# Cervidil- Was this typical?



## onetwoten (Aug 13, 2007)

Just got back from a birth and I have a few questions. Mom was being induced because of a combination of IUGR and PIH. She's been sitting around 140/90 for the past 6 weeks, with not really any help from the meds.

She got the call to go in at 9am, and after some discussion, at 1:00pm, she had cervidil inserted, told it would stay in for 6 hours. We were immediately told we should go down to the cafeteria to grab some good food before labor starts. Good= mom got a great nourishing meal, and took her mind off the waiting game. Confusing= everything I've read says that moms should be monitored while on Cervidil.

We lunched, came back, and got monitored for an hour before they sent us over to Antepartum at 3pm. From 3-5:30 there were barely noticable contractions. From 5:30-7:15 there were noticable contractions, and mom prefered to concentrate and breathe through them, but was also able to talk and carry on conversation when needed/wanted. (ie- she was sending text messages and talking to her father on the phone).

At 7:15 (after 6 hours on the cervidil and no checks or monitoring), she had one major contraction that felt totally different. From that point on, they were 1-2 minutes apart, getting close, and 4-5 minutes LONG, and quite intense. We were now really working through them, trying to focus on breathing, often having to 'restart' and meet the contraction again, and she was needing hands to squeeze. At 8pm, the nurse and Dr came in to check, realized I wasn't lying when I said 4 minute contractions, and immediately took out the cervidil. She was 5cm and 50% effaced. We were moving to L&D.

Got to L&D at 8:30, and was offered epidural. She said yes. Just as the anethesiologist got to the room, we made our way to the bathroom, had a bit of blood, and then mom said she needed to get back to the bed. As we leaned over the bed she went into full blown transition behaviors, telling us she needed help, needed to be saved, etc. Nurse said she wanted to check her- and boom- she was 10cm, fully effaced, and baby was at +1 station and ready to come. Skip the epidural.

Mom was absoluely fantastic, gave a deep sigh of relief when she was given the a-ok to push at about 9:40, and only pushed about 8 times (about 10 minutes), on her last push she went from not quite crowning to bay on the table. THe doctor had just entered the room and was still putting her booties on. The nurse looked down in shock and passed baby to mom, who looked at me and said "Oh my God! The baby's here!"

I was thinking the same thing! We'd been gearing up to start the pitocin at about 8pm, and then maybe start actually laboring sometime late that night and have a baby by supper the next day. We never dreamed she'd respond like that to the cervidil.

I'm trying to figure out if that's a typical reaction? Most places I'm reading information on it talk about how it's meant to soften and start dilating the cervix, and that it may cause contractions. Hers acted as a full on pitocin.

Also- not that I'm complaining, as it allowed her more freedom- but is it very odd that she wasn't on any monitoring from 3pm onwards (until they started prepping her for the epidural that didn't happen)? Also she was allowed free reign on food and drinks- good, but is this typical?

Any thoughts would be great. I'm still in a little shock. We essentially believe she probably went from 0-10 and birth in less than three hours. Mom and baby are both doing fnatastic, although she's not anxious to try that anytime soon!


----------



## kltroy (Sep 30, 2006)

Wow - that's great that the cervidil worked so well for Mom! From what I understand (not having had any firsthand experience) they usually monitor you, AND I think they usually want you laying down while they have the cervidil in (?) I've heard of it working to start labor like that in cases where Mom was close to going anyway....


----------



## Mama2Xander (Jul 3, 2004)

Wow - that is not what I have seen with Cervidil (I used to be a L&D RN and it was used there from time to time, not super often). She must have been very ready to go into labour anyway! Usually it does act more as a cervical ripener and then pitocin would be used after it - as you were expecting. The protocol in the hospital I worked in was continuous monitoring for 24 hours while the Cervidil was in place. I can't remember the policy on food & drink in that case, sorry.


----------



## Aubergine68 (Jan 25, 2008)

I had a Cervidil to start labor with both my younger children.I'm in Canada. ETA, I was 2 weeks overdue with both pregnancies, so pretty ready to deliver.

I was given the cervidil in the am and sent home, told to rest/eat , go for a walk, and to come back when contractions started or the next am, whichever came first. Lots of monitoring when I got back to hospital after labor had started, none to speak of before that.

Hard labor startred after 7 hours with my first son and he was born 14 hours after, with no further induction.

