Homebirth Midwives using cytotec , ethics question, Florida

[birthgoddess21]

Hi, I am new here.

I know that several central Florida Licensed Midwives are using cytotec. Sometimes, the client knows what they are getting. Sometimes, they do not- they are told it is a "homeopathic".

I think that this is a terrible practice, ethically. I have seen this done with my own two eyes, transfer clients have told us about it from previous birth experiences, friends experiences, and a studnt at FSTM talked about seeing it done also, in class and birth circle- which again filtered through the Midwifery grape vine, to me. So, there are too many incidences to dismiss.

I have spoken to one Midwife who uses this- she is convinced it is safe. The other, has not answered my phone call.

What, as a patient advocate,should my place in this be?? I do not want to go to the state.

[LoveChild421]

I really hope this isn't happening. Do you work at a hospital?

Are they CPMs? You can report them to The North American Registry of Midwives. http://www.narm.org/

In this case, I wouldn't feel bad involving the state. Women and babies have died and suffered serious injuries because of cytotec. The FDA has never approved it for this sort of off-label use and has issued warnings about practitioners abusing it in this manner.

From the FDA: http://www.fda.gov/cder/drug/infopag...ol/default.htm

This Patient Information Sheet is for pregnant women who may receive misoprostol to soften their cervix or induce contractions to begin labor. Misoprostol is sometimes used to decrease blood loss after delivery of a baby. These uses are not approved by the FDA. No company has sent the FDA scientific proof that misoprostol is safe and effective for these uses.

There can be serious side effects, including a torn uterus (womb), when misoprostol is used for labor and delivery. A torn uterus may result in severe bleeding, having the uterus removed (hysterectomy), and death of the mother or baby. These side effects are more likely in women who have had previous uterine surgery, a previous Cesarean delivery (C-section), or several previous births.

The only reason more women have not lost their lives to cytotec is the fact that they were in the hospital when it was administered and the Drs were ready to do a c-section and in many cases a hysterectomy before the woman bled to death.

Telling someone that you are using a homeopathic while knowingly using a very powerful drug is beyond unethical. Please do something about this, even if it means reporting these women to the state before someone has to die.

[sevenkids]

Hmmm, that's scary.
How are they using it? For PPH? Or to induce? If they're using it for pph, then no, I wouldn't say anything, because sometimes the back up OB will only agree to be back up for someone with a Hx of PPH if they prescribe cytotec to have just in case.
If they're using it to induce, well, you'll just have to follow your conscience on that one. I don't know of any who do use it to induce, and if they do, they're (wisely) not telling me. I can't believe they're talking about it so openly. I don't know if I could keep that info to myself. If I think someone needs to be induced that badly they'll be going to the hospital.
It's not safe and someone will eventually be seriously damaged or die.

[pamamidwife]

the interesting piece here is that they are lying to clients about what it is. surely if the midwife is hiding what she's giving the client then that says something about the mw realizing that it's risky or controversial????

If it's being used for labor, I'd definitely look into filing a complaint to the licensing board (along with any consumer who has had this happen!) and with NARM. It's just not ok to approach a homebirth with this risk.

Then again, if clients WERE informed and they CHOSE it....well, I don't know. Even then, as a midwife, I couldn't bear the poor outcome that might result. If a client needed a medical induction, they surely shouldn't get one at home.

[mclisa]

I can't believe that they would do that.

cytotec has so many issues with it that it needs monitoring which isn't done at home.

How aweful that these midwives have gone above their scope of practice.

[mamabearing]

that's awful

It's horrible to use it out of hospital. In the hospital we use it with careful monitoring and next to an OR!

But what sickens me worse is lying to the patient about what they are doing. A doctor or nurse could lose their licsence for telling the patient they were not administering a med or lying about what they were giving. And we SHOULD lose it if we did such a thing. Any patient, or mother, has every right to know what is given to her. And if for some reason she is transported to a hospital--it could be very dangerous to the mother if no one knew she had cytotec on board. It could completely lead to bad decision making.

