Opposing Views on Cytotec (Miso, misoprostol)

Recently, two of the blogs I read have posted opposite conclusions regarding the safety of Cytotec as a cervical ripening and/or induction agent. First, A Midwife’s Tale voices the pro-Cytotec opinion (obviously, within reason — not on women with a uterine scar, and at low doses); secondly, Science & Sensibility voices the anti-Cytotec opinion. I put them both up so you can see what has been said for and against it, and you can leave comments on either site if you have any questions about it.

On a side note, it is interesting that even though they cite the same studies (both mention the Cochrane Database, for example), the conclusions are anything but the same. Which is a lesson in how one’s views colors or biases how you look at the data. This has ramifications far beyond birth or studies, but life — look at politics, as an example of how opposing sides can take the same facts to each bolster their own argument and tear the other down. Interesting how that works, sometimes.

Some people have noted that home-birth and natural-birth advocates will point out the possibility of a uterine rupture with Cytotec, playing up the danger of its use, while downplaying the possibility of uterine rupture with VBACs. Perhaps it is hypocritical — however, repeat C-sections have risks of their own both to the mom, the baby, and any future babies; and often the “risk” of not using Cytotec is merely avoiding a non-medical induction. Sometimes inductions are necessary, but of course, often they’re not. Cytotec is introducing an artificial risk into a natural situation; whereas VBAC is a natural process that only an artificial surgery can circumvent. That is a difference. To me, anyway. Vaginal birth is not an intervention; Cytotec is.

I like what the Science & Sensibility article emphasizes:

ACOG STATEMENT: “No studies indicate that intrapartum exposure . . . has any long-term adverse health consequences to the fetus in the absence of fetal distress [emphasis mine]. . . .” (p. 387).

FACT: Well, that’s the catch, isn’t it? The long-term adverse health consequences to the fetus occur in the presence of fetal distress subsequent to uterine rupture…

So, as long as the Cytotec doesn’t cause fetal distress, it doesn’t seem to hurt the baby in the long-term. But how often does it cause fetal distress? I mean, “as long as your baby doesn’t drown in the bathtub, leaving him alone in the tub doesn’t cause any harm.” But how many times will the baby drown without competent adult supervision? I might also say, “In the absence of fire, an electrical short doesn’t seem to cause long-term adverse consequences”; “As long as it doesn’t hit you, lightning doesn’t seem to hurt you”; “As long as you’re not in a car wreck, seat belts don’t help to keep you safe.”

Both blog posts I linked to include multiple study references and/or links, so you can do your own research and reading. For my part, I still don’t like Cytotec — especially as it’s being used and overused. If interventions only happen with the risk of doing nothing outweighed the risk of doing something, then that would be one thing. But they’re not. You don’t have to read very far — birth blogs or birth story websites or just among your friends, family and coworkers — to find stories of women who got unnecessary interventions. And when they’re used when they’re medically unnecessary, then it only serves to introduce medical risk without the corresponding benefit. If, for example, a woman is electively induced then any induction method introduces risks, whereas the “risk” of doing nothing is… nothing. If a woman does need to be induced — for example, if the baby isn’t moving much and seems to be compromised, or she has pre-eclampsia or something — then there is a risk if they do nothing which is greater than the risk involved in doing something.

Finally, let me emphasize that the midwife at A Midwife’s Tale is not a “medwife” — she recently said she has a 6% or less C-section rate, which I don’t think would be possible if she were inducing unnecessarily or otherwise intervening too much. Also, my second midwife (a CPM) liked Cytotec, and thought it helped save some of her mamas from otherwise-certain C-sections. So, Cytotec is a controversial topic, but not everyone who is pro-Cytotec is anti-home/natural birth, nor a medwife.


9 Responses

  1. What about cervadil? That is what we use in my neck of the woods?

    • In one of the “Midwife’s Tale” comments, she says that her hospital only has a choice between Cytotec & Cervidil, and she’s found that Cervidil can often be “too gentle” — not enough women go into labor, and end up with C-sections, I infer, or multiple doses of Cervidil & loooong inductions.

      The thing that stuck out to me in the two blog posts is that some providers will think that Cytotec is safe (however they define that term, which may mean that women assume it is risk-free), and a case can be made for it using the literature — as Ciarin showed in her post. But there is another side of the evidence, another take on the evidence, which comes to the opposite conclusion, using the same literature. Often, women are only given one side or the other (and I count myself guilty in that… although a lot of times I say that I am merely balancing the pro-medicalization side). These two things were written within just a few weeks of each other with diametrically opposite conclusions.

      The S&S writers say something like, “Why not use Cervidil, since it has a proven track record, is gentler, and seems to have much less occurrence of catastrophic problems, even if the problems Cytotec causes is rare.” So, that is mentioned in a link, even though I didn’t go into it in the post.

      Honestly, my main concern right now is that home-birth midwives may jump on the pro-Cytotec bandwagon. I’m not sure if the benefit is worth the risk on that. And if women assume that their home-birth midwife will only use safe medications, they may be less likely to ask the hard questions, like a pro-natural-birth woman might drill a doctor.

  2. Hmm. Science and Sensibility has refused to post thecomment and questions about the piece that I submitted two days ago. That suggests to me that they don’t know how to address the issues raised by a doctor.

    Readers should be very wary about anything written by Amy Romano or Henci Goer, if they can’t handle even the simplest defense of their own claims.

    • No, I think they’re just ignoring you.

      • You wish.

        You know as well as I do that they don’t respond because they don’t want to look foolish, or worse. Belief in the drivel they produce depends on being unaware of the actual scientific evidence. When the real scientific evidence is presented, they must cover it up or address it. Covering it up is evidently the preferred mode.

        It’s an interesting contrast with what you do. You may believe something very strongly, but you allow people to present another point of view. Indeed, this post is about presenting opposing points of view and letting others decide.

        Goer and Romano are afraid to do what you do. They know that their “science” is suspect and don’t want others to find out.

        • You may believe something very strongly, but you allow people to present another point of view.

          You can thank yourself for that. I got so tired of having my comments on your blog mysteriously disappearing that I developed a distinct distaste for deleting comments. Which reminds me — your complaining about S&S deleting your comments is a bit of the pot calling the kettle black. You have no room to complain about deleting comments — your blog was practically a cyber Bermuda triangle for lost comments! I do think they’re ignoring you and/or giving you a taste of your own medicine.

          FWIW, the S&S blog post does have some ensuing comments that are pro-Cytotec usage, so they’re not just shutting down all opposition. Plus they also link to this post, so if people come here from that, they’ll be able to see your comments here.

  3. I don’t delete comments that disagree; I only delete comments that are abusive or vulgar.

    I can only search the comments of Homebirth Debate for one year in the past, but according to the search feature, you had more than 20 comments in the past year that the blog was active.

    • LOL!!! I never said you deleted them all, just that there were numerous comments (from myself and others) that disappeared into the Bermuda Triangle that was your “debate” blog.

  4. Thanks- I really appreciate this post. I’ve read the literature and I’m not totally convinced that Cytotec is necessarily quite as bad as everyone thinks, but I agree with you that I still don’t trust it. Very balanced point of view.

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