Hard labor started after 4.5 hours with my second son and he was born quicker than expected, similar to the situation you described. I was told not to push until dr got there, but ds was born after just a couple of pushes! Once the second stage of labor started, it went REALLY fast!

My first pregnancy was a planned home birth, water broke, and three days later I'd had enough and went in to be induced with pit. So I can compare cervidil to pitocin. Pit was much harsher and quicker.


----------



## onetwoten (Aug 13, 2007)

Thanks for the responses guys. She was only 37 weeks, but I think her body must have been just on the cusp of getting ready to go anyways, with how it responded.

I feel bad for her, because now she equates that with normal labor, and keeps saying she doesn't ever want to do it again. I want to let her know that 5 minute contractions with one minute breaks are not really normal, but she's too shellshocked still to get past it.


----------



## dutchgal (Nov 25, 2006)

I had much the same experience as Aubergine68 had. Water had broken, no action for 48+ hours, cervadil put in, monitored for an hour, was told to go home, and return in 24 hours for another cervadil if labor had not started. Cervadil had been insrerted at 6:00 PM, started to feel light ctx at about 3 AM, full on labor at 8AM, Hannah was born at 2 PM.

My contractions were about 30-45 seconds in length and extremely intense, even the doula said they seemed intense from the way I dealt with them, and came with one minute breaks. Apparently they were enough to do the trick.


----------



## onetwoten (Aug 13, 2007)

dutchgal- I just had to comment- I know you from WB







Good to see you here. I remember you telling me about mothering waybackwhen.


----------



## balancedmama (Feb 16, 2007)

I have seen that happen before with a cervadil induction. I don't think it's the norm but it certainly can happen. The mom had a 'normal' labor pattern with her second, non-induced baby. Said it was much easier, albeit slightly longer.


----------



## onetwoten (Aug 13, 2007)

Thanks balancedmama- that's a lot of what I want to be able to convey to her. I know *some* women do have those rapid whirlwind labors like that, but I'm assuming hers was probably due to the chemicals- and I don't want her thinking that that's how all her labors will automatically be!

Poor mama is going through UA violation right now, as she's been sent home, but they decided after two days that the baby looks too preemie to send home, and also he had a fever, so they're treating him now as if he has a GBS infection. THe nurses won't allow her to breastfeed him, but she did buy a pump yesterday and has started pumping. I'm so proud of her! (And wanting to wring their necks)


----------



## Aubergine68 (Jan 25, 2008)

Quote:


Originally Posted by *jeninejessica* 
T

Poor mama is going through UA violation right now, as she's been sent home, but they decided after two days that the baby looks too preemie to send home, and also he had a fever, so they're treating him now as if he has a GBS infection. THe nurses won't allow her to breastfeed him, but she did buy a pump yesterday and has started pumping. I'm so proud of her! (And wanting to wring their necks)


Good for that mama! How worried she must be! Group B strep in a newborn is no joke








Will they AT LEAST let her feed ebm to her baby, do you think??


----------



## mwherbs (Oct 24, 2004)

looking over your notes she was monitored for about an hour after you came back from eating-- which will sufice for "monitoring" it usually takes a little bit of time to start to work that is why they sent her out to eat so she wouldn't be hungry starting labor -- constant monitoring is not necessary- cervadil doesn't usually work so fast but I have seen that it can trigger labor and moms don't always need pit...

it sounds like her body was about ready to give birth -- frequently preterm inductions take cervical ripening and a very high dose of pit to get a baby out-

-- some times natural labors go just as fast as what you have described so although it is not average it can be normal-- no crystal ball as to what any future births may be like--


----------



## sweetsadie77 (Jun 13, 2006)

Although it's not typical, I've seen this kind of reaction to cervidil a couple of times (no labour ,to labour, to pushing, to baby in no time flat)....I think high blood pressure can also be associated with precipitous labours so that may have had something to do with it??


