Cochrane Collaboration has a relevent review. They are a group that does reviews and issue statements of evidenced based care. They have have this to say about it :
"Injectable uterotonic is the drug of choice for routine third stage management. Misoprostol may be used where no injectable uterotonic is available
After her baby is born, the woman's womb (uterus) muscles contract and bleeding decreases. If the womb does not contract, postpartum haemorrhage (heavy bleeding) can occur, which can be life threatening. Prostaglandin, oxytocin and ergometrine are drugs that cause contractions of the womb (uterotonics). The review of 46 trials, involving 42,621 women, found that oral or sublingual prostaglandin (misoprostol) may be useful in places where injectable uterotonics are not available, and is not as effective as oxytocin and has more side-effects. The main side-effects are shivering and high temperature occurring in a significant proportion of women. Injectable prostaglandin may be effective in reducing blood loss but has adverse effects and costs more."
I work in a place where homebirth midwives can easily get anti-hemorrhage drugs legally, I think that is probably a factor for midwives in some areas considering homebirth midwifery is still illegal in some States...I know midwives in the areas where it's illegal to carry drugs would probably rather carry misoprostil/cytotec than pitocin or methergine, because it is used for stomach ulcers and is easy to get and cheap. I know midwives have had real trouble getting pitocin or methergine in areas where midwifery is illegal/allegal, so if they can carry cytotec over just herbs and homeopathics, then thats great! As a side note, the midwives that can not get drugs are often excellent herbalists and give those of us who can carry drugs and thus rely on them more great information about natural remedies for hemorrhage. They have years of working with out drugs, and often have big arsenals of natural remedies and experience relying on them that midwives that carry and use pit don't.
It is fairly well resreached as an effective option against hemorrhage. It is dangerous for induction.
I believe in appropriate level of intervention, meaning start by doing the least you can do and work up to the more interventive stuff, as I think most midwives do. For hemorrhage, I would massage the uterus, get clots or debris that were keeping it from clamping down out, use homeopathics, use herbs, use pitocin injection IM in the leg, do another pitocin IM injection in the other leg, do methergine injection in leg, then do rectal or sublingual (under the tongue) misoprostil, do bimanual compression. For me, given my practice climate, the cytoec is the last of three meds I would give to stop a bleed and I am very accustomed to pit and methergine and know what they do. Both pit and ,methergine give uncomfortable cramping, too, the methergine worse than the pit from what I hear. I have carried cytotec for five years and never had to use it, pitocin usually does the job fine with an occasional methergine shot every now and then for the bad bleeds.
The prostaglandin drugs like misoprostal do give diarrhea. The biggest guns anti-hemorrhage drug is called Hemabate, and its a prostaglandin injected directly into the muscle of the womb, and I hear that clears you out rather dramatically.
Hope that helps.
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