My midwife uses Cytotec!! - Page 3 - Mothering Forums

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#61 of 69 Old 03-08-2009, 02:49 PM
 
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Originally Posted by maxmama View Post
Manufacturer labeling is a ridiculous source for safety of off-label use. By definition, they will warn against it. It's a CYA. Miso is incredibly cheap and off-patent. There is no incentive for the manufacturer to support its use.
Is the FDA, which also opposes its against-label use, a ridiculous source?

As for there being no incentive for the manufacturer to support its use for induction and PPH, how can you be so $ure?

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Originally Posted by maxmama View Post
There are literally dozens of articles supporting the use of misoprostol for active management of third stage and for treatment of PPH. There are no case reports of UR in a non-pregnant uterus (and yes, that includes a PP uterus).
The only articles that I have seen claim that it is "effective." It's strong stuff. Of course it's effective. But again, the side effects pose considerable risk.

And as a health care provider, you have an ethical duty to present these risks in their entirety so that women may make an informed decision.

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Originally Posted by maxmama View Post
Once again: fear and paranoia are not helpful places to make decisions from. Since one of the arguments against obstetrics as a discipline is that they don't give evidence-based care, why this reflexive fear of an evidence-based intervention, just because OBs do it?
Withholding vital and relevant health care information from women is not a helpful place to make decisions from.

Is the AAFP resorting to fear and paranoia when it brings up real, legitimate, and well-cited concerns about the Cytotec?
Although you have been this forum's longstanding cheerleader for against-label use of Cytotec, when I present such evidence, I would appreciate hearing it addressed rather than dismissed as "fear and paranoia."

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#62 of 69 Old 03-08-2009, 05:45 PM
 
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Turquesa, is anyone here talking about using misoprostol for anything BUT a last resort item? I don't think I hear anyone championing using it for any old blood loss. I also don't see anywhere in the AAFP article that mentions side effects other than "shivering, pyrexia, and diarrhea" with higher than recommended dosages...all of which I'd take over continuing to hemorrhage at home, transferring to the hospital and then being administered....Misoprostol! The AAFP article also recommends active management of third stage for all labors to prevent hemorrhage which I doubt you'd find one person here to agree with.

Also...while the FDA has its place, I don't think that's a particularly effective road to go down. I can't imagine that the FDA has good things to say about using shepherd's purse for hemorrhage either, KWIM? There have certainly been no research trials conducted on a lot of midwifery practices and it can be argued that we too are "using something until proven unsafe".

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#63 of 69 Old 03-08-2009, 05:49 PM
 
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Originally Posted by Turquesa View Post
Is the AAFP resorting to fear and paranoia when it brings up real, legitimate, and well-cited concerns about the Cytotec?
Although you have been this forum's longstanding cheerleader for against-label use of Cytotec, when I present such evidence, I would appreciate hearing it addressed rather than dismissed as "fear and paranoia."
The reason the AAFP recommends cytotec as a 'last-resort' drug for PPH is that there are some nasty side effects. Not dangerous, just not enjoyable (like diarrhea). I believe they have been listed before on this thread. If you notice on the link you provided about the AAFP, they list the evidence supporting cytotec for PPH as "A" quality. I don't interpret the AAFP position as having reservations about cytotec in treatment of PPH.

The packages of cytotec are printed with the caution 'not for use in pregnant women'. It is on the pregnant uterus that cytotec can be absolutely devastating. I would NEVER, NEVER let a cytotec pill anywhere near a term pregnant woman's body.

I don't think you'll be able to find ANY documentation or study of a uterine rupture that occurred from cytotec use for PPH.

I am a licensed homebirth midwife in my state, and our state regulations allow licensed midwives to purchase and administer cytotec for PPH. I carry it, along with pitocin and methergine. In all likelihood, I will never use it (I never have). But, I have been at births where pitocin and methergine both have been used and the mother is still profusely bleeding. (The midwife I was training with at the time didn't carry cytotec....she does now). It is rare, but it does happen.

Because I do occasionally do births in very rural areas, I feel some security knowing that I carry it, although in almost all cases, nothing more than pitocin would be necessary for a PPH.

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#64 of 69 Old 03-08-2009, 06:19 PM
 
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Turquesa, miso costs approximately $4 for the standard 800mcg rectal dose. Hemabate is $230.

