me just say that you still have time for a prenatal class. This one can be done in just a few hours and people LOVE it. In fact, they’re prepared before they even know it!
Ok, let’s dive into the different methods. This, of course, is after learning about the pro’s and con’s about the medication in general from your provider (we will also discuss the risks and the benefits down below). Be sure to discuss the risks and benefits JUST for you as it may vary on you and your specific needs.
This was the gold standard for a long time. It was all we did when I first started. The Cytotec pill (normally given as 100mg pill and then cut into 1/4ths by either the pharmacy or the RN — leaving 25 mg dosing) is placed in the back of the birth canal, called the Vaginal Fornix.
Pro’s of Vaginal Cytotec: As long as no lube (yes, you read that right — no lube) is used there shouldn’t be an issue with absorption. It works faster and longer according to the studies (As it’s slowly being absorbed vs in the stomach or buckle). Some places do use lube, but there is some concern it hinders absorption.
Con’s of vagainal Cytotec: The pill is given every 3-4 hours and it can make the vaginal walls “friable” (aka, they get more painful over time because of the hormones they’re absorbing). Plus, there is being uncomfortable when you have an exam every 3-4 hours with no lube. Some places recommend you wet your glove for lube, and some places allow you to use a “small amount of lube” (that is my personal preference).
Pro Tip: You will still likely have an exam every 3-4 hours because they need to see if you cervix is opening with the medicine — but it is a less-uncomfortable exam for just checking dilation.
This is where you take the Cytotec just like a pill and swallow it. Fun fact, Cytotec was actually created as a stomach pill — to help with things like ulcers. It helps decrease stomach acid production (in addition to helping your uterus contract). There are actually a few stomach pills that can help with hormonal things, so this isn’t unusual.
After vaginal, Oral misoprostol is the next method we tried for a labour induction when using Misoprostol for cervical ripening.
Pro’s of Oral Cytotec: Easy to take a pill (unless you have issues taking a pill).
Con’s of Oral Cytotec: Some concerns about eating and how that can inhibit absorption (so some facilities will keep your NPO for 2 hours after taking the pill. Some people have some stomach upset from the pill (although not frequently).
This is where you place the pill under your tongue and it disolves
Pro’s of Sublingual Cytotec: This pill easily dissolves, should be gone in about a minute. No issues with absorption. You can freely eat or drink afterwards as it goes directly into your system and food doesn’t affect it.
Con’s of Sublingual Cytotec: It takes pretty bitter and people don’t love that. Because it’s all being immediately dissolved and absorbed, some people think it doesn’t last as long.
This means where you place it between your gums and your cheek and disolve it that way.
Honestly, all the same pro’s and con’s to sublingual, it’s just a little different.
This is actually my preferred way. I think it’s easier to keep a pill “buckle” than under your tongue. You can still talk and feel more “normal” as it’s disolving (vs under my tongue I feel like I can’t talk). Still absorbs the same way.
This is when it is placed in your rectum (where your poop comes out).
We don’t use this method for an induction much as it is such a small pill (and baby’s head can sometimes come by and push it out, or you’ll need to poop…. and….). Plus, it’s your bum hole — just most people prefer this to be an “out only” type scenario.
It is used post delivery if a patient is bleeding too much (sometimes called a hemorrhage). It can be placed as pills or a suppository in the rectal area. The benefit here is that is absorbed quickly (vs taking pills), and we can’t place it vaginally as you’re bleeding and the blood might wash-out the pill.
During a hemorrhage it is a larger dose that needs to be absorbed very quickly, so this works well for that.
Why can Cytotec be placed so many ways?
It is sort of weird if you’re not in medicine.
Most drugs can be given in a variety of ways. For instance, Tylenol can be given orally, rectal and also IV. It allows us some flexibility in how we use the medications, which is great.
So, what is the standard way to give Cytotec for an induction?
Here’s the fun part. Cytotec is not actually approved for an induction of labor (here is the FDA’s stance on Misoprostol). But, before you freak-out. A few thoughts:
- We’ve been using Cytotec for induction of labor for a long time. In fact, long before I started in 2001. It has been used safely in in the US for this reason for years.
- There are a lot of drugs that we use outside of what the FDA has approved them for. This isn’t unusual.
- Cytotec is a bit controversial because it is a pill used in the abortion process, which may hang-up its FDA approval. Which is a bummer.
- Cytotec is also a LOT cheaper than it’s counterparts (going to talk about that next) and I have seen first-hand that these more expensive drugs will stop another cheaper version not get FDA approval (because they have lots of money for lobbying).
The studies really do point to it as a very safe and effective method of induction. Look at this Cochrane review here that reviews six studies and shows it to be very effective.
How will my provider give Cytotec?
