Free Born in the USA by Marsden Wagner Page A

hospital in New England all testified in a lawsuit involving a Cytotec induction that resulted in the death of the mother. Every one of them demonstrated their anti-precautionary approach to obstetric practice by saying that unless there is data proving significant risks, it is okay to use a drug before it has been approved by the FDA for this use.
    Table 6 shows reliable estimates of the risk of uterine rupture during labor. When ACOG published recommendations for labor induction saying that Cytotec should not be used on women having VBACs, the organization took an ambiguous and somewhat confusing position on whether to use the drug for vaginal birth without previous C-section, saying only that it works: “Prostaglandin E analogues [a category that includes Cytotec]are effective in promoting cervical ripening and inducing labor.” Of course the contentious issue is not whether Cytotec works, but whether it is safe, and ACOG neither addresses safety in the bulletin nor actually recommends that Cytotec be used for induction. Contrast this to what the organization says about Pitocin (oxytocin) in the same bulletin: “Women in whom induction of labor is indicated may be appropriately managed with either a low or high dose oxytocin regimen.” 17
    TABLE 6. ESTIMATES OF RISKS OF UTERINE RUPTURE DURING LABOR
Normal (unscarred) uterus
1 in 33,000 births
VBAC–no induction
1 in 200 births
VBAC–oxytocin (Pitocin) augmentation
1 in 100 births
VBAC–oxytocin induction
1 in 43 births
VBAC–Cytotec induction
1 in 20 births
Normal (unscarred) uterus with Cytotec induction
UNKNOWN *
Neurological injury or death of baby after uterine rupture
30 percent
Death of woman after uterine rupture
1–2 percent
    * Best scientific opinion–all evidence currently available shows significantly increased risk of rupture of unscarred uterus with Cytotec induction but the exact level of risk is unknown due to inadequate sample size of studies.
    SOURCES: Estimates are all conservative and based on data from the CDC, ACOG, and two papers: M. Plaut, M. Schwartz, and S. Lubarsky, “Uterine Rupture Associated with the Use of Misoprostol in the Gravid Patient with a Previous Cesarean Section,”
American Journal of Obstetrics and Gynecology
180, no. 6 (1999): 1535–40; and H. Blanchette, S. Nayak, and S. Erasmus, “Comparison of the Safety and Efficacy of Intravaginal Misoprostol with Those of Dinoprostone for Cervical Ripening and Induction of Labor in a Community Hospital,”
American Journal of Obstetrics and Gynecology
180, no. 6 (1999): 1543–50.
    ACOG’s position on Cytotec induction is undoubtedly a case of politics at work. The organization does not wish to explicitly recommend the use of a drug that has known serious risks and is against label, as that could make it liable, but it does want to offer ACOG members who use the drug some wiggle room. The subtlety of the organization’s approach, however, appears to be lost on some obstetricians, as my conversations with them demonstrate that many of them believe that the bulletin constitutes a recommendation by ACOG of the use of Cytotec for induction with no previous C-section.
    There is now good scientific evidence that inducing labor with Cytotec frequently causes the uterus to contract too fast (uterine hyperstimulation), and there is considerable anecdotal evidence that uterine hyperstimulationduring labor can lead to severe, permanent brain damage in the baby. (The only time the baby can get oxygen from the mother during labor is between uterine contractions, so if the uterus contracts too often, the baby cannot get enough oxygen.) So, in addition to the babies that have died from Cytotec induction, we know for certain that babies have suffered brain damage as a result of Cytotec induction, though we do not know how many.
    Here is one real-life story. A young married couple in rural Idaho, Mr. and Ms. M, were having their first baby