So no, there is no financial incentive for the manufacturer to support a new use for a cheap drug long off-patent. It's pretty obvious.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#65 of 69 Old 03-08-2009, 08:45 PM
 
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Originally Posted by mwherbs View Post
to me the use of cytotec for labor induction hasn't panned out to be safe in my book- I have yet to see the results of the studies on the use of a insert system that contains cytotec so that it can be removed if there is hyperstimulation- (something like the way cervidil is applied) even for evaluation they have strict protocols for use in unscarred uterus- no more than 4 pregnancies and no mulitples--
But for postpartum hemorrhage - the very qualities of being able to cause strong hard contractions are what make it useful- when you look at dosage and stimulation- the way that pitocin is given for labor a measured dilute solution is administered in drop dosage per minute so at any give minute it can be lowered or slowed down to stop hyperstimulation these dosages are very small for a term pregnacy - but in the treatment of and or prevention of a hemorrhage it is given in extremely high dosages, many times the total dosage that would be used for a full labor-and it is given that way to induce very strong contractions hard contractions that you would not want for labor but are useful postpartum- so you have 2 drugs that if given can produce strong contractions- if pitocin doesn't work then cytotec may- because the very qualities that make it objectionable as an induction tool-strong hard contractions that last- are something to be admired when used to stop a hemorrhage-now someone may decide to use it before pitocin because of maternal history or sensitivities - when I have talked to midwives in busy practices- the majority think it is a valuable tool - for me it only takes about 1 severe hemorrhage that couldn't be controlled by herbs, hands or pit to think it is nice to have more options--
: Couldn't have said it better myself. For PPH, that is one use for Cytotec I will NOT argue with. If it stops the bleeding and makes it possible for the mom to avoid transport, so much the better. The thought of an uncontrollable PPH is somehting that gives me shivers sometimes....
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#66 of 69 Old 03-08-2009, 08:52 PM
 
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The reason the AAFP recommends cytotec as a 'last-resort' drug for PPH is that there are some nasty side effects. Not dangerous, just not enjoyable (like diarrhea). I believe they have been listed before on this thread. If you notice on the link you provided about the AAFP, they list the evidence supporting cytotec for PPH as "A" quality. I don't interpret the AAFP position as having reservations about cytotec in treatment of PPH.
And I would have to agree. To repeat myself, I'm glad that women have benefited from it. If it's done as a last-resort and with a woman's fully informed consent (i.e. a statement about its off-label use and the lack of studies attesting to its safety for PPH), I don't have a problem with it. I'm simply joining the voice of health care consumers calling for some commonsense caution.

As to the objection about using herbs that haven't been proven, then great, let women know about that, too.

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#67 of 69 Old 03-09-2009, 04:28 PM
 
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Ok...but how is this any different than midwives using herbs for PPH, or even eating placenta? There's definitely not any gold standard research trials backing up any of those practices. It makes sense to question, but if you're truly going to only consent to treatment that has been "proven" safe by those standards, you're not going to be using hardly anything in the alternative medicine realm.

Yup, true. I don't really use any alternative medicines. When it comes to treating medical problems, I want care based on scientific evidence for my family & me.

Of course, I have a more holisitic approach to life than the mainstream in that I believe a healthy diet & exercise are vital components of good health. & I have a good respect for the mind-body connection (so often ignored in modern medicine.) But, again, when it comes to a medical problem for which I need treatment, I want evidence-based care.
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#68 of 69 Old 03-09-2009, 04:51 PM
 
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I haven't read the rest of the thread yet, guess I should... but thought I'd say we use cytotec too... for postpartum hemorrhage.

Would you rather take a ride in an ambulance after the birth if herbs, pit and methergine don't work, or get a little cytotec?
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#69 of 69 Old 03-09-2009, 06:08 PM
 
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Originally Posted by MegBoz View Post

Yup, true. I don't really use any alternative medicines. When it comes to treating medical problems, I want care based on scientific evidence for my family & me.

Of course, I have a more holisitic approach to life than the mainstream in that I believe a healthy diet & exercise are vital components of good health. & I have a good respect for the mind-body connection (so often ignored in modern medicine.) But, again, when it comes to a medical problem for which I need treatment, I want evidence-based care.
then I suggest you look at the evidence- there are too many for me to quote here but the studies are many that support the use of misoprostol for postpartum hemorrhage. - go to pubmed- and do a search
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