Friday, December 17, 2010

Cytotec Is Dangerous, No Matter What Your Doctor Told You...

There has been renewed conversation about Cytotec in my local doula community recently because a doula was concerned that this was what a doctor had prescribed for her client. A few doulas commented that their clients had experienced medically-induced labor with Cytotec and had good outcomes. But we must remember that a few happy endings are not evidence that the practice is safe.

This article by Marsden Wagner in a 2001 issue of Midwifery Today covers the major points...

Induction with Cytotec should never be attempted anywhere, most especially in out-of-hospital settings. Incredibly, the American College of Obstetricians and Gynecologists (ACOG) recently approved Cytotec induction: 1) in spite of lack of FDA approval; 2) in spite of a letter to doctors earlier this year from Searle (which manufactures Cytotec) imploring doctors not to use it for induction; 3) in spite of lack of approval from the Cochrane Library (the best scientific opinion); and 4) in spite of the fact that it is not approved nor used for induction in any country in Western Europe.

Recent articles in prestigious medical journals such as The Lancet have questioned the validity of standards of practice from professional organizations like ACOG, because their goal of protecting the health of women through using scientific evidence to guide members toward best practices too often conflicts with their other role as a trade union representing the interest of their members. As a result of this "trade union" role, ACOG recommendations are too often compromised by the needs of the obstetricians. A classic example of putting the doctors' needs ahead of the families' needs is the ACOG recommendation not to permit videotaping by families of a hospital birth.

So ACOG quotes studies of Cytotec induction, none of which have a sufficient number of research subjects, and consequently, none of the studies quoted have sufficient statistical power to detect small but potentially important risks such as uterine hyperstimulation and uterine rupture. Furthermore, because published studies of Cytotec induction have such wide methodological variability, meta-analysis is impossible and the published attempts at such meta-analysis are seriously flawed. But Cytotec is a godsend for busy obstetricians, as its use allows them to schedule the woman's labor at a convenient time and speeds up the labor, resulting in a return to "daylight obstetrics"-pharmacological induction of labor has increased from 10 percent to 20 percent in the past decade in the United States. So with their members' needs in mind, ACOG plows ahead, ignoring the best scientific evidence as well as the recommendations of the best scientific bodies, of government agencies not only in the United States but in every country in Western Europe, and of the pharmaceutical company. Instead, ACOG uses weak, inadequate evidence to approve Cytotec induction. Midwives should stay as far away as possible from such vigilante obstetrics-obstetricians taking matters into their own hands while ignoring the recommendations of the real judges.

article from Midwifery Today, Issue 57, Spring 2001, page 44

by Marsden Wagner MD, MSPH

Cover photo of Jessie and Hans © 2000 by Caroline E. Brown, DEd, MS, RNC.


Emily said...

Hi Emily! I am also a doula named Emily, and I found your blog in a google search... thought I'd say hi! :)

Doula Emily said...

A follow-up quote from Dr. Marsden Wagner, published in the International Journal of Gynecology and Obstetrics, 75, supplement s25-37, 2001.

"Obstetricians, like all clinicians, work hard to help one patient at a time. In balancing efficacy and
risks, doctors desire to help puts the focus on efficacy rather than risks. For example, in US
publications there are 41 randomized controlled trials (RCT) on misoprostol (cytotec) for labour
induction proving efficacy but not a single RCT is large enough to adequately measure risks. (8) So
the Cochrane Library recommends not using midoprostol for this purpose. (9) But it works and is easy and cheap so it is used widely in the US, even though not approved by the FDA for this purpose. Now research is emerging showing serious risks for using misoprostol for cervical ripening or labour
induction in women with a uterine scar. (10,11) But it is too late for the many US women with previous
caesarean section whose uterus ruptured after induction with misoprostol and their many dead
babies. So misoprostol for labour induction on women with previous caesarean section in the 1990s
joins prenatal X-ray pelvimetry in the 1930s, di-ethyl-stillbesterol (DES) for pregnant women in the
1950s and thalidomide for pregnant women in the 1970s as examples of obstetric interventions which
have had tragic consequences because they went into widespread use before adequate scientific