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.