Cytotec: Used by Doctors Off-Label to Induce Labor

Southbury, CTTammey Dickerson is a Registered Nurse who works in the delivery room. Although she has never personally used Cytotec, she has seen it administered by doctors for off-label use in order to induce labor. Dickerson says that she has seen Cytotec cause uterine rupture, placental abruption, and "violent, rapid labors with poor fetal heart tracing," when used to induce labor. Unfortunately, she also says that doctors will not admit that they have used the drug, or that it can cause such serious problems for mothers and their babies.

This is what Dickerson has to say about Cytotec and the doctors who use it:

"Cytotec (misoprostol) is not approved by the FDA (Food and Drug Administration) for use in pregnant women but it is used to induce labor and meant to soften the cervix. To use it, you insert a 25 mg tablet into the patient's vagina in order to induce labor. The problem is that once the tablet has been inserted you have no control over the pill.

A major problem is that when the first dose is given, there is no onset for up to twelve hours after that dose is administered. However, doctors give the patients doses every three to four hours. By the time twelve hours comes around the pills can have a cumulative effect.

It is not always twelve hours for onset. Some patients contract right away when given the tablet, some patients do not contract at all. Some patients have contractions but their cervix does not dilate, which leads to thinning of the uterus.

What happens in some women is that they start having too many contractions. Basically, more than five contractions in a ten-minute window are too many. It means that the placenta is not getting enough oxygen, which in turn means that the baby is not getting enough oxygen. We know that the baby does not actually breathe while in the womb, but the effect is similar to the baby gasping for air because it is not getting any oxygen.

Cytotec can also hyper-stimulate the patient, which can cause the placenta to abrupt off the uterus, causing the uterus to rupture. The baby is then no longer in the uterus, requiring an emergency c-section. Uterus abruption can cause fatality to the baby and/or the mother.

It takes a lot during the natural labor of a woman's first baby to cause the uterus to rupture, but it has happened at my facility twice. Both times the drug was used. Labor that involves (Cytotec) is somewhat violent and furious, not naturally produced.

Cytotec was meant to be used for ulcers, not for pregnant women. Because it is in tablet form, the drug cannot be controlled once administered. There is another medicine that we can use and it is given through an IV so it can be turned on or off at any time. The half life of that medicine is eight minutes, so we know eight minutes after shutting off the IV, the contractions will slow down, and eight minutes after that they will slow even further. With misoprostol (Cytotec) we do not know what the half-life is or how to control it.

You have to understand that there has not been any research done on the effects of Cytotec on pregnant women. The company that makes it (Searle) does not want it used to induce labor, so no research has been done. Everything that I say is based on what I saw; it's not based on studies.

Physicians do not tell patients that they've used this drug. They do not give the patients informed consent because what patient would agree to a drug that could cause abruption of the uterus? They say to the patient 'We'll just put this pill in and you'll have some contractions and then you'll have a baby.' But mothers can die from it.

In some places it is used because it is less expensive than other drugs. But it is also used for convenience. A lot of patients come in the morning and want to be done labor by the evening. It is a drug of choice for someone who has not given birth before.

Hospital policy is that contractions should only occur every two to three minutes for 60 seconds each. But that policy does not address patient pain or changes in the cervix. A patient could be contracting but a doctor will look at her and say 'her cervix didn't change,' or 'she's not in pain,' and so they give her more of the drug. But more contractions are not necessarily safe for either the patient or the baby. Some patients do not feel pain or contractions until they are four centimeters dilated, so pain and contractions do not really mean anything.

I find Cytotec to be very dangerous. Doctors say bad outcomes from it are all anecdotal, but nurses and midwives have different opinions. Every nurse I've worked with has something to say about this medicine. It has a huge warning on it 'Do not give this drug to pregnant women.' Physicians have been asked not to use it, but they continue to."

If you suffered serious side effects and believe Cytotec was used to induce labor, contact a lawyer to discuss your options.