I Promise to tell the Truth, the Whole Truth and Nothing but the Truth!
Today, I had a client who was being induced because of high blood pressure. Sometimes this just happens. This momma had done everything right. She was young, fit, and healthy. She had educated herself about all the best practices for pregnancy and labor - and had religiously carried out all those practices. And still, her blood pressure had risen unexpectedly at the end of her pregnancy. When the doctor called in, I was on speaker phone with her, as well. The first medication the doctor recommended to my client was Cytotec (misoprostol). She recommended this medication because my client was already dilated to 2.5 and partially effaced. The doctor kept talking for several moments explaining what the process would be. When she took a breath, I spoke up and asked her a question, "Isn't that the medication with dangerous side effects?"
"It's just a prostaglandin. That's a natural hormone that your body already makes. When we did a membrane sweep, that's what we were doing - releasing prostaglandin." This was her response. The explanation was incomplete and misleading.
Yes, the body naturally produces prostaglandins. Cytotec, however, is a synthetic prostaglandin, which can act very differently from naturally occurring hormones. Some people respond to it really well. Other people react violently to it. Extremely violently.
Unlike Pitocin (synthetic oxytocin that can be turned down) or Cervadil (a different synthetic prostaglandin that can be removed), once Cytotec has been given, you can't stop it. In rare but serious cases, families are forced to endure complications that can include severe pain, fetal oxygen deprivation, unwanted interventions, dangerous heart rate decelerations, uterine rupture, emergency cesarean, hysterectomy, and very rarely fetal or maternal death.1
This isn’t merely from my personal experience as a doula. A high-level summary of publicly available medical information highlights several widely acknowledged risks: “Cytotec (misoprostol) is FDA-approved to reduce the risk of stomach ulcers, but it is also used "off-label" to induce labor. Its use for labor induction can cause serious side effects for both the mother and the baby due to its potent ability to induce strong uterine contractions.
“I deserve the truth, the whole truth and nothing but the truth!” -Your Baby
Potential Maternal Side Effects
The most significant and severe maternal side effect is uterine rupture, particularly in women who have had a previous C-section or other major uterine surgery. Other potential maternal side effects when used for birth include:
Excessive Uterine Contractions/Hyperstimulation (tachysystole): Contractions that are too frequent, long, or strong, which can cut off the baby's oxygen supply.
Severe Bleeding/Postpartum Hemorrhage.
Cervical Laceration.
Maternal Shock.
Amniotic Fluid Embolism.
Maternal Death (rare cases).
Potential Fetal/Infant Side Effects
The intense uterine contractions can lead to complications for the baby:
Fetal Distress: This is typically caused by a lack of oxygen (hypoxia) during labor when the placenta doesn't have enough time to recharge with oxygen-rich blood between contractions.
Birth Injuries: Oxygen deprivation can lead to severe and permanent brain injuries such as hypoxic-ischemic encephalopathy (HIE) or cerebral palsy.
Fetal Death.
Birth Defects: If the drug is taken earlier in pregnancy.
Meconium Staining of Amniotic Fluid.
Due to these significant risks, Cytotec is considered dangerous for labor induction by some experts and is contraindicated in certain situations, such as in women with a history of Cesarean delivery.”
Note that last sentence. “Cytotec is considered dangerous for labor induction…” This concern is significant enough that the FDA has issued an explicit warning regarding its use in labor. They are not neutral on the topic, as they are with some off label drugs. If you look on their website you will find a warning against using Cytotec for labor2.
The American College of Obstetricians and Gynecologists (ACOG) takes a different position. Their statement on Cytotec mentions potential uterine hyperstimulation, but mentions nothing about uterine rupture, fetal distress, or the death of either mother or baby. They state that, when used according to their guidelines, Cytotec is generally safe and effective. And they “strongly recommend the use” of this drug3.
So why didn’t the doctor share any of this with my client this morning? When I specifically asked her about dangerous side effects, why didn’t she acknowledge that these things can sometimes happen? I don’t really know. Maybe her experience with the drug hasn’t included tragedy. Maybe she has chosen to listen to (ACOG) instead of the FDA. Maybe she just doesn’t know.
What I do know is that my role as your doula is to help ensure you are fully informed. You should know both the risks and benefits of each intervention offered by your doctor. We don’t make the decision for you. We don’t push you one way or another. Informed consent is paramount. It is my privilege to be with you each step of the way.
-Joy Elliott (Ada’s Gift Doulas)
1. https://birthinjurycenter.org/delivery-complications/cytotec-induction/
Disclaimer: The information provided here is for educational purposes only and is not a substitute for professional medical advice. Every pregnancy is unique, and decisions about labor interventions should be made in consultation with a qualified healthcare provider. As your doula, my role is to provide support, education, and advocacy, not to prescribe or direct medical care.
While we encourage mommas not to be induced for routine purposes, we are very appreciative of the ability of modern medicine to intervene when medically necessary.