----------



## CEG (Apr 28, 2006)

I am an L & D nurse and this does happen from time to time. Our protocol is to put the cervidil in after we have at least 30 minutes of reactive monitoring. We then monitor the patient for 1.5 hours. If in the 1.5 hours there is no issue then we take the patient off the monitor. We usually monitor for 30 minutes every 4 hours and take the cervidil out after 12 hours, either to put in a second dose or wait one hour and start pit. Occasionally the cervidil does start active labor, I think more often in multips or people close to their due date or postdates. If my patient is having regular contractions after I put in the cervidil I usually leave them on the monitor (we do continuous monitoring on 99.99% of our patients and rarely does anyone ask to be taken off). We also start a saline lock before starting pit in case they do go into active labor. Our patients eat whatever they want until we start pitocin although I do usually tell them I recommend they avoid really greasy or heavy food or they may regret it later on. We never send the patient home with cervidil although occasionally we have sent a patient home after 1-2 doses of cervidil has not made any kind of change to their cervix- only after it is removed and they are monitored for 1 hours.


----------



## DoomaYula (Aug 22, 2006)

I had a cervidil induction with my twins -- I was a primip. I was only 34w, being induced for IUGR relating to TTTS.

I was not expected to go into active labor. I had the cervidil put in, and the "plan" was that after 12h they were going to remove it and start pit.

But apparently my body had a different plan! Babies were born 8h after the cervidil started. I remember some doc or nurse frantically shouting, "Take out the cervidil!"


----------



## onetwoten (Aug 13, 2007)

Quote:


Originally Posted by *DoomaYula* 
I had a cervidil induction with my twins -- I was a primip. I was only 34w, being induced for IUGR relating to TTTS.

I was not expected to go into active labor. I had the cervidil put in, and the "plan" was that after 12h they were going to remove it and start pit.

But apparently my body had a different plan! Babies were born 8h after the cervidil started. I remember some doc or nurse frantically shouting, "Take out the cervidil!"

This is exactly what happened! Shortly after her "change" cxn, she looked me straight in the eye, totally calmly, and said 'get a nurse, this isn't normal'. We went and got the nurse, who thought we were exagerating, but once they watched her for a few minutes, they were panicing too. The nurse actually 'shouted' at the doctor, to get it out 'now'.

So basically what I'm seeing (from anecdotal experience) is that this isn't how it's "intended" to work- but it seems to go that way almost 50% of the time, obviously being affected by how 'ready' the mom already is. It seems like most women who have this 'reaction' tend to have it 6-8 hours after the cervidil is inserted.

Definately interesting. I just want to know 'the usual' you know? If a client asks, I want to be able to tell her more about what experiences tend to be, not just what it says on the label.


----------



## onetwoten (Aug 13, 2007)

Quote:


Originally Posted by *CEG* 
I am an L & D nurse and this does happen from time to time. Our protocol is to put the cervidil in after we have at least 30 minutes of reactive monitoring. We then monitor the patient for 1.5 hours. If in the 1.5 hours there is no issue then we take the patient off the monitor. We usually monitor for 30 minutes every 4 hours and take the cervidil out after 12 hours, either to put in a second dose or wait one hour and start pit. Occasionally the cervidil does start active labor, I think more often in multips or people close to their due date or postdates. If my patient is having regular contractions after I put in the cervidil I usually leave them on the monitor (we do continuous monitoring on 99.99% of our patients and rarely does anyone ask to be taken off). We also start a saline lock before starting pit in case they do go into active labor. Our patients eat whatever they want until we start pitocin although I do usually tell them I recommend they avoid really greasy or heavy food or they may regret it later on. We never send the patient home with cervidil although occasionally we have sent a patient home after 1-2 doses of cervidil has not made any kind of change to their cervix- only after it is removed and they are monitored for 1 hours.

Thanks. It seems like they did sort of a variation of this. I don't think they expected it to 'work' as quickly on her, and thus weren't monitoring as closely. Even when I went to ask the nurse about it being 6 hours, and not 12 (doctor said 6, but nurse in antepartum told us 12), she kind of shrugged me off. It was only after she came into the room and saw for herself that she believed me.

It's funny because we went and had lunch and she ate chicken fingers and dip and some fries. No problem. What came up was the hospital food she'd gotten for dinner. lol


----------



## DoomaYula (Aug 22, 2006)

Yeah, what came up for me was the Wendy's chicken I'd eaten just before they inserted the cervidil









Labor wasn't an instantaneous thing... however I wasn't anticipating actually starting labor, ya know? It was about 4 hours after they inserted it, that I said to the nurse, "Um, am I supposed to be having these bad cramps...?" Babies were born about 4h later.


----------