I hope those of you who live in Florida will do something about this. No one who is this fuzzy on ethics should be a midwife, nurse or doctor.

[onlyboys]

This is so troubling.

I would certainly contact a member of the board--Jennie Joseph is no longer on the council, but could advise.

If any midwives in FL who are operating so freaking far out of the law and rules are reading, PLEASE STOP. It endangers midwifery in FL. I know the rules are strict, but come on! Women in FL need midwives and midwives certainly don't need any help with the appearance of unsafe practices.

[Reha]

[Ruthla]

I have to wonder if this problem is confined to Florida.

I'd like to think it's just this one midwife who's doing this- but the reality is that if one midwife can "sneak" in cyotec without the patients' knowledge, then others may be doing the same thing in other locations as well.

[sebarnes]

I can tell you from personal experience that the use of cytotec to induce at hb is not confined to FL. It is scary and sad, and women may agree to its use because they erroneously assume a cpm will not use anything harmful. It is an abuse of that trust and an abuse of their position. Please report this.

[JanetF]

Please report this. We can't have a flourishing open homebirth community if practice like this is allowed and supported by women and other mws staying silent. It shocks me to the core and I cannot adequately express my horor.

[SublimeBirthGirl]

You should absolutely report this. When midwives start lying to patients then covering up for each other, they become just like the OBs lobbying to limit women's choices because it's easier for them. I prefer midwives to OBs because they are more likely to use evidence based practices and to empower women to make their own choices. When a midwife gives a powerful drug to a woman without her consent (or does anything to her without her informed consent), she is no better than the OB doing an unnecessary cesarean to get out of the hospital in time for his golf game. Maybe even worse, because she is presenting herself one way and behaving another.

[Acacia]

wow...this is truly sick. As a doula, informed choice is huge for me and expected of the midwifery community. I can't fathom anyone thinking that this would be okay. It's scary and plain sad that women are unknowingly being put at risk because of the trust they have in their midwives. I can't even imagine the turmoil in Florida midwifery if and when a women dies because of this. CPM's turning normal birth into a medical event is something I thought I wouldn't ever have to hear about.

[3daughters]

Originally Posted by Ruthla

I have to wonder if this problem is confined to Florida.

Its not, my friend was induced with Cytotec for a homebirth in NY. She was so afraid of going post dates and ending up in the hospital she consented to Cytotec at home.

[MidwifeErika]

I know it isn't just in Florida, there are midwives scattered about who think this is a safe practice. I understand that cytotec has a use in PPH, I just don't think it should be used for inductions at home. What is really, really concerning to me is that these midwives you mention are slipping it to the women without their knowledge. That is NOT anywhere close to ok. That needs to be reported.

[mamabearing]

yes really outrageous

Originally Posted by hotwings640

I know it isn't just in Florida, there are midwives scattered about who think this is a safe practice. I understand that cytotec has a use in PPH, I just don't think it should be used for inductions at home. What is really, really concerning to me is that these midwives you mention are slipping it to the women without their knowledge. That is NOT anywhere close to ok. That needs to be reported.

It is such a basic tenet of nursing to tell the patient what they are getting and why. The idea of sneaking cytotec is actually much worse than those ( I never saw they ) gloves I heard of where the doc could AROM...at least the mom knew her water was broken!

Having seen Cytotec result in severe fetal distress more than once it is totally WRONG to use it at home and hubris ( or ignorance ) on the part of the midwife who would do so. It's so tiny that it is easy to see how it COULD be done without the mom's knowledge. What an incredible betrayal of trust...

[Human_Being]

Hi- I just saw this over in finding the tribe, too.

I am a Florida Licensed Midwife and heard of this once before too. I handled it with the consumer who contacted me about it, and then called that midwife. I was satisfied with the way it was handled and did not contact the State in that instance.

If this is a common or wide spread practice, it needs to be stopped NOW.

