Induced and Seduced: The Dangers of Cytotec

By Ina May Gaskin
Issue 107, July/August 2001

Early in her second pregnancy, Gretchen Brown (a pseudonym) decided to get care from an obstetrician. After all, she was 35, it had been 16 years since her last child was born, and an obstetrician seemed like the safest possible choice. The one she chose worked with nurse- midwives, but it was he who saw her at each of her prenatal visits. Still, Gretchen was taken aback by the way he reintroduced himself at every visit, a clear sign that he didn't remember her from one time to the next. "I felt like one of the cattle being herded in and out," she later told her sister. Despite these misgivings, Gretchen fully expected that her obstetrician would be present for the birth of her baby and never considered looking for a different doctor or going to a midwife. She felt healthy during her pregnancy; any complaints she had seemed relatively minor.

Gretchen's water bag broke at midnight on February 27, 2000, two days before her due date, and a mixture of amniotic fluid and blood gushed out. Although not in labor, she packed her bag, and her husband, Gary, drove her to the hospital. The maternity nurse who examined her did not seem concerned about the bleeding; she gave Gretchen a sleeping pill and kept her supplied with pads to soak up the blood that was still flowing during the night.

The next morning, with Gretchen still not in labor, the nurse-midwife on duty suggested that labor should be stimulated with a drug called Cytotec. Unaware that Cytotec is not approved by the Food and Drug Administration (FDA) for labor induction, Gretchen agreed to the plan.

Cytotec's manufacturer, G. D. Searle Corporation, obtained FDA approval in 1988 for its use in preventing peptic ulcers. By 1997, Cytotec had become "the predominant agent of choice" for labor induction, according to Dr. Charles Lockwood, chairman of obstetrical practices for the American College of Obstetricians and Gynecologists (ACOG). Even so, the package insert contains an explicit warning that "Cytotec may cause the uterus to rupture during pregnancy if it is used to bring on labor." The insert goes on to say that uterine rupture may lead to "severe bleeding, hospitalization, surgery, infertility, or death."

Without telling Gretchen about any of these possibilities, the midwife placed the small white tablet (or a portion of one; her notes did not specify the amount) in Gretchen's vagina and left. Very soon Gretchen was in hard labor, with intensely painful contractions coming one right after another. Refused an epidural because her cervix was not open enough, Gretchen labored on. When the midwife suggested Stadol to take the edge off the pain, Gretchen asked if the drug would have a negative effect on her baby. "You won't be having this baby until at least 6:00 tonight, and by that time, its effect will have worn off!" the midwife replied.

However, labor was no easier after the Stadol. The pain was just as strong, but now Gretchen felt as if she were floating and disconnected from what was happening to her. Still bleeding throughout her labor, she had the feeling that her contractions were abnormally hard and close together, and she wished that her obstetrician were by her side. At 6 or 7 centimeters of dilation, she was given an epidural, but it gave little relief. Suddenly, Gretchen began pushing, and the baby's head descended rapidly. She found out later that her obstetrician--who had not seen her since her arrival at the hospital--had left for home just as her baby girl was being born, shortly after noon. The baby's heart was beating, but she was limp and unable to breathe on her own. A team of nurses, joined by a pediatrician, worked intensively on her for ten minutes in the birth room.

Gretchen looked on, feeling increasingly weak. Once the baby was sufficiently stabilized to be wheeled out to the neonatal intensive care unit, attention returned to Gretchen, who was now losing blood at an alarming rate. "Your uterus is asleep," the midwife told her as she massaged Gretchen's uterus and turned up the medication in the intravenous line to her arm. The midwife and several nurses continued to work on Gretchen for almost 20 minutes, frequently paging her obstetrician on the intercom. By this time, with her blood pressure at only 68/35 (normal is 110/70), Gretchen weakly asked the nurses, "Am I going to die?" and passed out. Her cousin, who was holding a cool cloth against Gretchen's forehead, saw blood beginning to ooze from the IV site on her arm, a sign that Gretchen had lost so much blood that her blood had lost its ability to clot. This complication, called disseminated intravascular coagulation (DIC), is frequently fatal.