Making Cytotec (misoprostol) fit their agenda

In this article, Marsden Wagner, a perinatologist, neonatalogist and perinatal epidemiologist from California who is an outspoken supporter of midwifery, showed us that ACOG (American College of Obstetricians and Gynecologists) is the only organization out of a list of 10 that, despite its risks to pregnant women and their unborn babies, recommends using Cytotec (misoprostol) for labor inductions.

Here is an excerpt from the FDA’s 2002 statement (PDF):

A major adverse effect of the obstetrical use of Cytotec is hyperstimulation of the uterus which may progress to uterine tetany [uterus contracts and doesn't let go] with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy [removal of the ovaries and Fallopian tubes]), or amniotic fluid embolism [maternal and infant mortality is very high from this]. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia [profound slowing of the fetal heart], and fetal and maternal death have been reported.

There may be an increased risk of uterine tachysystole [contractions coming too fast], uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec; including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity [usually defined as more than four births] also appears to be a risk factor for uterine rupture.

Dr. Wagner had this to say about the reasoning behind ACOG's outnumbered stand on the continued use of Cytotec for labor inductions;

"How can ACOG possibly be willing to stand alone in opposition to the best scientific opinion in the world? Because so many of ACOG's members already use Cytotec induction off-label for its incredible convenience, the organization needs to support its members by recommending this practice."

Henci Goer , award-winning medical writer, internationally known speaker and the author of The Thinking Woman's Guide to a Better Birth., hit the nail on the head when she described it as "a rationale that amounts to “but all the kids are doing it.”"

So then the next question becomes, "why are all the kids doing it?" Why is it that so many obstetricians are using Cytotec for something the drug was not created for and that has the potential to cause SO many serious problems for their pregnant patients, concerning who they swore to first and foremost "do no harm"? I will once again turn to Henci Goer,

"Why, then, are obstetricians so enamored of misoprostol? The answer is summed up by this obstetrician enthusiast:

The best part about it is that you can block-schedule your nurses so that you have enough on hand. . . [I]f we start our inductions at 7 a.m., we know that we’re going to have X number of patients in labor being admitted by 4 p.m. That’s helped our hospital tremendously, . . . [Cytotec is] a great agent. It works very, very efficiently. . . . And it’s ungodly inexpensive: 27 cents per tablet.

In other words, Cytotec’s real benefits are convenience for obstetricians and helping the hospital’s bottom line. For women and babies, though, it’s a roll of the dice. Most times things go fine, but sometimes the dice come up snake eyes."

So, I guess the real question comes down to this. Are you willing to let a doctor, who very well could be more concerned with his bottom line than the ultimate health and safety of you and your unborn baby, roll the Cytotec dice for you? Are you feeling lucky?