In midwifery school, it was always exciting when a student midwife would get her “first catch.” I was there when one of my classmates got hers. After a sluggish labor, the baby came out suddenly and quickly, and the student almost didn’t have time to get her gloves on. We were all impressed with how quickly the baby was born, since the mother’s labor seemed to have petered out. She had been given some tea with “herbs” in it, and within 15 minutes the baby came practically shooting out. It was a memorable birth.
It wasn’t until much later I learned why: the tea contained crushed pills of a drug called Cytotec. It was Cytotec tea.
Cytotec is a drug that is intended to prevent stomach ulcers, but it has a well-known side-effect of inducing contractions. It is often used to help women complete a miscarriage, and it is used in hospitals to induce labor. It can be very effective in controlling a hemorrhage after birth. Because Cytotec can overstimulate the uterus, women who are being induced with it need to be monitored carefully. It is illegal for nonhospital midwives to use Cytotec for any reason during pregnancy, but it is legal in some states to use it for treatment of postpartum hemorrhage. Cytotec can be given orally, rectally, and vaginally.
I don’t know how often we served Cytotec tea in Miami. It wasn’t something that the midwives openly discussed, the clients were never informed, and it certainly was never written down in anyone’s chart. But sometimes, with a little wink, they might indicate that they had given her “just a little Vitamin C,” and let the students figure out the rest. It was drilled into us in class that we should never give Cytotec to anyone who had had a previous Caesarean section because it dramatically increases the chance of the uterus rupturing, a deadly emergency. But giving just a little bit to a woman with no history of uterine surgery? It might just be enough to help a lazy labor pick back up! Cytotec was also administered vaginally to induce labor; the midwife would tell the client she was inserting evening primrose oil.
Giving women drugs without their knowledge or consent was something that I refused to do once I began practicing on my own. I knew that it was wrong to slip any kind of medicine into someone’s tea (or into their body) without getting permission. I also knew that it was against the law for a midwife to misuse Cytotec. Early in my career as a licensed midwife, an experienced local midwife called me on the phone. She told me that she had a friend who was newly pregnant, who didn’t want to be. “Do you know anything about using Cytotec?” she asked. “Not really, not for that purpose,” I replied. She pressed a little bit. I felt like she was hinting that I should provide her friend with Cytotec so she could induce an abortion at home, something that is expressly forbidden by South Carolina law. I gently refused, but made a mental note that a midwife who was very well respected by the community seemed to be cool with the illegal use of Cytotec. Maybe it wasn’t so bad, I thought. I wasn’t ready to consider that this midwife, who I held in high esteem, was a dangerous woman.
I developed strong bonds with many of my clients. They truly trusted me, and I had fondness and affection for them. If one of them was struggling with contractions that just weren’t quite strong enough to finish the job and we had exhausted all “natural” methods to strengthen them, it would have seemed like a kindness if I could just help out a little. If I had suggested that “I could put a little medication in your tea… I can’t tell you what it is, but it just might help… or we can go to the hospital, instead…” they probably would have trusted me and drunk it. And when it worked, they would have been exceptionally grateful to me. And when other midwives saw that it worked, they might have asked me exactly how I did it. And I might have instructed them, and then they might have done it. And it is entirely possible that their clients were told that it was just some tea with honey, “just to get your energy up.”
I do not know how pervasive Cytotec induction and augmentation is among Licensed Midwives and Certified Professional Midwives; I have heard anecdotes of its use from coast to coast, from the far north to the tropical south. Were you given “tea” or another beverage during labor that seemed to be exceptionally effective at increasing your contractions? Did your midwife insert evening primrose oil (EPO) capsules or another “natural” treatment vaginally for you? If so, it is possible that you may have been illegally dosed with Cytotec.
**Update**
This post inspired Navelgazing Midwife to come out with her own confession regarding similar practices.
And here I thought the Valerie El Halta case was exceptional somehow. I didn’t know vacuum and cytotec usage was something that any other HB midwife did. I’ve seen one doula talking about giving it for abortions on FB. It didn’t make sense to me- weren’t they all about just waiting and seeing? Your insight into the motivation behind using illegal methods is invaluable. Bless you for writing your blog, its such important information to have out in the public so people can know that these practices are everywhere in the natural child birth world.
This is a wake-up that reminds us that whatever our training or initials many humans relax their ethical standards in ways that they would typically condemn in others. The kind of behavior described is not uncommon among midwives of all kinds and as we all loudly proclaim, common among physicians. Let us remain vigilant always to this possibility.
Thank you for your comment. I know that people are tempted to say, “That’s not happening where I live!” But unfortunately many of the practices that I talk about are very widespread. I have heard anecdotes from all across and up and down the country about the use of Cytotec and other interventions at home and birth center births.
This is SO NOT REAL. You are just out to badmouth midwives! No one would ever actually do this. You, “dishonest non-midwife”, are a fake, and a liar!
Andrea, unfortunately it is all too real.
Andrea, I used to have faith in the home birth community as well, and midwives specifically because of my feminist roots. I unfortunately had to come to the conclusion that portrayals like Fransen’s are not only true, but actually the norm in midwifery communities everywhere. I was treated horribly during my labor and found a culture of protectionism with midwives when I tried to complain or warn other people. The midwives all seemed comfortable with illegal things happening in their community, they made guidelines to cover up whatever was happening. I read From Calling To Courtroom which also solidified my conviction that illegal behavior and paternalism are absolutely the norm in lay midwifery. Then I saw the fundraisers for midwives that killed babies and my last shred of faith in the profession was ruined. The ethical people seem to just eventually get out of home birth because they realize that they are wrong. Frandsen and the navel gazing midwife are examples of this. Ex members of a group or belief system provide valuable criticism that is worth reading.
i am a registered and practicing midwife for 21years. i heard cytotec from women who seek abortion from me. they were asking if I can provide that for them but I never see that drug in person until now. I am surprised it’s really being used around..
Noeme, that is interesting to me that the midwives in your area never use Cytotec for postpartum hemorrhage at all. It’s very effective for that purpose. But perhaps it is illegal where you are?
How scary. And concerning.. I’m not any part of the medical field, but I am a mother. I know I personally was not given this drug. But to do it illegally? What if the patient had a bad reaction to it? Wouldn’t the nurse/midwife be obligated to tell them?
I was never at a birth where someone had a bad reaction. I was lucky. I can imagine what would have happened if someone had a bad reaction: it would have been explained away as a freak occurrence, something that just “happened” to her. The drug would never have been brought up or disclosed to anyone.
If it is such a useful, simple, and effective medication then why deny use of it. There are so many ridiculous over prescribed medications in peoples cabinets for daily “health”
issues, why make taboo a medication that
could be quite
useful rather than teach, make legal and use
responsibly. With obvious informed consent of mom. Which by the way they certainly don’t require at hospitals.
Cytotec can cause dangerous unintended effects that can lead to poor outcomes including death. Safe use requires careful monitoring and immediate access to lifesaving medical care, neither of which is available outside of a hospital.
it is an off label med. that means it isn’t approved for the usage of augmenting or inducing labor. It is negligent to use an off label medication without a physician supervising the administration and reaction to the medication.
Cytotec was used to induce my labor at a hospital, by my OB. Before she gave it she discussed the risks and benefits of several induction methods and I most certainly gave informed consent.
Christy, when used appropriately, Cytotec can really be a useful medicine for induction! The fact that it is so effective is part of the reason it is so tempting to use.
I think Christy was also responding to t smith’s assertion that hospitals don’t require consent for this sort of thing.