It mostly depends on what it is done currently where that provider works. Some hospitals still have policies that it can only be given vaginally, etc. However, a doctor’s order can always override that.
Wait, if Cytotec is not FDA approved can I use something else?
Yes, you can — but first:
Cytotec is cheap. Like cents vs the hundreds of dollars for Cervidil, the most commonly used other induction agent. It also doesn’t need to be refrigerated, and it is super easy to both place vaginally or give in a varieties of methods. There are a LOT of perks to Cytotec, which is why it is often the induction agent of choice.
Both there are a few other ways:
- Cervidil is like a tiny t-bag (or a tiny flat tampon) that is inserted in your vagina for 12 hours. This medication is harder to place (REALLY hard for newer nurses), it has to be refrigerated and is much more costly.
- Prostin Gel is squirted in the cervical area. The few times I have given it, the plunger was similar to the ones that we use for Monistat if you’ve ever had a yeast infection and had a vaginal treatment. I just don’t see this being used very much anymore. I’m not sure why.
- Pitocin is given IV but has been shown to be more effective if given after cervical ripening until the patient is about 3 cm (if you’re already 3 cm you’d be induced with Pitocin and skip the other medications). Some people will do a “low-dose” pit to mimic pitocin — especially in cases like a previous cesarean where the other methods are contraindicated.
- Wait — if you don’t need to be induced, you can always wait if none of these sound great to you. A good alternative, even if it’s just a day or two.
Ok, now that we’ve gone over the alternatives, let’s talk about why the reason they give cytotec and what the risks are — because there are definitely risks!
Benefits of Cytotec:
This study showed that it was more effective than just Pitocin and does increase your chance of having a vaginal delivery. I’ve seen other studies that show it does decrease the overall time of an induction.
Also, we can’t forget that Cytotec if given with postpartum hemorrhage is very effective. I’m a big fan.
Also, because Cytotec isn’t as high of a risk as Pitocin we often allow you off the monitors for an hour or two with every placement. This allows you to incorporate movement more into your induction, which I am a huge fan of. Which is why I include labor movement cards in here.
Pro Tip: Some providers use a dose of Cytotec along with placing a Foley bulb for an induction so you get the benefits of a pill plus the mechanical methods of the Foley bulb pushing on the cervix. We also talk more about that in here.
Risks of Cytotec
The biggest risk with a Cytotec labor induction is that once you give it, you can’t really “stop it” (like Pitocin where you can stop the IV infusion immediately and it’s out of your system within minutes). This means that your uterine contractions may get too firm or too frequent.
This is called uterine hyperstimulation when the uterus contracts too much and can lead to uterine rupture. However, there are medications we can give that will counteract the Cytotec (the main one is called Terbutaline). This is why most facilities will monitor you for the first 1-2 hours after administration before they let you up off the monitors to walk for a bit.
That’s the biggest parts you should know about Cytotec, but here are a few FAQ’s
How long does it take to induce labor with Cytotec?
It really depends on:
- How far into your pregnancy you are (earlier inductions — like ones at 37 weeks, normally take longer)
- Where baby is your birth canal prior to delivery (often told by how dilated you are)
- How well your body absorbs the medication (because that varies on all types of drugs)
- How ready your body is to start into labor
It really depends. Some people soften their cervix very quickly with it and some take a long time.
What to expect when being induced with Cytotec?
I would encourage you to plan on it taking a while and bringing some things to amuse you. I actually have a whole post just on Cytotec Inductions of Labor you might find helpful — but my three tips are:
- Ask your provider how long they guess it will take (they have a guess, even if it’s wrong)
- Bring things to amuse both you and your partner as much of the hospital is “hurry-up and wait”
- Use movement as much as possible. When you’re not on the monitor walk the halls, lunge and squat in your room.
How successful is Cytotec induction?
I am a huge fan of it, as a labor nurse. I really think it does help those inductions that we start before the patient is dilated to 3 cm. Studies have truly shown it to be VERY effective. I am bothered by the fact the FDA hasn’t approved it and given fodder to people scaring moms online. If you need it, Cytotec is a safe and effective means to get your induction going. However, if you have any questions about your induction of labour, please do talk with your provider!
And, be sure to get prepared for the rest of your pregnancy, birth and postpartum life in The Online Prenatal Class for Couples. It truly is the simple (and fun) way to get both of you prepared for birth.
Or, if you want to know JUST about inductions grab my Inductions Made Easy guide. In under 30 minutes you’ll know lots about inductions and be ready for that part of your birth.
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A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice. She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.
As an evidence-based prenatal educator Hilary has delivered thousands of babies and has educated hundreds of thousands of parents from a diverse patient population to help them have a confident birth.