If a midwife has been approached and "thinks its safe", then she needs to be reported to the State. Do not hesitate to report someone who is practicing outside of the law and endangers mothers, especially if she is doing it with out their consent! We do not need to be like hospital personal that "protect their own" to the detriment of women. If you have approached someone about this, confirmed its true, and they refuse to stop, they need action taken against them by the state. That's what that the law is there for.

I have had frivolous complaints filed against me by a hospital that did not like taking my transfers, and it is a pain. But you need to know it does not hurt midwifery to stop midwives that violate the law. That's is why we have a law, so we have a means of insure quality care and reigning in renegades that would put moms, babies, and the other midwives who practice in a safe way in danger. If midwives are found to be practicing outside the law and are disciplined, it shows our law is working to protect consumers.

I think each and everyone of you who have any knowledge of someone doing this has a moral responsibility to follow through in a way that insures the practice is stopped. If you have knowledge of this practice, it is something you personally must follow through on, even if it makes you uncomfortable. You could be saving a mother or baby. Or even the profession! If you look the other way or feel its not your place you are not taking responsibility for your role, or respecting the knowledge that has been given to you. That is how the holocaust happened, or why birth is so bad in hospitals....everyone thinks up ways to wash their hands of responsibility, and thinks its someone's else job to care or act. If you are a student, do not stay silent because you are afraid you will lose your chance to precept and learn. You can find a midwife with integrity to learn from, and you will not have compromised your own integrity to do it. Don't kid yourself with "I am only a student", "I am not sure she does it anymore", "I am only a consumer and I moved past that birth now" or whatever. Call her, confront her, ask her to stop or you will report her. Its not enough to post warnings to consumers here and hope they will know enough to protect themselves. Homebirth communities are small, and we need accountability amongst ourselves. You are protecting the moms that are not as informed as you have become.

Complaints can be filed with NARM


Or The State of Florida Council of Licensed Midwifery (follow link "How to File a Complaint")

[SimplyRochelle]

Originally Posted by mamabearing

It's horrible to use it out of hospital. In the hospital we use it with careful monitoring and next to an OR!

I think it's horrible to use it period. Setting doesn't make a drug any less dangerous. And obviously you know it's dangerous or you wouldn't need to use it next to an OR. I think more women should speak up and I agree that you should definitely report anything like this to the state.

[babycatcher01]

This scares me. What the worst part is, is the woman being lied to. A midwife should never lie let alone take advantage of their clients who in some states have guidelines about going over due. I hope that this is not wide spread and people take the right actions to stop this.

[mamabearing]

Originally Posted by SimplyRochelle

I think it's horrible to use it period. Setting doesn't make a drug any less dangerous. And obviously you know it's dangerous or you wouldn't need to use it next to an OR. I think more women should speak up and I agree that you should definitely report anything like this to the state.

No, obviously I know it has potentially serious risks or I wouldn't want to use it outside of a hospital staffed with an OB OR. I suppose you could say that I know it has dangers ( and I do ) and I want to be prepared to deal with those dangers too. I don't believe in elective inductions but I also believe vaginal birth is safer than cesarean for most people. So how does one induce labor with a cervix that is not favorable? There are times that I think cytotec may be worth the risk ( though I do think it has the highest risk profile of any drug we use to induce labor ) to accomplish a vaginal birth. It has been researched extensively and the risks are known but there are women in whom it is a better alternative than a cesarean. If the research stops supporting that it has it's place I would accept that too.

Frankly, I think even the lowest "risk" birth has enough inherent danger that I would not choose or recommend birth outside of a hospital setting. I am not trying to deny anyone's right to a homebirth, just my minority ( here ) opinion.

I completely disagree about a hospital setting not making a drug less dangerous. There are many many drugs, both used in childbirth or for other indications that have nothing to do with birth, that are only used in hospitals because a hospital has the capacity to deal with risky ( or dangerous ) side effects. You have to weigh the risks ( dangers? ) with the benefits.