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Wednesday, 11 October 2006

More on Postpartum Hemorrhage

In a previous post, I originally misidentified the abortion drug now being pushed on women in developing countries. This was easy to do, as text on the NPR website does not name the drug, and the original article it cited is not freely available online. Compounding that, several websites I looked at misspelled the drug.

Here's how one of these websites describes the use of Misoprostol in medical abortions:
"In the French Protocol, misoprostol is given in pill form (400 mcg) 48 hours after a woman has taken mifepristone. It is sometimes prescribed as a vaginal suppository (800 mcg) because this route can be safer and more effective, especially with pregnancies that are farther along. The use of misoprostol by itself for medical abortion has been studied, particularly in Brazil, where abortion is illegal and misoprostol is the easiest of the three medical abortion drugs to acquire. These studies have found that although misoprostol is about as effective as both two-drug combinations, there are many more unpleasant side effects.

"Among the side effects of misoprostol are diarrhea, nausea and vomiting. Some women also get hot flashes or episodes of fever. Possibly because it enters the bloodstream more gradually, misoprostol seems to have fewer side effects when given as a suppository than by mouth."

One of the unpleasant side effects of being a Voice Crying in the Wilderness is that you offend a lot of experts. Pharisees were the religious experts of Jesus' day, and he outright offended them in the very area in which they were the trained experts and he was the uneducated upstart from the back hills of Galilee.

I'm a Voice Crying in the Wilderness on the subject of Postpartum Bleeding, and I won't be able to write on the subject without offending the experts. A pity, because I've stood and watched a half dozen times as my postpartum wife lay bleeding, attended by experts at childbirth with licenses hanging on their walls that cost them up to a hundred thousand dollars to legally obtain. In every case, the expert's solution was an injection of a synthetic drug available only by prescription; a drug in one case that had to be obtained on the black market because the person administering it was only a registered nurse and not a medical doctor. A drug so dangerous that if given prematurely it can cause uterine rupture and swift death.

A drug that in some hospitals is part of the standard treatment given to postpartum women, regardless of medical indication.

And yet, in most of these cases, administering this drug, like so many other procedures associated with professionally managed childbirth, was totally unnecessary. How do I know this? Because twice I have seen a skilled woman--one a medical doctor, one a certified midwife--gently pull the placenta out of my wife's womb with minimal bleeding. This is a skill that any birth attendant can learn, but few practice. Giving a shot of Pitocin is just too easy--if you can get your hands on it in the first place.

Only once have I seen my wife give birth in a situation in which medical assistance was needed; that time, she suffered from a detached placenta, and the baby came so quickly--and well that it did, or it would have died from anoxia--that it was delivered by a member of the hospital staff not certified to do so. This person then stood by helpless, watching my wife continue bleeding, until the certified professional could come by and administer Pitocin. Had we delivered that baby at home, and had we been in a developing country, and had Bill & Melinda Gates succeeded in making Misoprostol available OTC, I could have given my wife three fifty-cent tablets and stopped the bleeding myself. Instead, I got a bill for $1400 from the medical professional. The woman who actually delivered the baby got not a cent of it. She had to get her cut out of the additional $2000 paid to the hospital.

I'm all for the availability of Misoprostol. I'd even like to have a few tablets on hand when my next child is born, just in case. But handing out Misoprostol tablets to every pregnant woman in the Third World would be like handing out loaded pistols to every middle-school student who wants one. Some won't use them at all; some will use them to save lives; but most will likely use them to put lives at risk, the very reason this will never be done.

There has to be a middle ground. Professional birth attendants, regardless of their level of training, should have access to Misoprostol tablets. Giving them to a pregnant woman should land them in jail for attempted murder.

That's the solution; but it's too simple for the likes of Bill & Melinda Gates and NPR. Instead we will have Misoprostol being dispensed like candy where it can do the most damage, all in hopes of saving some women from postpartum bleeding, and find ourselves having to shell out thousands of dollars for the same treatment back here in the People's Republic of America.

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