The risks of using Cytotec (misoprostol) for labor induction

Serena Williams recently revealed that her labor was induced, she developed “fetal distress,” needed a cesarean delivery and subsequently developed a major complication called “pulmonary embolism”. She did not reveal how her labor was being induced, but chances are that it was Cytotec (misoprostol).

Cytotec is a medication created to reduce the incidence of gastric ulcers. It was not made to induce labor, yet many doctors give it to their patients in addition to the standard induction drug, Pitocin. In the black box warning for the drug (the strictest warning put in the labeling of prescription drugs or drug products by the Food and Drug Administration), it advises against pregnant women taking the drug at all. In fact, it states:

“SPECIAL NOTE FOR WOMEN: Cytotec may cause abortion (sometimes incomplete), premature labor, or birth defects if given to pregnant women.” The black box warning also states that “vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor” and that it causes a higher risk for a cesarean section.

Serena Williams’ medical history of blood clots, embolisms, and hematomas, was well established before her labor and delivery as was evidenced in her HBO TV series, Being Serena. Her now husband, Alexis Ohanian explained in one episode: “The C-section was low on our wish list because of her history of blood clots. Any surgery that Serena has is potentially life-threatening.”

Not only was Serena induced which has a high rate of C-section, but she had to repeatedly ask for further testing to rule out blood clots. When she couldn’t breathe after getting out of bed the day after delivering her baby, she was given an oxygen mask which caused her to cough so hard, she opened up her cesarean section stitches and had to be taken back to the operating room to repair it. She was given a test (doesn’t specify which one) to see if she had blood clots and was told she didn’t have any.

That’s when she insisted on a CAT scan with contrast dye. It was then that the pulmonary embolism was discovered as well as other blood clots in her legs. She ended up needing three surgeries in all, including one to place a filter to temporarily prevent blood clots from reaching her heart.

Out of 3,859 people reported to have side effects when taking Cytotec, 26 people had a pulmonary embolism. Pregnancy in and of itself is risky as your blood volume increases and any existing medical conditions are affected. Being induced raises the risk of having a cesarean section so if you have a history of blood clots, you should avoid being induced. Any surgery has a risk of complications but that risk is exponentially higher if you have a history of blood clots or embolism.



Cesarean versus vaginal delivery – Which is best?

Until about 50 years ago the cesarean delivery rate was about 5%, but since the 1960s, it has steadily increased to about 1 in 3 now, though for the last 10 years that rate has remained steady.  About 1/3 of cesarean sections are done in women who previously had a cesarean, while 2/3 are done mainly for fetal distress, inability to deliver vaginally (“failure to progress”), and breech. There are often good reasons and indications to do a cesarean. In fact, studies have shown that in countries where cesarean delivery rates are too low (usually below 10%), there is an increase in maternal and neonatal mortality.

Risks for mom from cesarean

Going through labor and having a vaginal delivery can be a long process that can be physically taxing for the mother. A cesarean is a major surgery, and though the vast majority of cesareans can be done safely, there are certain risks to the mother such as blood loss, infection, anesthesia risks, and a longer recovery period. Some women and doctors assume that because the first baby was born via C-section that all of their children will have to be born this way to prevent the uterine scar from opening during labor. In addition, the next pregnancies have increased risks including “placenta accreta,” a serious condition where the placenta attaches or grows into the uterus, and threatens the mother’s life.

Risks for a baby born by cesarean

During labor and a vaginal birth, baby’s lungs get readied so there is a better chance to breathe oxygen after birth. Babies born via C-section often have respiratory issues with extra fluid in their lungs at birth because they don’t have the chance to undergo this process. During vaginal births, babies are also exposed to certain good bacteria (“microbiome”) which may boost the baby’s immune system.

A healthy baby and mother are the goal

In the end, the decision surrounding a vaginal birth or a C-section should focus on keeping mom and baby healthy. Sometimes there is a medical reason that a delivery doesn’t end up as a vaginal birth to keep either the mother or the baby safe. But to decide on a C-section for a non-medical reason may not be in the best interest of mom or her baby.

Delivering with a midwife in the hospital: the best of both worlds

When I think back to when my first child was born, one very vivid scene unfolds in my mind. It begins with me pleading for someone to go out and get the doctor who had vanished about an hour prior because this baby was coming now! My husband frantically ran into the hall and called the nurse who in turn called the doctor who yelled down the hall that no, it was not time yet. I was at the point of screaming and through tears said to my husband who had come back in the room, “Oh my god, this baby is coming now.”

Yes, I was young. Yes, it was my first baby. Yes, I had no experience with labor or childbirth and the doctor on call definitely had. So when he said the baby was not coming, I took his word for it…until I felt my daughter’s head crowning and pleaded with someone to believe what I was saying. A sympathetic nurse finally came in, took one look and sprinted for the door to find the doctor, who now ran in and scowled, “Don’t push. At least let me get my gloves on.”

My first daughter was born seconds later and luckily for him, I was so inundated with joy and happiness that I didn’t let him have it (although if I could go back to that day now, well, some things are better left unsaid!).

Naturally, with my next pregnancy, I wanted to avoid anything remotely close to this experience but did want to give up access to medically safe birth. I wanted to deliver in a hospital again, but this time with a more caring and calm professional. I did a thorough search and ended up choosing a team of certified nurse midwives whose practice was overseen by an OB/GYN.

From the first prenatal visit, I felt acknowledged and heard. I was given ample time for my questions at each 20-30 minute visit, and I had access to the team at all hours. I also always felt supported. Their stance was that as long as my wishes were medically safe, they would back me up. So if I wanted to stand up during labor or walk around, or sit or alternate, I could do it, as long as there were no complications necessitating otherwise.

While my midwife was supportive of my decisions and I delivered naturally with no intervention or meds, if I had needed them, they were readily available to me.”

My midwife was so incredibly calm. She had seen it all before and offered motherly support and also made me feel like everything I was doing was fabulous. This was invaluable … there is nothing more than a mother-to-be needs during a harrowing labor than encouragement.

My labor and delivery with my second daughter, and then my son after that, were glorious, in a beautiful wing of a hospital in a private birthing room. I didn’t need any medication whatsoever, no episiotomy, and delivered easily. I would not trade those experiences for anything.

However, while my midwife was supportive of my decisions and I delivered naturally with no intervention or meds, if I had needed them, they were readily available to me. If I wanted an epidural, it was there. I was asked but declined, and was repeatedly told I could change my mind. There was no judgment. If I had planned on a purely natural childbirth but wanted every drug available once the hard labor kicked in, my midwife would have happily given it to me.

Most importantly, if my labor had stalled, or if there was a cord prolapse, or the baby’s heartbeat declined, I would have been given a cesarean section in a matter of minutes because I delivered in a fully equipped hospital, had registered for a birthing room months before, and already had a team of professionals tending to me since early labor.

I wanted the best of both worlds. I wanted the expertise and surgical ability of a doctor along with the experience and support of a certified nurse midwife. I also wanted to deliver in a hospital with an operating room and an entire team of specialists just in case the baby or I needed it.

In today’s world, there is no reason to be extreme; we have great medical advances available to us, we should utilize them all.