Cytotec: Dangerous experiment or panacea?

By Ina May Gaskin

By Salon Staff
July 13, 2000 11:37PM (UTC)
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I was extremely disappointed to see the article on Cytotec written by Ina May Gaskin. Gaskin is a well-known critic of all modern obstetrical practices and has provided erroneous information, incomplete information and withheld vital information in order to create fear among pregnant women.

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To wit:

1) Gaskin uses the case of Holly as her example of the dangers of Cytotec. However, she neglects to mention that women who have already had five deliveries are known to be at 20 times greater risk of spontaneous rupture of the uterus than the average woman. In fact, many obstetricians believe that any type of labor induction, including Pitocin infusion (which is far from new or experimental) should only be used with caution in such women. One could argue that Holly's nurse-midwife was guilty of malpractice for even considering labor induction of any kind in this situation.

2) Gaskin claims: "Cytotec, however, doesn't have the benefit of such scientific debate, because it is still essentially an experimental birth drug that is being tested ad hoc by trial and error." This is simply untrue. A quick Medline search on Cytotec and labor induction reveals more than 75 studies published within the past two years alone. These include crossover double-blind studies comparing Cytotec to a placebo or to other methods of labor induction.

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3) Gaskin disparages Cytotec as an ulcer drug, but she neglects to mention that it is a member of a well-known class of natural substances and medications called prostaglandins. Other prostaglandins have been used for years for labor induction with good results. There is reason to believe that misoprostol, the prostaglandin in Cytotec, is more efficacious than other prostaglandins currently in use. It is being tested to find out if this advantage comes at the price of safety.

4) Gaskin claims: "In most cases an obstetrician must be present at the time the baby is born to be paid in full for a birth." This is simply untrue. In most states obstetricians are paid a single fee for all pregnancy-related care including the delivery. There is no financial advantage to inducing labor, and it is disingenuous (or worse) to suggest otherwise.

The article is filled with additional distortions and untruths.

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As an obstetrician, I am reserving judgment on the relative merits of Cytotec vs. other, older methods of labor induction. Yet Gaskin's comments add nothing to the debate and serve only to frighten pregnant women.

-- Amy B. Tuteur, M.D.

Ina May Gaskin may be a hell of a midwife, and a pretty good rabble-rouser, too, but she sure isn't much of a scientist!

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Gaskin says of Cytotec, "nobody knows its half-life." Patently untrue. I didn't know it before I read her article, but a 10-minute literature search over the Internet generated the information (0.70 hours, if you're wondering).

Gaskin goes on to discuss Cytotec and amniotic fluid embolism, the leading cause of maternal death according to her, and says she's read about two cases and heard of one case of a mother having this complication following Cytotec administration. So, that's three cases out of how many? If it's the No. 1 cause of maternal death and Cytotec is associated with only three cases, it seems to me the percentage of cases involving the use of Cytotec is the opposite of "alarmingly high."

Then she goes on to try to support her argument by saying there are people discussing bad outcomes with Cytotec in Internet chat rooms. This is patently absurd! If we want to defend our ideas using the presence of people in relevant chat rooms, we could easily assert that nearly all the U.S. population has psoriasis or owns a dachshund or is a Britney Spears fan! Gaskin cautions against ignoring anecdotal evidence. Well, I caution you against giving it too much credence.

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Finally, Gaskin implies that off-label use of drugs is just wrong. Personally, I want my doctor deciding drug regimens for me, not the FDA. To imply that it would be best to outlaw this aspect of medical judgement is dangerous indeed.

I am not a medical doctor, just a person who loves science and hates to see it ignored in the pursuit of sensationalism.

-- Sarah Anderson Wagner

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I wish to congratulate you for the excellent article on the obvious danger of Cytotec and induced labor. I often think of the young women entering our hospitals today as innocent lambs going to the slaughterhouse. As they emerge bruised, battered and cut with their darling baby they thank the doctor and go home to lick their wounds. It is time for all of us to awaken to the concept that we have created "toxic birth" in our hospitals. Healthy mom, healthy baby go in; sick mom, sick baby come out the hospital door. Women are awakening and rapidly. And they are becoming very angry once they are informed that often it was the induced labor that led to a cascade of life-threatening interventions. For the first time in Canada the AMA is now strongly recommending that all physicians must give informed consent before the induction procedure is initiated. It is now time for physicians to realize that they will stand alone when the induction lawsuits begin. Thanks for bringing this important issue to light.

-- Gail J. Dahl
Childbirth researcher, educator and author, "Pregnancy & Childbirth Tips"
Executive director, Canadian Childbirth Association


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