July 17, 2013
Volume 15, Issue 15
Midwifery Today E-News
“Cytotec”
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Belgium conferenceAttend the full-day class, Rebozo Techniques and Practice, to learn how this traditional Mexican tool is useful in all parts of the childbearing cycle. Thea van Tuyl, Mirjam de Keijzer and Eneyda Spradlin-Ramos will show you simple techniques that promote healthy pregnancy and birth. You will also have time for hands-on practice.

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In This Week’s Issue


Quote of the Week

If the timing is not right, the labor will not happen, and a forced labor ends in greater and greater interventions that put the baby and mother under greater and greater stress.

Sister MorningStar
Excerpted from Sister’s upcoming article, “The Times and Tools of Induction” (Midwifery Today, Issue 107).


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The Art of Midwifery

Many women are naïve regarding induction. They don’t realize that induction includes a multitude of possibly unnecessary interventions. Medical induction requires hospitalization, fetal monitoring and often internal uterine monitoring, confinement to bed, IVs and a high rate of obstetrical medication, particularly epidurals.

Sharon Glass Jonquil, excerpted from “Forcing the Issue: The Induction of Labor,” Wisdom of the Midwives: Tricks of the Trade, Vol. II, a Midwifery Today book
View table of contents / Order the book


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Jan’s Corner

Cytotec

I hope no one is still using this drug for induction. A couple of years ago a man called our office and talked with one of the women here who also works as a doula. The man said his wife and child just died because of a Cytotec induction. This drug is used off label and is a random killer. You never know which case will prove fatal. We as midwives have a responsibility to have good practice, and Cytotec use for induction does not fall into the realm of “good practice,” whether at home or in the hospital. Ina May Gaskin has a quilt with squares for each mother who has died in childbirth; many are the result of a Cytotec induction. She has a great article in the upcoming issue of Midwifery Today on induction and Cytotec use. Don’t miss it. You can subscribe here.

Hemorrhage control is another common off-label usage of Cytotec. I have been trying to get midwives to use what God provides for hemorrhage control: membranes and the cord if the placenta is still inside or a piece of the placenta if it has been born. There are other excellent hemorrhage control herbs, medications and prevention techniques. For a full discussion of all this, get the recent back issue of Midwifery Today, Issue 105. It is packed with information you can use on this very important subject!

Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

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Featured Article

Adverse Events Following Misoprostol Induction of Labor

“Off-label” use of misoprostol (Cytotec) for labor induction has been steadily increasing for 10 years, even though this use is approved neither by the U.S. Food and Drug Administration, other national drug regulatory agencies, the pharmaceutical industry, the Cochrane Library nor a number of national obstetric organizations, including the British Royal College of Obstetricians and Gynaecologists. Some obstetricians, particularly in the US, continue to promote induction with misoprostol, even though the available evidence suggests possible serious risks including uterine rupture, maternal mortality and perinatal mortality.

In January 2004, The Cochrane Library commented on the paucity of data on the serious risks of induction with misoprostol and asked for help: “The studies reviewed were not large enough to exclude the possibility of rare but serious adverse events, particularly uterine rupture, which has been reported anecdotally following misoprostol use in women with and without previous caesarean section. The authors request information on cases of uterine rupture known to readers.” This paper addresses this appeal.

In the past eight years, I have consulted on 16 medico-legal cases involving adverse events following misoprostol induction of labor in the US. In every case, I have carefully reviewed all prenatal, intrapartum, postpartum and neonatal medical records, including all electronic fetal monitoring strips; all laboratory results, including maternal ultrasound examinations; non-stress tests; cord blood gases; and the infant EEGs, MRIs and neurological examinations. All cases of uterine hyperstimulation and hypoxic fetal heart rate patterns have been confirmed by thorough review of the electronic fetal monitoring strips. All cases of uterine rupture are not just dehiscence but clear, significant ruptures of 6–18 cm, confirmed by the operative report on the emergency caesarean section done in each case of uterine rupture. All cases of amniotic fluid embolism have been confirmed by the pathologists’ autopsy reports. Finally, all cases of hypoxic ischemic encephalopathy of the infants have been confirmed by EEG, MRI and pediatric neurological examination.

Marsden Wagner
Excerpted from “Adverse Events Following Misoprostol Induction of Labor,” Midwifery Today, Issue 71
View table of contents / Order the back issue


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Birth Q&A

Q: What do you think the dangers of Cytotec are?

— Midwifery Today

A: Cytotec is not meant to be used in pregnant or laboring women. It’s clearly labeled thus on the box! It can cause uterine rupture.

— Alexandria Makley-Martinez

A: I feel a large part of the danger comes from dosage or rather the inability to know exactly how much medication a patient is actually receiving. A 1/4 pill could contain 1/4 medication and fillers and binders, or it could be entirely medication. The second danger is that it’s absorbed, so there is no way to stop the effects once they’ve started.

— Stacey De Almo

A: Uterine rupture, high fevers, fetal heart rate descents leading to a cesarean. The doctor used it on me for a stillbirth—it was horrific.

— Jessica Solberg

A: Cytotec is approved to treat ulcers, but not pregnant women. The only reason hospitals are allowed to use it is through a loophole that allows it to be used experimentally! There is also no recommended manufacturer’s dosage, so doctors choose how much to give on their own. It has been shown to cause uterine rupture, fetal death, maternal death, profuse bleeding and emergency hysterectomies.

— Skyla Walton

A: Once in the blood stream, it can’t be turned off—a disaster waiting to happen! No pregnant woman should be given it without a full detailed explanation of its dangers!

— Susan DiNatale


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Conference Chatter

Conference Sweepstakes

Greetings everyone! I have some exciting news for those of you thinking of coming to our conference on 30 October – 3 November in Blankenberge, Belgium. Midwifery Today is holding its very first conference sweepstakes, and the prize is pretty phenomenal! You can enter to win one three-day pass to the Blankenberge, Belgium, conference (a $425 value). Entry is absolutely free, and there are extra entries for those who promote the conference via social networks. Find out more here. Log into Facebook if necessary, then click "Giveaway" to view sweepstakes information.

The sweepstakes will be running for the rest of the month, so be sure to pop onto our Facebook page and enter. We’re so excited to be able to offer this to all of you. Best of luck in winning!

For more information about the upcoming conference, please visit our website.

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— Andrea Goldman, Conference Coordinator


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